 Good morning and welcome to this morning's meeting. I am using the wrong part of my script. Good morning and welcome everyone to the health, social care and sport committee's 12th meeting of 2021. There are no apologies being received for today's meeting, but we are all here. The first item on our agenda is to decide whether to take item 3 in private. Are members agreed? Agreed. Llywyddyn, os ydych chi'n gweld ar gael sut dim o buchau ond data ac o ddigital gyfyngau ar gyfer y ffaith ffaith yng Nghymru? Argymintol yn siaradd os gweithio i chi'n gweld ac yn gyntgen, wedi yn dweud eich ysgolodau cynghorir o barat ac yn cynnwys y ffaith hwnnw, a'r ffaith hwnnw i ddadosgol yng Nghymru, sy'n diger yn ei cyffredinol. Edd Humphreiston, the head of office for the Office of Statistics Regulation. Good morning to you both. I think I'll start things off and my colleagues have got some quite detailed questions but I guess I want to ask you both what you see as being the key data gaps that currently exist in health and social care in Scotland and I guess I'll go to Scott Held first. I thank you very much, chair. Good morning. One of the first things to recognise is that Scotland does have good health data, so we have got lots of data that we can use to good effect. We have the ability to link the data to understand pathways of care. It's really important to recognise that we're building on strong foundations. I think that there are a couple of areas in particular that we need to focus on and we are focusing on around social care in particular and also primary care. Those are two of the big areas that I would say we need to direct our attention. I can also just bring in from a public health perspective thinking beyond health and care data, it's really important that we understand other impacts that lead to poor public health so things like being able to bring in housing data, education data and economy data and things like that. I think that it's really important that we think about the data state in Scotland and its widest sense not just purely around the kind of data that we collect on health and care. For anybody who is watching this and wondering why we are focusing on data, it really is a case of having the information in front of you so that policy and budgetary decisions can be made. Is that a correct assessment of why that is so important? We'll just wait to unmute your microphone. If we can unmute Scott Hell's microphone. Some individuals and understanding what's happening in local communities in particular. A lot of the work that we've been doing recently in Public Health Scotland highlights that there are quite big regional differences across the country so it's not all about one-size-fits-all for the whole country. It's really important that we have that ability to connect in locally and understand what's happening in different parts of the country. I'm right about driving policy and understanding what's happening but I think that it's wider than that and thinking about the wider impact on society. If I can come to Ed Humpherson to ask where he thinks that the data gaps are. Thank you very much for inviting me to give evidence. It's a real pleasure to give evidence for the committee. We've done quite a lot of work with the committee, provided quite a lot of evidence but this is the first time I've actually given evidence. Thank you very much for the invitation. In terms of gaps in coverage of statistics in Scotland, I'd agree with what Scott has said. For us, the most salient, the most striking gap is the gap around social care. The information available on need, on-need outcomes, the demographic characteristics of the recipients of care is relatively less well covered than the acute care sector. The acute care sector is very well covered, the social care sector is much less so. For us, that's the most salient gap. It's also worth saying that during the pandemic there was recognition that data on ethnicity in Scotland and ethnicity outcomes in healthcare were relatively weaker and the chief statistician of the Scottish Government, Roger Halladay, acknowledged that in a blog in June of this year when he said that our data on ethnicity was shown not to be adequate and that at that time he announced a series of measures to create much better data on ethnicity. There's the two things that I would pick out. If I could just pull off on another thing that you asked Scott, which was about the need for these gaps to be addressed, I certainly agree that a bigger picture will help policy makers. That's absolutely right, but as the Office for Statistics Regulation we exist to represent the interests of the wider public in having statistics and data that they can rely on. I think that what the pandemic has shown us is that there's an enormous public appetite for reliable, trustworthy statistics on health and care and the wider impacts on society of the pandemic. I think that for that reason we shouldn't just think about these data being useful for policy makers. I think that they're useful for citizens as well. Thank you very much, that's really helpful. I'm going to move on to my colleague Sue Webber. Yes, thanks convener. Yes, Mr Humphries, you mentioned there about some of the salient gaps you've said in social care being the unmet needs outcomes and demographics. If they are the gaps, how could we start capturing that data? Well, we produced a report on this in February of last year and one of the things that we highlighted, of course, that this requires quite a significant degree of investment. Investment in analytical resource, the kinds of people that Scott has working for him who are able to take the data and integrate it, analyse it, produce insights from it, but also, of course, underneath that, the data themselves being accessible, being linked, being available in electronic form. I think that the good news is that on both of those there is a real progress and Scott will be much better placed than me to talk about the progress. But one thing that I'd like to pick out, which I think has moved things forward, is the use of a database called Source, which is created by Public Health Scotland to collect social care data, and that's produced an output called Insights into Social Care, and I see that Insights into Social Care as the start of the process of filling these gaps that I've outlined. There's a lot more to do if you look at that Insights into Social Care report itself. Public Health Scotland are very honest about the gaps, the quality issues that they face, but I think it shows the pathway to improvement. As I say, Scott may well want to follow up on that, seeing as he's responsible for those outputs. We'll bring in Scott. Thanks very much. Just to follow up, do you recognise Source is a data collection that allows us to capture data on people who are receiving care at home at individual levels? One of the benefits in Scotland is that, by having that individual-leveled data, we're able to link it across different data streams. Ed highlights making those connections between social care and the health service. Our Insights to Social Care report did a bit of work about understanding what happens to people once they enter into the social care system. To pick up on a couple of points that Ed made to Source is a great step forward. One of the challenges with Source is that it's a data collection that comes in quarterly from local authorities. We have had to use it to produce the annual report that Ed talks about. It's one of the areas that we're looking at in Public Health Scotland is about bringing in the data more quickly. For a lot of the things that we have so far published and analysed, data at that annual level is adequate and tells the story of what's happening across care at home in Scotland. In terms of data being a bit more real-time, helping to inform what's happening right now, there are improvements that we recognise that we need to make. That's one area. The other area that Ed touched on was analytical resource. It's a highlight that, relative to the amount of resource that we have going into a health data state, the amount of resource that's going into social care is considerably smaller by quite considerable magnitudes. That's something that we're currently actively looking at in Public Health Scotland. I think that it's coming back to a point that Ed made around outcomes and understanding why we are collecting the data and what is good. Is it having the impact that we need it to have? I think that it's a highlight to the committee that one of the big things for Public Health Scotland is that we need to do a review of all the different data flows that we've currently got and the outputs that we currently do. In order to make the shift into looking at particular areas such as social care, we have to think about doing things differently and doing different things. I think that that's a really important piece of work that we're doing. The other really important area is that there's also an analytical team in the Scottish Government who also collects data and report on social care. One of the things that we've done recently is that we are more actively engaged with that team so that we're effectively pulling the power of the analytical capacity that we've got in this area, particularly to ensure that we're not duplicating efforts so that we're doing things once. That's really, really important for the local authorities who submit data to us. I think that I can just highlight on that at the moment. One of the challenges that we have is not so much just the capacity nationally to manage the data and analyse it, but also the capacity locally to collect it and submit it to us. There's been a real lack of investment for various reasons in the data collection of states in local government, and that needs to be addressed. I think that there are real opportunities now with the national care service on the horizon. I've been accepting the pushing in Public Health Scotland for the legislation to feature heavily requirements around data at the heart of all of that. I guess that building on the legacy of the health data that we've got from ISD, which moved into Public Health Scotland, which, as you know, is well established, I think that something equivalent at the heart of the national care service is going to be fundamental to how we tackle this. The other final point, if I may, is also about partnership. Public Health Scotland can do that alone. We are talking to COSLA, one of our joint sponsors, so having that joint sponsorship between local and national government will help. We're also talking to the local government digital office, who I know will give an evidence later about how we can connect to what they're doing to improve the flow of data. Thank you. Thank you very much. That's very helpful, because you spoke about someone of the challenges being that local collection, I suppose, and then due to the lack of investment specifically with local authorities. Do you think that there's been enough work being undertaken to understand those issues? Yes, investment is a big thing in terms of that money, but what else is the hurdle and the other gaps that might be existing in terms of that data collection that creates the variance? I think that that's work that we're continuing to do, so it's working in progress. As I mentioned, we are working with COSLA and the local government digital office to understand that. What's really key is understanding the current data landscape, so it's a bit fragmented. There are data collections in the public health Scotland, the data that comes into the care inspectorate, the data that comes into the Scottish Government, not understanding the totality of what comes in and then reviewing it, because we need to make sure that we're not duplicating effort, and we're also important to understand the gaps. I think that the other really important point is about having data at individual level to allow us to link it to the other data, because to allow us to understand outcomes and to understand what happens to people, that ability to follow people through the system that's going to be really important. I would say that the other issue that needs to be looked at more—we have made progress on that particularly during Covid—is the whole aspect of information governance and data sharing, particularly around social care data. We have that well-established for the health service. There are well-established processes and pathways around how we deal with information governance. It is more complicated, involved in local government, and that's certainly one of the areas that we're with Public Health Scotland in having that dual accountability. I wanted to make sure that we're doing more work on that space to make data sharing as straightforward as possible. At the moment, it can be quite a paper chase to get the appropriate sign-off to allow the data to flow and to allow the data to link. I'm interested in the issue about duplication of effort and wondering about the capacity that Sue Webber talked about as well—the capacity to obtain certain data. During the pandemic, there's obviously been more data gathered. Has there been any pause to some data collection? In some of the work that I've been doing, people are a bit fed up of data collecting and feeling like all they're doing is hamsters on a wheel gathering data about what the data is for. If some data has been paused in collection and whether you think that there needs to be more work done so that people on the ground know what the data is being gathered for, what are we going to do with it? You make a really good point there. In terms of data that's stopped, most of the national data sets that Public Health Scotland has responsibilities, mainly around health and care and the source data set that Ed talked about, have continued. Most of those are fed from electronic information systems that manage the health service, so that those systems still exist so that data can still flow. I totally understand what you're saying about data collection fatigue because there have been additional asks around Covid. One of the challenges is making that connection between the people who are responsible for collecting and managing the data locally and understanding ultimately how it's used. I would say that we need to do or work and build that narrative of the people who are collecting the data. One of the reasons why that's really important is that the people who are collecting the data, by understanding why it's being used, can then major or make sure that the quality of what's then submitted is as good as it can be. No data sets have been stopped, but I recognise that there's been more data collected as a result of Covid. We need to do that narrative around helping people to understand what the data has been collected for at source. I have a number of questions based around ethnicity. Ed Humphries, you've mentioned ethnicity in your first answer, but I just want to focus in on that. How can we ensure that we get good ethnicity data? I'm not just talking about patients, I'm talking about workforce as well. I think that you'll probably get a fuller and a more complete answer from Scott. One of the key things to say about ethnicity data is that one of the best sources of ethnicity data in Scotland is, of course, the census. It's self-completed by individuals to identify their ethnicity. One of the important steps that the chief statistician, Roger, outlined when he addressed this problem this summer was to say to make greater use of linking census records into other data sets, like the healthcare data sets, but also the school census and others. I think that this is an area where, in a way, to go back to the last question, the answer may not be necessarily in launching lots of new data collections, which have the risks that we've just heard about in terms of burdens on data providers, but more in using the power of data linkage to draw on the data that we do have and then to populate the other data sets with the attributes, the characteristics, which are recorded, particularly in the census. That would be my sort of high-level answer. Scott may want to be embellished that and provide some more specifics. We'll come to Scott. Yeah, if I've said that, that's exactly the approach that's been taken. I guess it's been tackled from two fronts. One is that there are some data collections that do collect ethnicity. One of the challenges, though, is that the ethnicity data is often poorly recorded, so we don't want to, for personal reasons, to disclose it, so we don't know, or some of the categorisation isn't as good as it could be. We have got ethnicity data on some of the data collections, the main one being our hospital discharge record does collect ethnicity, but it's not of the best quality. One of the areas that we'll be looking at is, as Ed says, thinking through how we link other data sets that also collect ethnicity like the census to understand how we can triangulate between the different data sets. One of the other areas that I think is important that we look at, and I'm not close to this work, but I could certainly find out more about it before the committee, is around the development of the CHICE, the Community Health Index in Scotland, which is obviously the unique number that we all have that features on all our health records. Having a way to add the ethnicity details to the CHI would go a long way because, in effect, that's the central spine that populates a lot of the personal details around a lot of our personal data. If there's an opportunity with the kind of divisions that are happening at the moment around the CHI, think about how we bring in some of those characteristics that we don't currently collect data on. However, it is recognised as a challenge, and we have, within Public Health Scotland, been able to publish data looking at the effect, particularly in Covid, on different ethnic groups, so things like the testing and vaccination that is work that would be published publicly on ethnicity. However, I would agree that more needs to be done on that. Thank you. Certainly, Scott, talking about how data is poorly collected, NHS Lothian, for example, went from 3% to 90% in ethnicity over three years. That linkage to the kind number goes back to a point that Emma Harper just made about data fatigue, where if we ask ethnicity on multiple occasions, if it's answered just once and it's linked to your CHI and that CHI goes through everything, surely that would be the way that we would ensure that all ethnicity is captured in that way. I have a question around, once we capture ethnicity data, are we absolutely sure that we could then use that data to work out symptoms and how you present, work out how we should be managing you and work out how we can treat patients using that data? With high blood pressure, where, if you're of black descent, you shouldn't be started on an ACE, you've started on a calcium channel blood, so it makes a huge difference in that ethnicity to the way that we can treat people. I would completely agree with you. I think that there's two aspects to your question. I understood it right—data is for direct patient care, so data that's held in systems that allows you, when you're having the conversation face-to-face with a patient, that you understand the ethnic group and what that might mean for the individual. I think that from the perspective that I was talking about, it was around the kind of nationally available data that we have within Public Health Scotland. I'm absolutely confident that, if we can reliably capture data on ethnicity, we can analyse it in many ways. We've shown that we can do that through the work that we've done around ethnicity in Covid. One of the things that we're ready to keep an eye on is data quality. It's really really key that, when we start getting the data that we understand the patterns, it doesn't make sense. The old mantra of use, improvement and quality will definitely be key there. I think that one of the key things, though, is that you're absolutely right about if we could collect it once and connect it to other data. We should definitely be looking at that. I think that the CHI is the root, but at the moment it's not collected through CHI, so that's definitely something that we would need to look at. We would need to consider how we would populate the CHI, because many of us are a CHI-generated when we go to the GP. We'd have to think about potential data gaps initially and how we would address that. That has all been looked at, as Ed said, through a group being led by the chief statistician at the Scottish Government. I definitely think that the approach of having it collected once then feeds other data sets will be key going forward. Before I come to Sue Webber, who wants to talk about the integration of data, there's something that occurs to me when I'm listening to you both, is around the patient's rights about where their data goes. Is that one of the barriers to this? If you're given your data, you want to know where it's going, when it's coming back to what Emma is saying, what it's been used for, is that data security and the knowledge of the individualist of what their data has been used for? Is that an issue? I don't know who wants to come in on that. It's just a very short thought that I've had, Scott. I'm not aware of that being a major issue, but one of the key things that's highlighted in our data and digital strategy and Ed has highlighted it in the work that we have been doing around maintaining the public trust about what happens with the data and how it's used. I would say that in Scotland we've got a proven track record through the work that bodies like Public Health Scotland do in managing data safely and securely. We've got mechanisms and processes for making sure that that happens and that access is only given for appropriate reasons. It partly comes back to the question that one of your colleagues made earlier about the actual data collectors and helping them to understand why the data is important. I think that we need to do more on the narrative around that, but we can likewise be doing a lot more in our conversation with the Scottish people about why we use their data, why it's important and all the safeguards that we have in place to keep it safe. That's definitely something that we need to think about taking forward as well. I would like to come in on that very quickly. Two points. One is that I completely agree with Scott that Scotland is well placed and has a very good approach to the engagement with the public around the public acceptability of their data being shared. I think that in some ways Scotland has got a better platform for this, as Wales and Northern Ireland and England do. That's the first point. I think that there is a strong way. I think that the second point is that it's really key to go back to where I began. My very first comment was that we should always remember that data and statistics are not simply for central decision makers, but they are also to inform the citizens about what's happening in their community and in their country. The more that that can be remembered as being the purpose of this data collection, it's not simply to inform a few commissioners at the centre of the system that to inform the whole population, then the population will appreciate that their data are being aggregated with other people's data to create these rich pictures. Always coming back to that, that purpose is really important here. In terms of integration of that data, Sue Webber. Thanks, convener. I suppose you spoke about that rich picture there, Ed, but I suppose when it comes down to individuals, what we often have to do is translate it into what that means to them, for them to understand and that comes down to whether or not you're the patient or if you're the data inputter, the healthcare professional that's run ragged with nothing, 100 balls in the air and is being asked to type in some stuff. What can you do for those two groups, both the patient and that healthcare professional, what that means to them? Can we translate that maybe by giving a specific example, if that's possible? Ed Humpherson. I suppose that we can do a couple of things. Firstly, lots of the improvements that we've outlined as the Office for Statistics Regulation build on there being easily accessible, portable electronic records. Obviously, that has huge benefits for the aggregation of statistics to give this aggregate picture that I've been talking about. For the individual, of course, that has benefits in that they won't need to feel, they need to repeat the same information to repeat it in different healthcare settings. It's clear, for example, from the FEDE review and from the Scottish Government's digital healthcare strategy, that this issue of people being frustrated by having to repeat their own personal circumstances and their personal health history is a frustration. I think that they can see a benefit there. On the professionals, obviously, they benefit from that too because they will have information on which to provide better care and better professional judgment. I also think that the ability to know that the situation that you're dealing with in individual case is part of a broader societal pattern is really powerful. Knowing how the specific relates to the general, which I think is what statistics are for, they help you to understand how an individual situation is part of a bigger pattern. Those are the two points that I bring out in answer to that question. I'm not sure if Scott wants to say anything on that. Sorry, convener, for taking it over from you then. No, I agree with the other point on the FEDE. I think that another point that we need to consider is the IT infrastructure across the country and the digital estate that we've got. Colleagues who are speaking in the next session will have better places to speak about that than me. Obviously, a lot of the data that we are managing and collecting and analysing in Public Health Scotland is a product of things that happen locally using local IT systems. One of the challenges is that they don't all join up. They certainly don't join up between social care and the health service. I think that one of the big challenges or ambitions for us should be to have more of that joined up so that we can enter the data once it's aware and it's available for all the different pathways of care. However, we need to recognise that that there is a digital IT part of this that also needs to be tackled. How are the front-line staff and those who are involved in the data input being involved in deciding what data should be produced and how? Obviously, you are really wanting that data to go in accurately to start with, which will then stop lots of problems going down the line, so that quality aspect is really key. That's my question there. I can take that one first, so that's absolutely crucial. I think that, in two parts, one of the aspects is that, as I said, we've got a good health data state already with well-established data flows that come in automatically from particularly the hospital systems. There's lots of data that we capture and use through that process. One of the key things then is about working with local teams, local commissions, local nurses, patient groups, to help them to understand what the data is saying for their local area. Sometimes it's not until you do the analysis and pull it together and enable those comparisons between a particular local area and the rest of the health board or the rest of Scotland that that starts generating questions about why there's a difference. Sometimes that difference can be down to how things are recorded and you can then have that dialogue. The other side of it is data that's newer and stuff that's not as well-established, and certainly at the heart of any new kind of data conversations, as it were, the users and the people who will be collecting the data are fundamental to those conversations. Just as a couple of current examples, we, as I mentioned, are doing work through the Scottish Government, the local government digital office and COSLA, around social care data. There is a local government data elites group now, which Public Health Scotland will become a member of, and we are keen to be talking to those data producers, as it were, to help them to understand the power of what we can do if we pull the data together in a consistent manner. The other side of it is just thinking of some of the work that we've been doing recently on cancer, so we've been on a big modernisation journey around our cancer data, which is hugely important at the moment. We've tackled that with clinical groups and patients, through having a series of roadshows around the countries that are having presence, for example in the Western in Edinburgh, so that people can talk to us about the data that we are collecting or planning to collect, so that they understand how it's been used. That's been great, because that's facilitated really good conversations with clinicians about how they intend to use the data that we are collecting and producing. There are two aspects to that. One is about new data. It's really important that we have the users and the providers in the conversation at the start. For well-established data sets, it's really important that we continue to have the conversations so that people understand what the data is looking like and what it's telling them. We're going to look at primary care data and questions from Paul O'Kane. Thank you, convener, and good morning to our panel. Primary care is obviously very much in focus at the moment, particularly in the context of the pandemic, but it's fair to say that over many years there's been commentary that data hasn't always been good or available enough in terms of primary care and understanding who is using primary care, where the trends are, and those sorts of areas. Perhaps, just as an overview at this stage, if the panel could outline what information on primary care activity and demand is publicly available at this stage? I can begin that one, and I might want to come in on this. This is an area that I identified that is still a challenge, so I think that the short answer is that there's not much data published on primary care. However, we are taking steps to address that. We are now collecting data, and we have now got 700 practices submitting data to Public Health Scotland on disease prevalence. A lot of the focus of the data that we collect at the moment in Public Health Scotland is on the clinical side of primary care, so understanding why people are going to the GP and what the patterns are looking like across Scotland. That's less on the workload data around who's turning up and what the volumes are. Definitely improved data, and we are now looking at how we publish that into the public domain so that people understand the disease prevalence across the community from that primary care data. We are currently working with colleagues in NHS National Services Scotland on captioning data on what I would cast more of the activity data about people who have turned up appointments and so on in primary care. We hope to have or a plan to have a data set in place over the next month or so on that. The next steps around that would be looking at the data quality and understanding it to enable that to be published in due course. That's making big strides forward compared to where we've been. The other thing that I would highlight around GP data is to explain why it's so tricky. At the moment, the GP data is essentially held in each of the practices individually. We've got 900-plus instances of data stored. At the moment, there's no straightforward way of extracting all of that, although we have the mechanism in place to bring in data from the 700 practices that are participating. However, we have learned a lot from the Covid pandemic. There has been considerable GP data that has been brought in, particularly around vaccinations at pace, and the work that we're doing with NSS around more of the activity data is based on the work around those data flows. The other key thing is that the GPs and cells of the practices are the data controllers, so it's really important that we maintain trust with them about how their data is being collected and used. Data is often at what we call aggregate, so it's at a very anonymous level. That still allows us to do a lot with it, but one of the challenges of that is that you're not able to link those data to other data. Further work that we're doing is looking at how we can bring in individual-level data that would require further conversations with the GP community and, in particular, the patients. Finally, on the horizon, there's something called GP IT provisioning, so it's upgrading all of the GP IT systems. My understanding of that is that the way that the data is stored and managed will be very different. It will be much more cloud-based, from what I understand. The advantage that that brings is that organisations such as Public Health Scotland, with the appropriate permissions, will be able to access the data a lot more straightforwardly than the current situation where we have to go to 900 practices individually. There's quite a lot in there around the background to the primary care data. We are now making progress around the disease prevalence and looking at activity data and there are opportunities on the horizon with the GP IT provisioning. Thank you for that very comprehensive answer. The question for me following on from that is probably twofold. One, how do we use that data that we're hoping to bring on students to chart somebody's journey through health and social care? You may present to your GP, but you may go elsewhere, or you may feel that A&E is an appropriate presentation for you, but there's a discussion at the moment about where presentations have been made. How do we perhaps link and look at someone's journey? How do we chart almost unmet needs to where people aren't having their needs met in the most appropriate place? Particularly in digital, where a lot of people use digital more and more, so how do we chart that? That comes back to the point that I was making about the ability to link data in Scotland in order for us to link the data in Scotland. That relies on the data being at an individual level, so we need to have other conversations around primary care in particular, around the individual level data, because to allow that pathway analysis about where do people go, what are the pathways of care, who starts in primary care and ends up in hospital, et cetera, we do need to do more work on that. One of the things that I would say is that there are effectively other data sets and proxies that can be used for some of that, so we do have good prescribing data, for example, in Scotland and the prescribing data is at individual level, and we link that to hospital records. What you can do is, for particular conditions, understanding the prescriptions that go with that. That is one way of understanding what the pathways of care look like. I also think that it is about taking steps in the right direction, so being able to have the aggregate data understanding disease prevalence, for example, in the community, will be hugely important. That would help us to understand the difference between what it looks like prevalence in the community versus what it presents at the hospital. The hospital data itself does record what the path into the hospital was, so if it was a ferro from a GP, we know that and we know the practice, or whether it was through ANE. Some of the work that Ed mentioned that we have done in our insights on social care report is doing exactly that, looking at those pathways. How did people end up in hospital and what was the path to get there? It is also really important to believe what is the pathway after hospital and where do people end up going. Definitely more to do with primary care data, but there are things that we can do with the existing data that we have got to answer some of those questions that I think you are posing. Ed Humphreyson? Just to supplement that, I think that this issue about availability of primary care statistics and data has been quite long standing. If you look back at Audit Scotland reports on the NHS in Scotland over the last five or so years at least, probably going back further, they have highlighted that there is very good data about the acute part of the NHS, the acute hospital sector, but more limited data on primary care. Actually, we wrote to this committee, its predecessor, in August 2019 again, highlighting the very point that we are just discussing about the difficulty of charting journeys through primary care and community care into the hospital system. I think that I would just say a couple of things. Firstly, I completely agree with Scott's analysis that thinking about community prevalence of disease is an important place to start, because that starts to get you to the population health, not what is happening through the system. I think that that is a very important thing to understand. The second point is that I mentioned earlier very positive remarks about the insights into social care reports. Scott referred to some of the insights that that report has on primary care, but I think that I would say that there is not such a clearly obvious equivalent yet in the primary care sector that pulls together a range of information. I think that that is really the thing that we would encourage public health Scotland to do, is to do an insight into primary care output, something along those lines. I think that that would be enormously helpful to start to paint this picture of the primary care landscape. Just a quick question. If we are talking about patient journeys or a person's journey throughout the whole system, will the clinical portal support that if everyone had access to the clinical portal as far as journeys? I am thinking also about social prescribing. When we are referring people to men's sheds or third sector, for instance, would that be something that could be part of any data processing as well? I will be honest here. This is an area that I am not as familiar with in terms of how the clinical portal works for our digital and data perspective. I think that colleagues who are joining the next session would know more about that, but, from the way you described it, it certainly sounds like the type of approach that would be helpful to avoid what we talked about earlier about the multiple instances of adding the same data about the same people. I apologise, I do not have the detail on that, but I think that it could be followed up in the session all on this. Everything that we have spoken about here is fantastic when it comes to the data that the GP is holding and having it across everyone and everyone being fully integrated. At the moment, the GP system does not talk to itself, so vision and emis do not talk to each other. There is no data integration between the two, and I am straddling the two themes here. What can we do in the immediacy to allow GPs to access data from simply another GP data source? I think that that is probably a question that would be well directed to the digital colleagues who are joining later. From a data and statistics perspective, exactly what you have described is part of the challenge that we have brought with the current set-up in primary care and being able to access the data. You are right that vision and emis have not been able to talk to each other. I am not familiar with the exact details of all of that, but even with those two suppliers, there can be different ways that it is installed in different practices as well. It is not necessarily as simple as solving it for a vision and emis talking to each other. I think that it is more about how we facilitate that safe and easy transfer of data across practices will stop. By again, it is not an area that I am familiar with. I think that talking to digital colleagues in the next session, they should be able to give more clarity on that. My second question—I will be brief. At the moment, you have said that there are 900 different data holders, so it is about the cold-court guardian. The GP is responsible for that data. If we move the data on to a cloud, if we allow lots of other people to access it and we are going the way that we want to, who is responsible for that data? Surely, it can no longer be the GP? That is a good question. Again, digital colleagues may have a view on that in the next session. The important thing will be about how the data is stored and how it is accessed. My understanding of that will be that practices will still control the data that is their data, so they will still be data controllers. The important conversation that needs to take place is about how we build on the good infrastructure that we have already got around things such as the public benefit and privacy panel, which considers access to the wider speed of data and is able to link it. For example, when data becomes available in Public Health Scotland, so if we receive data from practices, the current process is very clear that Public Health Scotland then becomes the data controller for the data that we then hold and we are responsible for maintaining the safety and security of it. However, I do not think that it is nuanced that practices do not continue to be data controllers. That will still be the case, but, again, colleagues who are joining us in the next session will be more familiar with exactly how the approach is planned to work. We are going to move on to talk about social care data, and Stephanie Callaghan has questions on that. Sorry to talk about primary care, but we are talking about the challenge of pulling together that data and that information to use it effectively. However, when we start looking at social care, we are in a whole different situation there where we have really big gaps, if you like, too. Certainly, it is helpful that you mentioned earlier on about trust and confidence of the public, which I think that going through Covid people are appreciating more the importance of data and getting access to that there as well. For quite a long time, our GPs have been incentivised, if you like, to record core data in a standardised way. What do you think about the NCS and how that could perhaps assist with bringing that through for social care? Who would like to go first on that, Scotland? I do not mind starting on that. I mentioned that there are opportunities with the national care service. The key thing would be to ensure that data is at the heart of the legislation that comes with it. The fact that we have really strong health data is largely down to the legacy of how that was all set up through ISD as it was before it joined Public Health Scotland over those years. We have got the kind of learning and the legacy from how we have handled health data. We need to carry that forward into the national care service. It is about understanding the data needs and the conversations that we have been having about talking to people about understanding what data is available and what data might be needed to be able to answer the questions. We have been really clear on the questions that we are trying to answer to determine the data that we need rather than the other way around. I am not so sure about what you are relating to on incentivising. I think that what is really important in the set up to the national care service is that, whilst recognising that data is important, we also recognise that we make sure that we fund appropriately the kind of data and IT infrastructures that have to come with that. I think that we would definitely miss a trick if that was not at the outset of the national care service. It is really important that we work across the country to get those common definition standards, understand what the questions are across the country so that we are doing things in a consistent way from the get-go rather than where at times we have to grapple with the fact that the 32 local authorities do things in a slightly different way. The national care service has a huge amount of potential for transformation. There are some things within the architecture of the national care service that will help with the issues that we have been talking about this morning. Not simply the focus on data and individual's data being more complete, but the emphasis in sending the fee review on engagement, engaging with the public and engaging with the individual. That creates a much better platform for ensuring that data is used to answer the questions that people are interested in. I think that that is really powerful. If there is one thing that I would encourage those who are responsible for designing the NCS to give a bit more thought to, it is something that you as a committee raised in February 2021 when you published a report on the future of adult social care. You made lots of the points that we have covered today, but you made an additional point that I thought was really important. You said that more needs to be done to educate and inform the wider public about adult social care and to challenge people's assumptions. Aside from the moment of crisis, when people in a crisis mode need to engage with social care either for themselves or for a family member, there is not a broader understanding of what social care offers and how to access it, the choices that are available. The point that you made well as a committee is that there is a job to be done of informing and educating the public. I think that it would be really nice to build that into the national care service design, as well as all of the good things that we have talked about already today. That is great. Thank you very much. I mentioned the fact that GPs are incentivised, but I think that it is about recording that core data in a standardised way. That is probably the really important part of that. What can we learn from perhaps other countries about the minimum data sets for social care that is helpful? I can maybe come in on that one. One of the things to say is about Scotland is that we are often ahead of the game, so it is really important that we learn from other countries. However, as Ed mentioned, we have got what we call the source data set, which is a data collection about social care that already exists. We went through quite an extensive period of consultation with local government, various groups, etc. We talked about the data that we need to capture to answer the key questions that are being answered. It is not that we do not have data already on social care. We have that to build on. The challenge that I highlighted at the start is the frequency of how that is collected and how it is done. It is not high, so it is quarterly. It is quite an ordeal for the local areas to collect and submit it. We have probably got a solid foundation already about what the data are that we need to be collecting. I think that there is further work that is needed on the underpinning IT and digital to harmonise that if we can across the country, making sure that we have those common definitions and standards, as you said. Then, using the source data set that we currently have as a platform to think about where the gaps are and what we need to add in. I think that you are absolutely right that we need to understand what other countries are doing, but I think that it is just sometimes taking a step back and recognising that Scotland is well placed to do that. I guess that because I am having a body like Public Health Scotland and our custodian of the national health and care data, there are a few other countries that have that ability to link it to the other data sets to provide that more nuanced understanding of what happens to individuals as they flow through the system. I am actually quite optimistic that, without the investment in the underpinning digital and data in local government, I think that this will continue to be a challenge. I think that the first thing to say about social care statistics and data is that this is a challenge everywhere in the UK—Scotland, Wales, England and Northern Ireland. The issues that we have talked about today arise everywhere. In some ways, I agree with Scott that there is a very good platform in Scotland based on the source database. I think that it is also something that we have not mentioned, but the survey analysis of carers, which has identified the extent of unpaid care in Scotland. I am not aware of such a comprehensive piece of analysis being done elsewhere in the UK. It may exist, but I do not think that I have seen it. I think that there are some really strong foundations there. Having said that, there are things to learn from other parts of the UK as well. This is one of the benefits of having in us as Office for Statistics Regulation being able to look across the UK and identify the areas of learning and so on. Two areas are primary care. I think that there is much richer data in England on primary care. In terms of linkage, the place to look, the top of the league table, I would say, would be Wales. It has an incredible resource called the sale data bank, which is market-leading in terms of safe linking of individual data and making that accessible in a safe way to both Government and researchers. I think that there are things to learn from other places. Good morning, panel. It is really good to hear Scott say that he is very optimistic about social care data and to see that Scotland could lead the way in looking at social care data. Obviously, from the evidence, it seems that social care data just now is quite poor and it is not integrated really with the healthcare system. Do you feel that we have enough leadership to take that forward and to really be world leaders here? I think that the answer to that is yes. I guess that the scale is a bit odd, but I guess that I am one of those leaders in this space. I think that with Public Health Scotland and the role that I have got within Public Health Scotland and that dual accountability that we now have as a body to local and national government, we are well placed to lead the conversations around this and make progress. There are other colleagues that I know who are joining you in the next session from local government digital office so that there is great leadership there, too. We are actively talking to them at the moment about how we work together essentially to make this happen. I think that we are a unique stepping point here. I think that the decision taken about Public Health Scotland at start to have that dual accountability will begin to pay dividends as we go forward through that really strong connection that we now have with working with local government. In terms of leadership, I think that the potential is there for some really significant changes and improvements in social care data. In fact, one of the reasons I say that—I cannot believe it—is one minute past 10 before I even mentioned it, but we have just gone through a pandemic where the statistical system in Scotland has shown that it can work collaboratively in an agile way, it can produce things at enormous speed, it can actually get access to shared data in a way that probably would not have been seen possible beforehand. Amazing things, remarkable things, have been done. Building on that leadership, which made all of that possible in the pandemic, means that we have the potential here to really drive further change. Of course, we as the regulator will be watching this keenly. We want to see it happen and we want the potential to be realised, but I think that the potential is there. Thank you, convener. I think that just following up on the point about how local government has worked across the piece to try and drill down into people's experience and perhaps the services that they require, I was quite interested in Professor Bruce Guthrie at the University of Edinburgh's work and recommendations in this area, but particularly the idea that we can use NHS data around unique addresses to link people, to understand people whether they are living in sheltered housing or whether they are in care at home scenario or whether they are in a care home. I am keen to understand how we ensure in the national care service that we are still getting that quality of localised data and information about a person, and that helps us perhaps to see the bigger picture in terms of housing mix, housing need, requirements in an individual area, whether that is rural or urban and those sorts of issues. We go to Scott Held first. Thank you. That is a really good point. I know Bruce Guthrie well. Bruce and I have worked together on a number of areas, particularly during Covid, so I am well cited on the work that he does. Scotland is well placed to do what you have described. I have to confess that I cannot remember what it stands for, but there is something called the UPRN, which is all about that kind of thing that you are talking about, about understanding people's addresses, where they are and all the characteristics that go with that. That is a bit like the kind of CHI number in a sense that you need to address or you need to wherever somebody is staying, so the power of being able to analyse and use that is really important. I am probably linking back to the conversation about leadership, so I think that recognising that leadership can come from many different sectors. For example, Bruce is well respected in the academic sector and we work really closely with the academic sector in a lot of work, particularly around some of the challenges with childcare data. That is why I think that it is about making sure that those voices are also heard and that we learn from that and that we make sure that we build us into, as I was saying, kind of what is the underlying data infrastructure that will go with the national care service. Did Ed Humpherson like to come in on that? No, thank you. Can we move on to talking about workforce data with Gillian Mackay? Thank you, convener. Good morning, panel. What would the panel consider to be the biggest gaps currently in our workforce data? I am happy to take either of you. Do you want to go to Ed Humpherson first of all? Actually, can I suggest we go to Scott first? I am probably not as knowledgeable about that. Thank you, Scott. This is an interesting one. Maybe I should start to highlight where responsibility for workforce data and statistics lies. That is the responsibility of NHS Education Scotland. Colleagues from Nez will be well placed to talk about the data gaps more than perhaps I will be. I was involved in workforce data years ago, but not as close to it now. I know that colleagues from Nez are joining the session next, so I think that they will be able to answer that more fully. I think that what I would say is that we have, certainly readily available, strong data on the NHS workforce. I think that looking at other sectors such as social care, less so, and certainly the perspective of what I am cited on within Public Health Scotland. I have to confess that workforce data is not something that I am hugely close to at the moment because of that responsibility now lying with NHS education. I do not know whether you want to save your questions for the next session. We will move on, then. That makes sense. We are talking about data sharing and common data standards. We said earlier about how we were very agile and we moved at pace during the pandemic in terms of our data. I was interested—one specific example draws my mind, and I was wondering how it manifested. NHS Lothian was very reticent to accept the browser Chrome on any of their systems, and that was a massive hurdle in the utilisation of their patients and the NHS attend anywhere platform. Now it seems to be—I am just wondering how you got around that at the point of the pandemic, when, as a councillor in the city of Edinburgh, I had a motion at the IGB at the time to get them to move on to that system. I am just looking for a bit of what was it that was the final trigger to get them to move over. I do not know if anyone wants to come in on that. I have absolutely no insight into the fact that NHS Lothian's decision-making would be good, but I would imagine that these things get caught up in different people's responsibilities, somebody's responsibility for security, the IT procurement and nothing much happens until you get an external pressure, which is sufficiently great to shift everybody into more activity. I imagine that that is what has happened here, is that eventually people talk about a burning platform that is a bit of a cliché, but maybe it is the time when the cliché is really relevant that the platform was there that finally meant that it had to be done, but I am afraid I do not know a great deal about NHS Lothian's decision-making. I am speculating, and I apologise to them if that is not what happened. It may be a question directly for NHS Lothian, rather than our panellists today. In terms of sticking on that theme, in the innovation that you have been using in terms of statistics, I cannot say it, data collection, during the pandemic allowed a more or less risk-averse attitude to gathering data by both the public and the healthcare professionals, I suppose. Is that directed at Scott? Either, I suppose. I will give a quick answer, and then Scott, who has been close to this in Scotland, will be able to supplement it. I think that there has been a shift. One of the things that we have not talked about today is the development in very fast time of daily dashboards. Daily dashboards are very useful for decision makers, ministers, officials, centre of government and health boards, but what we have discovered is that, by making information available on a daily basis, there is a huge public appetite. I think that something of the order of 20 million visits to the Public Health Scotland dashboard is something like that. I am sure that Scott will correct me if I have not got that quite right. I think that not only has the experience of the pandemic unblocked some of the things, and we were just talking about the browser issue, maybe as an example of that. I think that there are examples around data sharing, very much so, about bringing data together more quickly. I think that it is in the presentation of data in creating dashboards that are really responsive to public interest. I think that those innovations can stick if they can outlast the pandemic. Scott, you may want to supplement that. I hesitate to connect the stats regulator on a figure, but I will do that if I may add. It is 45 million hits now on the Public Health Scotland dashboard, which is quite phenomenal. I think that the whole pandemic has brought about huge innovation in how we work. We have highlighted it in the Public Health Scotland data and digital strategy about how we need to build on that, and we must go back to old ways of working, and we must learn from how we worked in the pandemic. Our daily dashboard is just the phenomenal reach and use that it has had to help people to understand in particular what is happening in their local areas around Covid. It is still getting lots of use each day at the moment, but what is hidden from view is the work in the background to pull that together every day. There are thousands and thousands of data items that feed into that every day. I know that the stats regulator has encouraged stats producers to think about something called the reproducible analytical pipeline. It is about how you can automate end-to-end so that manual intervention is as limited as it can be. Essentially, the processes that we have behind the production of the daily Covid numbers and our daily dashboard, I hesitate to say that it is push-push button because it is not quite push-push button, but it is as automated as it can be so that we are confident that, each day, we can produce the figures that are required. That whole legacy of automation investing in the time that it takes to automate it in the first place to get the gain further down the line is a message that we are taking further into public health Scotland. One of the reasons why it is so important is that, if you can automate, you eliminate human error. That is critical, so that includes the quality of what we do. It also reduces our ask on our analytical workforce. I am going to call, I do not mean this unkindly, but some of the more routine for them is pretty boring going together with the numbers every day to do much more of the value-add about what is the data that is telling us and what does it mean for Scotland. A real legacy for me in my area in public health Scotland is about building on that, so we are doing much more automation. I would like to see much more use of dashboards, so I think that I can say this. The historic way that we have produced our official statistics with lots of PDFs and Excel cables and things like that is old-fashioned. The huge engagement that we have had with the dashboard shows that, if we present it in a good way, people will engage with it and act on it. The current thing that we are thinking through just now is what is the public health equivalent of our daily dashboard for the future that we will get that engagement with the country. It is not really important to talk to people about that. We also recognise that Covid is, hopefully, once in a 100-year-type event, huge focus through everybody. Everybody is thinking about what Covid is, and everybody wants to understand it in the local area. That will drive people to our Covid dashboard. How do we build that kind of momentum around all the other stuff that we do so that we are adding that value? That is back to the point that I was making earlier about reviewing what we do and how we do it so that we can make sure that we are adding the value and the least capacity to do more about some of the stuff that we have been talking about around areas such as gaps, such as social care and primary care. Although I have got the floor about Covid, it would be remiss of me not to mention the huge power of work that all our staff in Public Health Scotland have done across the system in maintaining the level of output in scrutiny over the past 18 months. I have never done anything like that in my career, but what is great is that there are real lessons that we can learn about how we do things going forward. That is the number of colleagues that I want to drill down into the lessons of Covid, but can I bring in Ed Humphrieson before I go to Emma Harper? Yes, two things. One is that I am very happy to be fact-checked in real time by the head of professional statistics of Public Health Scotland. Sorry for getting my numbers wrong there and thank you for the correction, but a bit more seriously, just to say we as the regulator really support the line of thinking that Public Health Scotland is developing around how to develop dashboards that are accessible to the public on a wider range of topics. I think that that really is a promising future. Emma Harper The information that we have available to the public is fabulous. I have been using the Public Health Scotland dashboards myself in order to better inform me. I am interested in what we can do to support the health literacy of people digitally, because it is something that if we are going to encourage people to not only take better care of themselves outside of a pandemic, but how do we support the development of a more health-conscious public? That is a really good question. I think that that is part of our thinking and our challenge around what the future of how we present our statistics and data about all aspects of health and public health to help people to understand what it is telling them. However, I think that that point about health literacy and people understanding what it means for them is really important. It is probably a bit of a remiss not to highlight that within Public Health Scotland we do a lot more than the data and stats that I have responsibility for. That question about how we are messaging key public health messages so that they land with people is really important. How we can get that by and from people, so that people understand what that means and what it means for them is a challenge. One of the things about Covid is that it impacts on everybody, so everybody is affected by Covid. Everybody wants to understand what is happening in their local area. Everybody wants to know what they can and can't do. I think that it is more challenging when it is particular health conditions that are more unique to different parts or segments of the population. However, it is absolutely the heart of what we also want to do. I am thinking as well about, digitally, are there tools that we can develop that can help people to get that kind of health literacy that you talked about? I think that that is work in progress, but that is definitely something that is on the forefront of our minds. I do not have a lot of thoughts about health literacy. It is not a specific topic that I have given much thought to. I am very often asked about statistical literacy. People say that it is an issue with the public value of statistics bound up with challenges with the statistical literacy of the population. I will say the answer that I give to those questions, because I think that it might be pertinent to health literacy as well. I am always a bit reluctant to say that there is a problem with the general population's statistical literacy. If you say that, you will imply that there is some kind of deficit of knowledge or of capability in the population. I am not ready to sweepingly dismiss the capability of the population as quickly as that. A better way of thinking about this is that people often have quite good understanding of things that relate directly to them. They can be quite sophisticated in understanding those things. The trick for professionals is to communicate things in a way that latch on to and land with those understandings that members of the public have. That may be a way of thinking about health literacy, not thinking about it in terms of there being a deficit in public understanding and knowledge, but more about how to translate professional knowledge into insights that the public can engage with more easily. I think that one of the challenges that we need to be mindful of is things such as dashboard. Our Covid daily dashboard is great. It is loads of traction, but the nature of the speed of how it is produced and how the data goes out. There is not much narrative that goes with it to help people to understand what all this data is telling us about the state of the pandemic. That is why we have got the complimentary Public Health Scotland weekly report, which tends to do that and walk people through what are the different aspects of the data that are telling us about the pandemic. It is important that we think about how we do that going forward. In particular, the pandemic, understanding the patterns and trends, I would say, is of much more interest now than the daily numbers that are fluctuating during the day of the week. Ed's point about how we, as the statistical community, help people to understand what all this is meaning is going to be crucially important. Emma, you have a short question. I am happy to move on. It is a really good point to not imply a deficit in knowledge. We need to look at the positives. The public, because of the pandemic, are probably very educated now about clinical vulnerabilities and things like that. What learning will we take forward from what has been initiated in data collection during the pandemic, and how will we take that forward? I think that, as I said, the very nature of the ways of working within an organisation like Public Health Scotland, more automation, doing things at pace, all that will continue post-pandemic. Back to your point about the fact that we have developed products that have really engaged the public. People are using them. We need to build on that going beyond the pandemic. As we are coming to our last eight minutes, Camill Malkin, you have some questions about Public Health Scotland's digital strategy, just to round us off. I was interested to hear a wee bit about your view on the digital strategy. You have clearly stated that you look at the strategy in terms of both data and wider digital IT solutions. If you think that that is the best way of moving that forward, the second point that I am interested in is that you acknowledge the difference between your strategic level thinking in Public Health Scotland and then, locally, it tends to be more driven by business as usual rather than initiatives and what changes we can make for public health in general in their areas and across Scotland. I was just interested in how we can try to move that area forward. I recognise and agree with all that you have said. What is important is that a body like Public Health Scotland has set the vision about how data and digital can be used to improve public health. We, as a body, have been set up with that ask of addressing some of the public health challenges that Scotland faces. The reason why it is a data and digital strategy in essence is that the two have to go hand in hand. Usually, data feeds from a digital or an IT solution, so it is really important that we crack both hand in hand. That is why, as I said, our work with, for example, local government digital office is going to be really key. The point that you made about often what is happening on the ground is driven by today's needs, not future needs. That comes back to the points that were raised around leadership and how we are engaging with the people who provide the data, but also wider in other roles within local government in particular, also having that understanding that they can then cascade through their organisations. It still comes back down to what we can talk about, the best data in the world, all this great digital stuff. However, if we do not get the investment right, and with this amazing opportunity that we have got with the national care service to have the data and digital work at the heart of it, we will have really missed a trick. I would really, really encourage that in thinking about the legislation for the future national care service that we make sure data and digital is at the heart of it so that we can do a lot of this ambition that we are laying out here. I do not know if there is anything that either of you would like to add that you maybe have not had the chance to say about the system. We have got a rather panel, of course, and I thank you very much for setting up those detailed areas that we can go into with our... Just give you the chance if there is anything else that you wanted to... Ed Humpherson. Just at a final point, which is something that I should have said right at the beginning, actually. The essence of what we do at the Office for Statistics Regulation is make sure that the public can have confidence in statistics produced by government. A lot of that obviously needs to do with gaps and it needs to do with quality in all of the things that we talked about. However, I think that another really, really important aspect of it is what we call trustworthiness. In other words, the public can be confident that the statistics emerge from a professional analytical process. They are not just the subject of what policymakers want to tell the world. They are not a product of communications effort, they are a product of professional statistical effort. Really, we are here more than anything else to preserve that. I think that that is so important. The lessons learned review that we produced highlighted how, in Scotland, Public Health Scotland has played that role and Scotland's leadership has been really important in preserving that professional independence. It is really important. It should never be taken for granted and, of course, we continue to be a regulator who takes it very seriously and is vigilant about it. I just thought that it would be remiss for me to leave this session without making that point. It is the real foundation on which everything else is built. Thank you very much. That is a good note to end on in terms of public trust. We are very grateful to you both for your time this morning. It has been very interesting and very helpful. We are going to suspend for 10 minutes or so until our next panel to on-board. I now welcome our second panel on data and digital services in health and social care. We have a number of experts in front of us remotely. Before I introduce you all, I am just a bit of meeting management. With us all being here and our panellists all being remote, what would be very helpful is that if our MSPs might be trying to direct their questions to individuals, but those individuals, if you want to come in, if you have not actually been asked to give it, but you have something to add, if you could use the chat function on the BlueJeans app, the platform that you are on just now, I will see that and I will try and bring you in, if that is helpful. We have Martin Wallace, chief digital officer for local government digital office, Christopher Roth, director of NIST technology, Jim Miller, chief executive of NHS 24, Shalona Shook, chief technology officer of the digital health and care institute, Chris Mackay, digital hub and Alice programme manager for the health and social care alliance, and Dr Steve Bagley, the clinical director for eHealth of NHS Grampian and chair of the clinical eHealth Leads in Scotland. Welcome to you all and thank you for giving us your time this morning. I guess that the first thing that I would like to ask you all, I mean I'm actually going to do a round robin of the six of you in contradiction to what I've just said, but just to allow you all to to talk about your support or otherwise of the three aims of the Scottish Government's refreshed digital health and care strategy, and whether you believe that there is alignment and support for that in the institutions that you represent. So if I maybe just go first of all down that list again and go to Martin Wallace first of all. Martin. Good morning and thank you for giving me up as I witness. I do support the three main ambitions of the new refreshed digital health and care strategy. I think behind the scenes we've got some great learnings from how we respond to Covid, we've got great learnings from the original digital health and care strategy of 2018, and from the previous panel as well, I do agree with a lot what Scott Heald has said about data standards, interoperability and principles, which is going to be the core components that we're going to have to do and create and implement if we're actually going to make it come to life. Good morning and thank you also for inviting me along this morning. Yes, I wholly support and agree with the aims of the digital health and care strategy, again, I think they are entirely sensible in the context of if you were going to look at a forward looking citizen centric approach to the way that we want to deliver health and care in Scotland, then that is the strategy that you would devise. I don't think the strategy is, if you'd like, the issue here. I think the challenge is the complexity of the existing landscape that we are working in in order to be able to do the sort of level of transformation that's required in order to achieve the strategic outcomes. It is a challenge, but it is an achievable objective, and I do think that the, again, just what Martin's just said, the Covid-19 pandemic, one of the good things that's come out of it is the absolute commitment that everybody involved in delivery of this strategy has to working together to make it happen. We've proven that not only is the technology that we're adopting the right technology, but the approaches that we have now worked through and are developing are the ones that are going to take us to where we go. So while it's still a bit of an uphill struggle, I think that we need to be optimistic about where we are and where we're going. Thank you. The desire is there, but the challenge is accepted. It's been quite a tough one for everyone, Christopher. Because of the desire and the need of everybody involved to ensure that the services that are currently being delivered can be maintained are safe and are able to keep up and keep pace with the demand. We would go faster if we were to building our greenfield, but we're not, so we have to find the right balance between citizen safety and care and the ability to transform services, and that's where the challenge is. But, you know, I can say with confidence that the colleagues that I'm working with across the entire enterprise of health and care have shown the necessary skills, capability and leadership to get it done. Thank you. Can I come to Jim Miller from NHS 24? Thanks and good morning, everyone. I would wholeheartedly agree with the colleagues that have came before in terms of support for the strategy. I'll probably add two things, and I think that one is that I think that the strategy has the balance between ambition and choice, so that it's not an either-or for citizens and users. Therefore, that idea of inclusion and equality runs through the strategy. I think that the second point, and we may well discuss it more throughout the session, is the attitude of the public and acceptance of the public using the pandemic as an accelerator, potentially, of how services are transmitted and, indeed, how services are consumed has changed. Therefore, we find ourselves in a position where that ambition is matched by the terminal capacity, but, indeed, a desire amongst the people of Scotland. Thank you. Can I come to Shalona Shute from the Digital Health and Care Institute? Thanks for having me on. We're very supportive of the three aims from the Digital Health and Care strategy. I'd echo everything that the others have said around recent capacity building that we've had around Covid. I'm looking specifically at the aims, aim two and three, predominantly about how professionals, be they health and care staff, or planners, researchers and innovators, use data and data-driven approaches to drive service transformation. That's great, and we support that, obviously. The thing that's most exciting for us as an innovation centre is that aim one is now strengthened, which is to say that citizens will have access to, but also greater control over their own health and care data. In the previous session around the Public Health Scotland and the statistics piece, we showed the value of creating that dialogue and giving citizens a more active role, giving them access to an ability to manipulate data. If you think about that in terms of someone living with multiple sclerosis or on a cancer care pathway, similarly, if we can start to co-manage the care data with them, professionals know a lot, but the citizens also know a lot, and they are the ones who understand their lived experience. They have the drumbeat day-to-day lived experience that can help inform more predictive and more personalised care models. It's really heartening to see that co-management of data with citizens is starting to come through in the strategy. Hi there, good morning, and thanks for inviting me along. Yes, from the health and social care alliance perspective, we would be supportive of the digital health and care strategy. I suppose that the devils in the detail, when we come to implementation to see the delivery plan, are exposed to the ambitions that the strategy presents. A few points that I would make would be that it is a digital health and social care strategy, so not to forget the social care aspect and the bit about people living good lives. I think that building on the comment about equalities, I would go further and like to see the full realisation of human rights approaches, and that allows us to look at not just the protected equalities characteristics, but looking at carers, poverty, migration and care experience people, for example, who need to have their rights upheld. We've done quite a bit of work around human rights approaches and principles within digital health and care, and I'll just run through those briefly. People at the centre are starting with the person, not starting with the shiny digital tools. Using digital where it's best suited is not always the best solution. Digital is an on-going choice, so people can opt in or opt out of digital. Digital inclusion is not just widening access, so that's about having the skills, not just the device and the data connection, but the skills to operate that. It's also a workforce point about skills development within the health and social care workforce that we need to address. Finally, as has already been said, citizens have access and control of their data, and that's come through quite strongly from the engagement that we've done with people who are sick of retailing their stories. They would like to see more effective sharing of data between professionals, but they would like to retain that control, and they would like to be reassured about the security and confidentiality aspects. Those are some of the main points that I would highlight in respect of the strategy. I think that the aims are certainly ones that I would support. I think that it's great to see the focus on citizen access to data and services. That's absolutely what we need. I'm under aim too about basing services on a person-centred approach. I'd be keen to draw out the benefits for staff in terms of removing low-value admin tasks, for example, from clinicians in particular. I'm keen to see how, as we develop the delivery plan, we connect the strategy to the levers of delivery in those hundreds of occasions across the country. Thank you very much. I'm going to hand over to my colleague, Sandesh Gohani. Thank you, convener. My question is perhaps directed to Martin Wallace, maybe Christopher Roth, but definitely to Martin. It's about aim 3, which is about allowing healthcare researchers and innovators secure access to data. My question is, how can we give companies and innovators access to anonymised data to improve services that they can provide, and how can we get a significant benefit from giving them access to our data? Thank you for a great question. I think that it has to come down to—I'm going to go back to the earlier committee with Scott. We need to have data standards and principles established. In the digital office, we have a data community. We have set up in local government. We have been working with people that create data in local government for a while now to look at operational standards and data standards and try to get things more aligned to ease that process through. Otherwise, we do pay quite a lot of money out to get integration, which is just crazy these days and age. We should have open standards for a lot of it, but cyber secure at the same time. I think that you would also maybe want to speak to Chal at DHI, because DHI has already done that kind of work already in aggregating anonymised data for test purposes. There is a balance between taking data, informing the patient, stroke customer, stroke citizen about what we are doing with the data and how we are putting safeguards and measures in place to aggregate it, to anonymise it so that we can do research for on-tests and purposes to find new ways of services. Sandesh, do you want to address somebody else? I don't know if Christopher wanted to come in on that or not. Christopher Roth? Yes, thank you. Unsurprisingly, I'm going to support everything that Martin has just said, but I think also one of the keys here is the technology that we're currently now building and deploying in order to make it meaningful in real time for people to be able to make the kind of decisions that they need. We need to have the technology based on data standards that are going to allow people to access the data when they need to. That's one of the fundamentals that we need to get to, that we need to liberate the data from being trapped inside systems and only being accessible after a whole series of processes, whether they're technical processes or whether they're IG processes. We have to get them to a place where people can access them on demand in order to be able to drive real value, because things are moving very quickly now and people's expectations are that that kind of process, that kind of business, that kind of service is available to people on demand, so they want it when they want it and we can't predict when that is, so we need to build technology that allows us to do it. We now have that technology, we are in the process of deploying it, so if you combine the technology with the standards then you're going in the direction in which we need to go. Shalona Shute, do you want to come in as well on this? Hi, thanks for bringing me in. I absolutely agree with everything that's been said. You'll probably hear this a lot in this session, the need to separate the data from products and systems so that we have more independence in how we can use it flexibly in a consented way. For me it's just worth noting that we have data safe havens set up in the north, east and west of Scotland, where people can already go as researchers and innovators to access those anonymised data sets. It's still in the early stages, but it's time to gear up now, so that kind of thing is starting to happen already. Under strict governance and ethical processes, I guess one last little point would be when people usually have these conversations about how we access that anonymised data set to drive innovation, typically in people's heads they go straight to the idea that the clinical record is the place that we need to be focusing that effort and getting that right. The reality though is if we're trying to dict and personalise services then the clinical record is only one part of the story. People may have their own activities, data living data, they might have their own smartphones and devices and smart home technologies, we might have social care data, social security data, so if you want to drive real prevention you can't just look at the clinical record data because the NHS records are the record of disease in the main whereas other systems may have the clues that give us the ability to anticipate issues and act in that more direct, repetitive way with the citizen consenting of course. Chris Mackie would like to come in. Yes, it was just a very quick point around interoperability and these different almost fragmented systems talking to each other and I managed the Alice programme at the Alliance and the Alice programme is built on open standards. When it comes to working with other platforms the use of open standards makes that process much more straightforward and those open standards are largely out there, that's the point about openness but I think I would make a plea to move towards that if new systems are being developed to use open referral standards or whatever it is so that it just makes the whole process much more straightforward. We have a number of questions on the national digital platform and data sharing in particular and we'll come to Gillian Mackay. Thank you convener and good morning to the panel. Could we have an update on the development of the national digital platform and a flavour of what work is currently on going on it? That's probably Christopher Roth maybe? So where we're at with the national digital platform, what we've realised through the pandemic is that the national digital platform can't be one thing. It has to be a collaboration and a collection of pieces of technology, information and data that is spread across the enterprise of health and care in Scotland. That's one of the lessons that we've learned very clearly and what that means is that in the specific details around the national digital platform the vaccination programme, the mass vaccination programme for Scotland has driven an enormous amount of data availability into the technology that we were already deploying in the context of the build site for the national digital platform. We now have some in the region of 10 million records and increasing every day which is relevant to somewhere in the region of four and a half to five million individuals in Scotland. So we now have the baseline platform in space and we've also started to build the necessary catalogue around the services that are going to be required in order to support it. I think the next stage is a more collaborative and active dynamic with the health boards but also with our colleagues in social care across all the different aspects of that from local government through to the private sector, third sector, all of those aspects on what it is that we need to build next which is going to drive maximum value in the earliest space because when you think about the ambition of the national digital platform which is to have all the data pertaining to an individual's care whether that's health or social care in a single logical space available to all the different aspects of individuals working with those citizens and primarily the citizens themselves, that's a big ask. So we've got to be able to figure out how we can drive the platform to deliver maximum benefit against the backdrop of a remobilisation for the NHS and for social care restructuring around the national care service. So the answer to the question is where we're at is we've got some in the region of about 10 million records in the platform now. We've got a connection to our CHI services which is going to be fundamental to linking the data. We're putting together a catalogue of services that we can provide to our social care and health sectors but we are now more importantly in a dynamic conversation about what's the next stages around the delivery because we need to make sure that with the finite resources available that are both there to support services that are currently in place and the ones that we need to bring forward in order to be able to build the platform, we need to get the balance right and that's what we're working through at the moment. With a view to having a delivery plan ready for the early part of the next financial year which is one that everybody can recognise as being the best way forward. It's a moment of time where we're taking a breather to say, right, we've put the platform in place, we've got the technology there but now we need to make sure that we build it out as fast as possible to deliver maximum benefit. At the centre of all of that will be delivery to the citizen which I figure I'll sort of explain a little bit later on in different questions. Thank you for that. What work is and should be undertaken to ensure that information sharing can take place between the wider primary care team and multi-disciplinary team, the acute sector and social care to make sure that we have all the records in the right place at the right time and what problems have there been in joining all those records up. And that's probably Christopher again. Sorry, is that me again? We broke up a little there. Yes. Okay, so I think that the problems, we've already touched on and I think we're going to continue to unfortunately reiterate some of the same answers which is at the moment there's an enormous disparate firmament of systems which we have to try to draw together. So there is no logical single record for a citizen in Scotland in health and care that just simply isn't. And that's for good reason. I mean the way that systems have been developed to support the services, whether it's primary care, whether it's in the acute sector, whether it's in social care, individual organisations, groups of people delivering services to citizens have had to independently build their technologies in a way that has not always been about interoperability, but it's about being delivering the services that those people want. Now what we know now is that with the right connector which is going to be CHI at this point in time, obviously the sophistications around personal identification may spread out as we try to become more pan public sector, but within the context of health and care, CHI is fundamental to the success of all of this because as long as we are now in a position where we can both standardise the data structures that we need inside the systems that exist already and then bring all the data into a single place will be fine. In terms of the barriers to success, I don't think that the barriers now are organisational or even to a certain extent IG, although we do have significant information governance challenges to get through. The problems really are now coming down to the technology itself. We have to move ourselves away from the technologies that have been really very good at supporting the type of services that we've wanted to deliver. I mean the technologies that exist out there inside our health boards and to a certain extent, I mean I'm not overly cited on social care, but the technologies have been really really good and very fit for purpose and have been supported and delivered with excellence. The issue here is that they are very much designed to support process, they're very much designed to support the capture of data and information to target specific outcomes in specific organisational settings. What they're not designed to do is to provide services to the citizen and we have to do that transformation, so the barriers to that are being able to deploy the technologies that we know are going to succeed in that while at the same time not disrupting those services. I think that we are on the cusp of being in the place where we want to be, but we've still got some challenges around delivering the technology while not disrupting services because we have a finite number of people that we can actually deploy to make this work and they're all fairly tired at the moment and they're all pretty stretched and trying to remobilise services both in health and care. I hope that that answers the question. And Dr Steve Bagley wanted to come in from his perspective. Dr Bagley? Yeah, I think in terms of all staff connecting to that data, I think that it's important to bear in mind the national organisations versus the health boards and the role that the health boards have in delivering these views and that then comes down to the different capacity that different health boards have in terms of resourcing priorities they have, the IG capacity to deal with these novel information flows and that those aspects start to come in. So I think that that's how you get to that issue around the strategy connecting to delivery on the ground and how we make that connection really firm in order to get the benefits of all elements of the strategy, including that central data spine. And Martin Wallace wanted to come in. One of the points. I think that we also misinterpret information governance and data governance in completely different ways depending on which council we're at, which health board we're working for and then central services. We really need to tackle that in an ethical and secure way with them also having data literacy being promoted back to the citizen so that the citizen understands fully what's happening to their health and care data records, how we're actually going to use that health and data record to help with better outcomes, give them the opportunity to actually get in through front door, which is obviously in the health and care refresh strategy, to get access to the health records to make more informed choices on how they actually want to be looked after or what care and services they actually wish to take. I think that there's a kind of element in the airport which is kind of slowed down things at times. The other thing as well is not just about access to digital health and care records, it's actually about collaboration between multifunction teams, as you mentioned as part of the question. We are doing work with Microsoft, with Microsoft teams that was rolled out across health and care back at the pandemic at great speed, but also how do we create common platforms, which means that we're not having to retrain or use different systems to access different health records, etc. We're using common platforms to get the right data at the right time to make the right decisions, therefore we can actually increase that health and wellbeing of citizens in Scotland. Sue, you have some questions on this area. Sorry, I've been at theme 3. No, we are still on the data sharing and the NDP. Okay, the data sharing then, thanks, sorry. I suppose it's great to hear of the work that's being done, but the reason we called this today was because we had a sense that there wasn't, there was a whole lot of groups that were raising concerns that there wasn't the data there for decisions to be made, so I suppose maybe to Mr Miller from the NHS 24 element in terms of, because that's almost the public face of the data, can maybe help, how can we help with that disconnectivity about everything that's going on and the impression from all those third sectors and the other people that have spoken to us about the concerns about that data? Jim Miller. Thank you. Yes, a very good question. I think in some respects, NHS 24 as an organisation is almost a pain of the ambitions of the strategy and it faces the challenges that have been discussed in the last few moments. Where I think organisations, national organisations like 24, have a place is almost the manifestation of the idea of the front door, so we talk about the front door and I think we need to be careful that that's well understood by the public and by users of our services. From a NHS 24 perspective, we have the opportunity to, because we engage with so many, so we have a close on 40,000 calls a week, we are able to supplement the engagement with those members of the public with the supportive documentation in terms of why do you ask those questions? What do you do with my information? Who is it shared with? We can use our digital and online resources to act as a trusted point of truth around how organisations within health and care use it. Clearly, there will be differences between the way that NHS 24 shares its services and other parts of the health and care service. I think that that has an advantage as a national organisation to be able to provide the answers to those questions that citizens increasingly are asking. I'm just checking in terms of the NES, so that's to Mr Roth. How do you look to collaborate with other stakeholders and organisations? You've spoken about that collaborative and active approach and Dr Bogley mentioned that we needed a strategy to deliver on the ground, so what are we doing tangibly to do that? There are a number of governance bodies that I am directly engaging with, the enabling technology board, which is part of the strategic portfolio delivery board for digital health and care, but I'm active in the process of directly engaging with organisations. My calendar is fairly full with individuals who have recognised that the significance of the role that I'm privileged enough to be playing in this work. I am directly engaging with organisations both at executive level and my teams are engaging with individuals working. That is about painting the picture and getting their overarching view as to what's important and what's significant to organisations. These are organisations in the third sector, these are local authorities, these are IJBs, these are obviously extensive a network of communications in and around our health boards. It is an active process and it's encouraging as well because people are coming directly to me as the person with the responsibility for co-ordinating this role. It's not as if it's not understood where to go in order to be able to work with this, but it's also very important to state again that the governance bodies are very important in the context of being able to create the necessary landscape for prioritisation. As I've touched on previously before, it's not difficult to figure out some of the basic things that people want. We can make statements to the effect of people wanting access to their data, organisations wanting access to sets of information and data about citizens and service users. All of these things are relatively straightforward and easy for us to be able to figure out that the issue is not so much what we're doing and the direction we're travelling, it's the prioritisation about what steps do we take to get us to that place because there is almost no area in health, healthcare and Scotland that isn't crying out for some form of transformational change, all of which in turn leads back to the same space, which is people need access to the data. Because the data is to a certain extent, and I don't want to use negative terminology, I think was like locked away, trapped inside, these are sort of negative terms, which I don't particularly want to get into, but the reality is, in the technology sense, and to a certain extent as well, and what Martin has touched on in terms of the information governance, it's not easily accessible, so we have to move from a model that we've been very used to and has worked very successfully to this different model. Going back to the question, I am actively involved in a whole series of conversations with a whole raft of different organisations, PHI, et cetera, in order to be able to work up models of how we're going to do it. I think, as I say though, the real challenge is about prioritisation. What do we do first? That's going to be a theme that I'll be returning to again and again over the course of this thing because there are so many different ways we can address this, but I think we need to do the one which delivers best value to the citizen as fast as possible, and that's not in itself obvious at the moment, but certainly it's something that we're working on. Shelon O'Ryns to come in. I want you to come in. I can see from my chat box. Just get your microphone up. Thanks for that. Just looking to build on what Christopher was saying there, so just reflecting on your comments around some of the frustration. I think the frustration is one of, as Christopher alluded to, supply and demand. There's simply not enough people able to create the supply of these sorts of digital platform technologies to meet the demand, so that there will be an enormous number of health and care organisations, charities, social care, innovation, Scottish businesses, academic institutions looking to contribute. It's very difficult because, historically, the platform components haven't been available to anyone other than the NHS people building them out, and so in terms of prioritisation, from our point of view, it's only a platform if other people can use it. If it's just one team that is gatekeeping the ability to use these tools, then we're going to forever be throttled by that capacity. If you look at what the NHS across the UK has done, NHSX, et cetera, it's focused on saying that the first task is to make test and sandbox environments of these platform components available to the broader innovation community, such as charities and independence, universities and businesses and others, to come in and learn by doing and self-service, so that we're not dependent on the NHS to hold their hand and take them through those processes. That doesn't necessarily mean that the things that they do will be switched on in live service, because that's still subject to governance, of course, and it's a subject to strategy, but, nonetheless, for me, the highest priority is making sure that we activate as much of our innovation community as possible by giving them open access to an open platform. That's the thing that we're missing prior to the pandemic, and while the vaccine delivery has shown what's possible, it's still only possible for a relatively small group of people inside to put the body of the NHS to enact, and we need to open that up and give people more access. Chris Mackie wants to come in on this. Yes, I just wanted to expand a little bit on the role of the third sector. Really, just to say that when we talk about involving different partners and having conversations, when it comes to the third sector, the inequality in relation to the amount of resource that third sector organisations have is a factor, and it feels to me that the third sector has some way to go to get to where it needs to be to work with the likes of the national digital platform. I'd also say, don't forget about the independent sector as well. That's an important provider of social care, as you'll already be aware. Finally, just to mention the role of libraries, that's something that's come through from the engagement that we've done. We've done quite a lot of work in working with libraries, and I think that they're often forgotten about in terms of the contribution that they make to health and wellbeing and can do so also in a digital sphere. Thank you. Sandesh, you wanted to come on to this theme. Thank you, convener. This is a question for Christopher Roth and perhaps Steve Bagley. With all the digital platform and the cloud sharing and all the wonderful innovations that we are looking to do, does the NHS, that includes primary and secondary care, have the appropriate hardware and the broadband speeds to actually access all of this? Mostly, I would say, is the answer to that. I think, yes, mostly. One of the key elements of the technology that we're delivering is the device itself that you consume the information on. The systems are essentially agnostic, so whether we're talking about an iPad or a tablet, device, phone, a computer, a laptop, all of these things are able to consume the information and data that we be supplying off the platform. That's one of the really exciting things about the new technology. In terms of broadband, in terms of the actual connectivity, I think we used to be a cure at Zeg. We used to be good in parts. I think now we're generally good with bits that aren't so good, and unsurprisingly, a lot of that has to do with the geography and the topology of this fabulous nation. Trying to get connectivity into the mountains of the north is not easy or straightforward. However, it is worth pointing out that, again, the mass vaccination programme was delivered in 8,600 different spaces across Scotland over the internet connectivity infrastructure that Scotland has. I think that that's pretty impressive. That's 10 million events, that's four and a half, five million people that have been affected by that, all of whom we're able to access health and care in environments that have never been used before, but for our Motherwell football ground, who knew that that would be a health environment that we needed to deliver into. The technologies that we're now building and delivering on are exactly the ones that we can do that as and when we need to. I don't think that we should be complacent about connectivity. I don't think that it's something that we can just ignore. I think that it's something that we need to keep pushing on. I know that there's the Scottish Government 100 series. All of those things are going to be incredibly important because success of the programme is predicated on connectivity. However, I think that we've come a long way in the last five years. Again, it's one of those areas where I'm optimistic that we're heading in the right direction. We have proven that we've got enough infrastructure to get to the population in its entirety. To do that on a daily basis, I think that we still need to push on even further, but I think that we are doing well, but we can always do better. The range of digital services that we've seen particularly during the pandemic and questions led by Paul O'Kane. Thank you, convener, and good morning to the panel. I think that panellists have already touched on the necessity during Covid to really upscale what we're doing in terms of digital and to move that forward by necessity. Obviously, NHS 24 has had a key role in developing many of those services, and it's fair to say that there has been a degree of very quick moving upscaling within that. Perhaps projects that were already planned to move forward, but I suppose that there's one to get a sense of perhaps Jim Miller's reflections on what has worked well and what has been challenging. I think that, from my own experience, certain applications have worked better than others at various points and have needed refining and testing as we go forward, but I wonder if Jim wanted to perhaps kick us off with some reflections on that. The simple answer is that the speed of implementation has both benefits and challenges. I think that it allows for a unique approach, certainly in the early days of the pandemic, where we had collectively as a nation a single aim, and that was to protect ourselves against the pandemic in whichever way we could. That gave a collaborative thought, which gave a real push and drive on innovation. That was fair to our ground. From an NHS 24 perspective, you're right to say that many of those plans were perhaps part of the strategic ambition, but moving from an organisational level where we were pre-pandemic predominantly and out of our service, where services would not be otherwise available, to truly a 24-7 service, and we have been now for almost two years. The benefits of that are manifest continue to be so as we are still within the pandemic, but I also think that the attitudes, behaviours and expectations of the public have changed, and they accept various ways of accepting and receiving services in the dead NHS 24. The reason why I say that is that, for example, where people now have a choice of services in hours from Monday to Friday in 905, whether that is to access GP services or primary care, or whether it is to access some digital-based services in NHS 24, we are seeing the numbers are steady and increasing in accessing those services. People are making a conscious choice and time and time again, so that tells us that they have many things right. Some of the challenges in terms of, I think, there is a demographic here, I think, certainly in that 25 to 34-year-old, whereas an expectation of perhaps an enhanced transactional ability for some of the services that they may be used to in terms of their broader digital interactions, that we are moving at a slower pace, so they are perhaps disappointed with the lack of ability to interact with those services. You know, it is maybe slightly old-fashioned in my consideration for some of the younger people who think that they can do this completely digitally, whereas some of them still require either information governance protocols or, indeed, that there is a lack of transactional ability within the service itself that requires further to left-leaf follow-up or, indeed, face-to-face follow-up. I am not sure that that is a bad thing, but I think that it almost goes back to the ambitions of the strategy around making sure that everything is people-centric, that people understand what it is that we are trying to develop, and we are not pushing solutions on people. The last thing that I would reflect on is important for all organisations to look at what it has developed at pace over the past 18 months. If those services are now becoming business as usual, and if those services are going to be maintained, are they going to be fit for purpose for the long-term, as they were, as an expedient? I think that it is incumbent on all organisations like 24 and others across health and care just to review those services. For example, the service that you build and implement over a weekend may actually be different from that that you would build if you had a period of time. I think that 24 has done remarkably well, and I think that the staff have done a fantastic job in running with the required pace. I also think that there is a period of reflection as we can hopefully move out of pandemic and become more business as usual for those services. Thank you for that response. I think that your assessment is fair. I think that there is a sense that perhaps there were challenges in trying to get things up and running initially around perhaps proof of vaccination, for example, which obviously took a while to come on stream into a more digital format. I think that that is an interesting point that you make about perhaps that younger cohort. To be fair, my sense from my inbox is that that goes across age ranges as well, and that people have a real desire to have things in one place, in one app perhaps, particularly in terms of their vaccination status. It is certainly issues around where they can book vaccinations and things like that. Covid has brought all that to the fore, so maybe to bring those things together, there is an ambition to have that sort of one-door, one-digital-door approach more broadly, and I suppose that is about how we access services as well. I suppose that the question within that is how do you bring all the parts of that together, and is there an ambition to essentially have something like a one-door app that will allow us to access our medical records if we require them, but also indeed to use services? That is to Jim Miller. I suppose that it might be Jim's bailiwick. I am happy to pick up, but I am sure others will have their contribution in this space. I will speak from an NHS 24 perspective, in the sense that I think that you are absolutely right for taking an NHS informed as an example of what a front door could look like. That has grown both in terms of, I think, its level of public trust, its transactional capabilities and all that, and all those, what we could do in that space. Even if we take the start of this year, so fairly heavily into the pandemic, NHS informed was running around five, just over five million hits a month towards the end of this year and indeed last month, that was sort of eight million hits a month. Part of that is around the content, particularly the increased content around Covid and vaccination status, so people are moving towards where they see a co-essence of data and services. There is definitely a demand there. I think that your point about that idea of, frankly, if we can make it simple, if all of the information and services are in one place or indeed the idea of the front door that you enter and then offer choices within it, that has been clearly really beneficial. I think that NHS 24 has a sales pitch. I think that NHS 24 has a fantastic opportunity to almost act as that front door. Indeed, if I reflect on some of the potential opportunity within the national care service, NHS 24 clearly still has more of a health than care focus. That may not always be the case. Indeed, is there an opportunity to expand those services using the technology, the approach and the acceptance of the public and understanding NHS 24 suite of services as to what that could mean if it was expanded across the health and care environment? There is definitely more to be done in that space and more to be considered. Whether it is through an NHS inform or an NHS 24-1-1-1 type service or something else, I think that our lessons can be learned from our experience, but I am sure that other colleagues will want to pick up on that. I agree with the successes that we have had around some of the Covid elements and the standardisation of access around some of those assets. I guess that I will put a point of caution there, which is to say that what we are talking about here with the front door is what was previously called a patient portal or a national patient portal. Globally, the literature that we have done systematic review around this is not positive on the impact for citizens, the benefits and the deliverability of that central one-stop-shop experience. That tends to be because the health and care experiences are so diverse with so many localities and groups and conditions and specialities and needs that it becomes incredibly difficult to create an experience that will meet the needs of such diverse groups and regions and peoples. That said, some things will absolutely land well in that space, such as booking a GP appointment, booking a repeat prescription, accessing a vaccine appointment or record. These are high volume, very easily standardised things in the relative terms that we should be thinking about for that kind of single experience. For example, if you were living with multiple sclerosis and had 10 to 14 different organisations that you interacted with and a dozen different carers and support people and complex care needs, it is highly unlikely that that single experience is going to cut it. Equally, if you were feeling maybe possibly stigmatised around maybe going in for a transmitted infection experience, for example, you may not want to go through the front door. If that makes sense, there are lots of different experiences that you might need to be somewhere else and create a bit of separation. Yes, absolutely, let's create those standard experiences, but let's not push and force everything into one space. I promise you that you will disenfranchise billions if we do so. I have got the pleasure of being the chair for this identity Scotland programme and Scottish Government. Getting in the front door is the easy part. The hard part that we have to do as health and care is getting the rooms in the house in order so that the patient and staff can walk through the GP room, the dentistry room, the pharmacy room, the clinical room and be able to get appointments and stuff like that. What we need to do as the technologist on this panel is to build the building blocks for those rooms around the individual, although we are still delivering services and protecting families, which is a challenge. In local government, we have had a front door for councils for seven or eight years with my account, and 25 councils have been using that. We have put a concept to Greater Glasgow and Clyde a few years ago for being able to access a patient record. The technology is there. The challenge is building blocks for those rooms and the governance, the ethics and the cybersecurity and the different ways that we do things to build that capability out, which is a more complex piece, but there are plans in place to make that reality. We are also working with the Digital Identities Scotland Board, as well as the Scottish Government, to ask me that reality to. Just to echo some of the points that have already been made, I think that it is hard to argue with the once-for-scotland approach to reduce our duplication. If investment funds are tight, then it does not make sense to be doing multiple things. However, when we look at communities and the way that life is, there is a diversity and complexity to the landscape in terms of what the third sector looks like in a particular locality, what the independent sector looks like and what people want may not be that one front door. There might need to be side doors or a back door to enable people to have access to whatever services that they need. As has been said, there are certain things that always make sense when you are talking about repeat prescriptions, for example. However, when it is a more person-centred, a more people-based service that is required, I will ask questions as to how that will operate in practice and whether we can make sense of bringing everything together in that way. It makes sense in terms of health, but looking at social care and looking at the wider health and wellbeing picture, can we make sense of all that complexity and bring it together in a way that makes sense? The point is so well made that this cannot be one size fits all, and there are absolutely varying degrees of what we need to look at here. However, NHS England operates an app, which looks at all the things that were mentioned by Shalina around appointments for GPs, prescriptions and Covid status, so I suppose that we should just understand what learning we are doing from there and why that has been in place for such a period of time and we do not have the equivalent here. I do not know if Jim perhaps knows anything about that. Thank you. Unfortunately, I am not so close to the development of that. We host another organisation national services in Scotland that is responsible for the development of it. I think that it is working progress, and you are right that we have an opportunity to add functionality to the app. Clearly, we have a different structure in Scotland than we do in England in terms of relationship with primary care colleagues, which adds a level of complexity to it. I am not saying that it should not be an ambition. From an NHS 24 perspective, we have the capacity, but I also think that it could be expanded in terms of—the last thing that we want from an experiential perspective is circular routings, so that you contact one part and your foistage to another part and you end up probably starting with—that is a bad journey, a bad experience, regardless of your requirement. Where there is an opportunity to speak to an organisation like 24 and be immediately directed to another part of health and care, I think that that is a really positive opportunity. The redesign of urgent care, which committee members might be aware of, really has improved that ability and has taken pressure off area tendencies. People will be able to contact 24. If, indeed, there is a requirement potentially for them to attend A&E, they no longer simply turn up. They, through local flow navigation centres and the point about locality, I think is important here. Those are bespoke in understanding of those local services, and they will be given an appointment time. The end-to-end journey time from speaking to 24 to potentially being a treehouse diagnosed and treated at A&E is much, much shorter. As I said, the flow is balanced between A&E. If you take that as an example, what else could we do with that, particularly in the primary care space? I think that there is an opportunity for us to consider how well we could have that as an example of not quite a one-stop-shop and not quite taking away responsibility from all the past of the system, but actually smoothing demand across the system and also signposting where other services are available. I think that there is potential there. Shalun Arshut wants to come in on this. Yes, it is just a quick one. I am sure that Christopher will probably say similar. The NHS in England is a good example where they have said that a single user interface for those common transactions, but the important bit and the bit that is not often publicised, is that the thing that makes that app work is, as Martin had put it, the walls and the door frame and the rest of the house. They have an appointment scheduling system, which is separate from the user interfaces, which means that a number of different user experiences can be built by a number of different groups using a common engine, so that the appointment system works in a coherent way, but you do not necessarily have to use the NHS app. In principle, a charity could help people with appointment booking through their own interface and might do it in a slightly different way. Imagine, again, if you were dealing with people who survive trauma, for example, and you needed a more gentle up ramp and a bit of counselling and a bit of support. As part of that process, you needed booking into an NHS service, for example. You can imagine that that experience could be quite different from expecting someone to turn up, download an app and self-serve. The point is, you can have both. The infrastructure, the plumbing that you put in place to make that NHS app work, can be reused flexibly by a range of groups and people for a range of experiences, and then you standardise what you can. Common standards, common language, ideally common look and feel, common definitions, and so you get a sense of coherence, but at the same time, if there is a bit of flexibility there and there are a number of different interfaces that you could use depending on need. Christopher Ruth wants to come in on this. Again, unsurprisingly, I support everything that has been said, but I will say that this is one of the few areas where we need to recognise absolute scale. In turn, that means prioritisation around the resources available to Scotland and to massively oversimplify it. In England, if you want an app to do those things, you have 10 or 20 times the resources that are unable to be able to build that single outcome. In Scotland, if you want that single outcome, you have one tenth of one twentieth the available resource, and it is already spread pretty thin around the outcome. What we have to do is prioritise. In England, we are able to do those kinds of things. We can build an app, and they are off you go and build an app. In Scotland, we have to slot that into all of the other demands. I believe that we are prioritising correctly, because what we are prioritising is exactly as challenge, and Martin has just said what we are prioritising is the back-end architecture that is going to allow us to build out slowly and incrementally. The back-end architecture is going to give us the data. When we have the data, the app that we will be building and extending out will be even better, because we will be able to co-ordinate the data that is required. We are building the house, but we have only got one tenth of the builders, but while we are looking for the same outcome, we need to be aware of that. It is a relative issue, but that does not mean to say that we are not doing it. I do not think that we can get there as fast as we might want to. If we had ten times the resources available, I think that we would, but it is one of those things that we just need to bear in mind. On the theme of digital services, Stephanie, you have a couple of questions, and I will come to Sue Webber. A lot of interesting stuff is coming out today. It reminds me of one of the NHS workers out in Lanarkshire who said that it is like building an aeroplane while you are flying it, which I could relate to. I am very interested in what Chris Mackay is saying about keeping people at the centre about choice, about inclusion, about citizens having access, having control, having that ownership, but still having the security there. Obviously, the pace of things has been pretty mind blown, but we have huge demographic changes coming in as well. Although, yes, we need to reflect on that, how can we make sure that we are still picking up that pace and really accelerating that? Do you like to direct that to anyone in particular to start off? Possibly Shaloner? Shaloner. If anyone else wants to come in, use the chat box. Shaloner. I was just saying about building the aeroplane while we are flying it, if you like. Can you hear me okay there? Chris Mackay was speaking about keeping people at the centre about choice, about inclusion, about people having access and control and ownership and security. We are also looking at the pace that has gone through the roof, but while we can reflect that in reality, we actually need to keep picking up going forward with the huge changes in demographics, etc. How can we actually look at doing that? A few things there. From my point of view, THI is obviously the Scottish Government's Digital Health and Care Innovation Centre, so we grapple with this in everything we do. How do you spend enough time putting fuel in the chainsaw? You've got to put down the extra enough time to do so, if that makes sense. It's always really difficult to create that capacity. That's why we keep saying, as an innovation centre, for us the highest priority is making sure that we activate the largest possible number of collaborators to work within a common standards framework. We've got a number of Scottish universities, huge groups of clinical, academic, industry, third sector innovators who are queuing up to offer support. The problem is that it's difficult to activate them, because if we don't have common infrastructure, if it's not openly available and accessible, there's a chance that each of those groups goes off and plows its own furrow and adds more noise without necessarily helping to keep the system together. That's why we're saying again, so I keep reflecting what NHSX has done well, is focus on, as Christopher has described, focus on, here is a national clinical data store. Here are some test environments to be able to work with that data store on a self-service basis, so it doesn't depend on us having staff to help them get there. Here are some guidance, here are some standards, and they're basically saying, if you can come and show us working with a charity in a business, a university or whatever it may be, that you can deliver a local service for someone living with frailty or otherwise, and if you can show us an improved outcome and you can show that you've done that in accordance with these standards using the common infrastructure, at that point we can talk about activating that, thinking about what that looks like as part of the bigger piece. It's almost like let's crowd source some of that bottom-up will to change, give them the tools to do it in a standardised way, but let the flowers bloom. I think that would be my argument, is that we need to tap into that network, that broader Scottish community, and then have some sort of process whereby we figure out what the acceptance criteria for the things that people build would be, and then what the formal health and care services can then help them on board into the national infrastructure fully. At the moment, everyone's queued up at the door, but there's no door handle. Can I bring in Martin Wallace, who wants to come in on this? I think that it goes back to our principles around how we help individuals in Scotland to understand health and data literacy about what's available to them, and that's from people in the most vulnerable parts of society to the higher-class society who are just using a smartphone every single day for living their lives. I'd like to put it into three points or ACE for short, so the assets. What are the assets available? We've had Connected Scotland last year, massive multimillion-pound investment, giving devices for vulnerable children, vulnerable families. We've got a device for every child happening with the Government's commitment in education. What physical assets are there for that individual to go to to get learning support? That could be through third sector or using SCVO's digital essentials literacy piece. From the citizen point of view, go to where the citizen is or the customer is and understand what matters to them, how do we get and support them and help them to understand how they can do things digitally and with data, with connectivity as well around about it. Last but not least, the employees, the E of the ACE, to make sure that are the employees engaged, are they getting the right information at the right time to make the right choices with that individual, that citizen that they're actually dealing with on a daily basis. There are also mechanisms already in place that we could use to manipulate that, but we work as one sector with third sector to make that deliverable happen. It will be a challenge for some of the smaller organisations, smaller health boards, smaller local authorities, to maintain a pace in comparison to the larger organisations. It's echoing what Christopher was saying a minute ago about England versus Scotland, the same is true of these different organisations in Scotland, because the scale is so different between Glasgow and Shetland, for example. We need to have a different model for delivery, probably more things supported, at least nationally, with our local domain knowledge of what's going on the ground in Lowick, for example. At the same time, that will help things to happen, good things to happen in those places. I think that the current model is concerned that the pace will slow down because the smaller organisations have that relatively limited resource when it comes to change and electronic patient records implementation. Chris Mackie wanted to come in on that. It was really just to build on the themes that I mentioned before about human rights. What we've seen with the pandemic is a very rapid pace of change. As has been said, some things, if you had considered them over a period of time, you wouldn't have done them in that way. I think that at times there have been instances where people's human rights have been overlooked in the interests of getting something out there and getting something done. I guess that it would be to remember that people's rights should be respected even though we've got some exciting innovations coming through. We can do that through meaningful co-production with disabled people, people living with long-term conditions and unpaid carers, using the Scottish approach to service design, which seeks to achieve that meaningful co-production. There are a couple of examples that I would mention from the Alliance perspective. One of those is the Alice platform, which has been around about 11 years now. That's been a co-produced piece of work that we've done as a democratic crowdsourcing of community assets to benefit people's health and wellbeing. The Alliance hosts the digital citizen panel, which seeks to support the work of the digital citizen delivery board. However, what we've been doing with the citizen panel is to bring citizens in to the conversation about health and wellbeing and digital health and wellbeing so that they can better support their independent living. It's possible to achieve meaningful engagement and meaningful involvement with people. That would be the main point that I would like to make, which is that innovation is great. However, let's just check in with people and to ensure that we are respecting the needs of the whole population. You had a very short question, Stephanie, and I'll need to go to Sue and move on. Yes, just very, very shortly. There's quite a bit of talk about diversity in the variation that we have across the country. I'm noticing today that there's not a great deal of diversity as far as the panel goes. Is that something that's an issue that needs to be addressed going forward, or have we got that diversity going across the teams in the collaboration and the co-production just to check that's the case? I can see Christopher both nodding there. Would you like to come in, Christopher? I set myself up there, didn't I? The lack of diversity is, to a certain extent, a reflection of the traditional development and career path for people who work in and around technology. I think that's what you're seeing here in the context that this is a technology session and traditionally in the United Kingdom it has been a profession where individuals like me have come through. I would say that working in the NHS in Scotland, diversity is enormous. The leadership is very diverse. I'm also very pleased to say that the technology diversity is now entirely changed. The individuals that I'm privileged enough to lead in my group have a significant degree of diversity, and I'm very pleased to be able to articulate that absolutely. The other thing to say is that this is a bland thing to say, but it's not just new technology that's going to change everything. It's actually the application of new methodologies—well, relatively new methodologies, public sector and agile. The only reason I would mention that is to go back to the point about the only way that you're ever going to build systems that people are actually going to use effectively in the way that you want them is to build it with the people who are going to use them. That's what agile methodology does and that's what we at NHS education for Scotland and across all of the other groups that I'm working with apply as the methodology for development. We target individuals who are going to use the software and ask them how it's going to work, and that comes back to a point that's been made previously before, which is that there is no one way of doing it. We must not make the mistake of thinking, but because it makes common sense to us that you'd want a single front door, you want everything on one app, that's actually how people want to interact with their information and their services. We don't actually know that and we must not go down the route of assuming it. We must ensure that our developmental processes, methodologies and outcomes are all focused around saying, actually, we know what the outcome is and we know what the data is that we can bring to bear. We've got those two end, we've got the start point and the end point, but the bit in between which actually builds the software, that's the bit where we have to engage with the audience that's going to use it. When you are talking about Scotland, that is an enormously diverse group of people, but we know that and we understand that. I was very reassured to hear that that explicit point was made earlier on, I think Chow made that point, that we understand that, that we can't assume that we know what it is that people want to do and how they want to do it, and that in turn is driven by the human rights approach that this has to be citizen-centric. We have the methodologies for that, as well as the technologies. What we need is more time. That's what we're doing, we're getting on with it, but there is diversity. I hope that that made sense. Of course we need to remember that there are still significant amount of people who are digitally excluded as well. I'm looking to my chat box and Shaliner wanted to come in on this. Yeah, I was just quick on to say what whilst it would be tempting to try and invest more time and effort in making technologists more diverse, I think what we're seeing in parallel is, and I hope this continues, we're starting to see that technology is being seen less and less of a thing that the IT department does, and it's more and more of a thing that everyone does. I think what you'll probably see over the next decade or so is that more people from caring citizen, clinical, broader managerial and broader workforce will start becoming part of the digital team, as it were. I hope that we can even stop talking about digital health and care or just be health and care. Hopefully, if that trend continues, that will help with the diversity as well, because everyone will be part of the digital leadership. Chris Mackay, before I move on to Sue Webber's question. Yeah, it's just around the diversity and saying that the health and social care alliance has 3000 diverse members across the third sector, disabled people, people living as long-term conditions and unpaid carers. Our DNA is equalities and human rights, and we actively reach out to seldom-heard groups trying to try and hear those voices. One of the things that I'd highlight is our Discover Digital programme, which is raising awareness around digital tools that promote health and wellbeing. We've given some grants out to community organisations working with seldom-heard groups to hear from them about their experiences and views on the use of digital tools in health and wellbeing. Steve Bagley, the diversity of the next generation of clinicians traditionally has been lots of doctors like me working in healthcare IT, but we've got the fantastic digital end-map leadership programme. It's been going for a number of years now, and there are some fantastic people coming through that programme, which will are already contributing to the debate and direction in where we are going across Scotland. I think that this might be the most appropriate for Steve Bagley, but if it's not, others can contribute. Right now, we're seeing a significant issue with delayed discharge, and a lot of that is down to care at home capacity not being there. We're also seeing people now what we're calling to that interim discharge element. How could and should home capacity and remote health monitoring technologies be further developed? Can you see that perhaps helping short-term, major-term and long-term on the crisis that we have in that process? What you've talked about here is the acute care at home model, where people are discharged from hospital but supported in the community for longer. There's definitely a trend, and there's various examples of that happening in businesses as usual across the country. The current crisis, as I see it, and the data that I was looking at yesterday locally at least, is beds in care homes and staff working in the home care sector to be there to support people who are discharged from hospital rather than the continuation of acute care to get them out of hospital. It's places people to go and be supported in their communities. That links in with the whole debate around social care, staffing and so on. That's not to say that there's not a role of technology to help this. Even basic information such as social care team knowing that the individuals in hospital not could help improve efficiency in many ways, for example, and allow resources to be diverted. There's lots of other ways that social care teams and health services can be better connected to manage that interface. Indeed, we have a whole programme nationally of digital-enabled care homes, which is helping to an extent. I think that you can't get away from the workforce limitations that we have in this area, which are behind a lot of the challenges that we're seeing at the moment. Martin Wallace wants to come in on that. I'm actually going back to one of the other committee members' questions about investment in health for data or hardware and connectivity. My other role is to be a senior responsible officer for the analogue to digital switch-off of telecare in Scotland, or switch-over of telecare in Scotland, when in September 2023 the UK phone carriers will stop initiating analogue services on traditional exchanges and, in 2025, they will have a switch-off of traditional telephone lines in the home. We have 180,000 people using telecare alarm receiving kit at the moment. We have been working with technology-enabled care, with COSLA, with DHI, around what is that challenge bring us and what opportunity does it provide as well. We have to look at investment in those areas for the hardware, because there is an increase in cost, and there is an increase in the chance that we have to round about cyber security. We have done mitigation round about that in significant ways over the last three years as part of our programme. However, to be able to discharge somebody from hospital into community, we need to again still have that interoperability that NES and others like ourselves are trying to build, so data flows with open data standards. We have worked with technology-enabled care for data standards for telecare services, and there is an opportunity to put that platform in care homes. We are using one platform, one cyber security model, one data standard model as well, to really help with the flow so that people can live independently but still have that peace of mind and security at home or from social care services, if anything was untoward is going to happen to them as well. That needs to require investment, but it is also helping to try to build those building blocks and data and intelligence to get those outcomes that we want to get. Shalynor? I will quickly end my show, Martin. We would say that, as part of that model, one platform must be many products. We will keep coming back to that cohesive plumbing that allows a number of things to co-operate and work well together. The point that I was going to come to was, as part of the original question around mobile and remote monitoring. There is obviously a large long-term condition management point to this. People living with COPD, high-potension, diabetes, et cetera. Again, sorry to sound like a stock record here, there are many digital tools and products that have been demonstrated to create impact here. We have seen work around COPD in Glasgow significantly reducing admissions to hospital and occupied bed days for people with COPD, and that is done through co-management with them and on-going dialogue-based remote care. There are many products that can do this. The difficult thing is how those products integrate, how they form part of the system, how they speak to each other. It comes back down to that infrastructure. If we are trying to help the NHS, in particular, to remobilise—obviously, Martins answered the degree on the social care piece—the NHS side, if we are trying to help to remobilise and reduce waiting lists and the other things. Again, I come back to the point that there are many solutions, many products, many digital service offerings, many collaborative partners across industry, academia and the third sector that are already working on this, so we are already trying to deploy it. We just need to give them more connective tissue, more plumbing, to help them to do it at scale and do it in a consistent way. We have given the digital service a bit of a good airing, but before we move on to talking about local delivery and the ones for Scotland part of our conversation with Emma Harper, I want to go back to a couple of our panellists, Martin Wallace and Dr Bagley, who wanted to come in and talk about the connectivity issue that Sandesh Gohani raised. If I can come to Steve Bagley first of all to pick up on that, you wanted to come in. Yes, it is just a quick point. The question was around whether we have the network capability at the moment to do all the things that we want to do. I would say broadly that the answer is yes. There is a big network reinforcement project going on in preparation for GPIT reprovisioning, making sure that all GP practices out in rural areas have a strong connection to the cloud centre. There is always room for optimization and we will always be doing more and more with our healthcare IT systems, so there will be a constant requirement for optimization. Broadly, the moment seems to be okay. Martin Wallace had a comment on that. Yes, of course we just answered it in my last answer there about connectivity. We have a significant challenge with analogue services being switched off, PID 23 being the first milestone in 2025, way to work together. We took out a paper for a national business case for digital telecare to the digital citizen boards last week, which was signed off, and we are about to publish that and start to work up what else needs to be done and how we attract investment to make that a reality. However, coming from industry, from telecoms industry for a number of years as well, I only know too well the challenges that Scotland has for connectivity. Of course, Scottish Government has the R100 programme to help fill with those infill things. I think that we are generally there. We are looking at alternative technologies for connectivity as well, such as 5G, Sacklight, infill, internet of things technologies as well. There is a whole range of different things that we can do to try to fill those gaps. However, we should never ever stop progressing things forward just because a certain area does not have it yet. We just have to push ahead and then work with our R100 programme and others to make sure that we have that investment that the connectivity is required. A number of you have mentioned already about the ones for Scotland approach, and it seems like it fits in some areas, whereas we need a tailored approach in other areas. I am interested. It might be a specific question about the DATIC's cloud IQ system, for instance, which is a cloud-based reporting mechanism to look at recording adverse events and safety and quality assurance and improvement of care. Is that something that would be a one-for-scotland approach, whereas there are other areas such as the ALIS approach, where it seems to be directing people to areas of specific social prescribing, for instance, in their own health board or local authority area? Great. That is a prime example. I do not know a huge amount about the incident reporting side of things, but I would assume from a health and care Scotland point of view, having a standardised single way of reporting those things so that there is quality assurance around that is a priority, whereas ALIS is a great example of an infrastructure that is designed to support a variety of actors and people. When we talk about ones for Scotland, I think that sometimes we possibly overuse it to mean everything. I think that our mantra is once for Scotland infrastructure and then diverse experiences. We separate out in your head the things that we do as plumbing. That should be done once and the things that we do for people's actual experiences should be proportionate and personalised as much as possible and localised where necessary. Steve Barglay wants to come in. I think that I am going back to what Christopher said at the beginning. Once for Scotland works very well at the moment when there is a greenfield site, we need to do something that does not exist anywhere. We can scale it and roll it out and then build on that and possibly extend into areas where solutions already exist in locations that are perhaps suboptimal. When it comes to doing things once for Scotland, which already exists in other places on the ground, that is a lot more challenging. That is the area that we need to perhaps get into where we are duplicating our results stores and document stores and all that sort of thing around the country at the moment, which creates waste in terms of duplication and challenges of access and so on. That is the area that we need to get into next. Doing that once for Scotland basis is certainly possible and needs to be right there on the delivery plan for implementation of that strategy. Chris Mackie wanted to come in. I was just to say that, in terms of the Alice programme, what it seeks to achieve is to try and bring together the diversity of communities and the different supports and resources that are out there. I would say that Alice in particular requires investment in order to keep pace with technological advances and the way in which the population is evolving in terms of demographics and needs. We put in an application to the UKRI for funding to step up what Alice is all about. Moving away from the specifics of Alice, I would say that there is an order of magnitude difference in terms of the resources that the third sector is dealing with, with respect to the statutory sector. It is almost the same again as we have spoken about in terms of the difference between what resources England has and what Scotland has. You are stepping down a level when it comes to resource, when it comes to digital services and the numbers that the third sector is able to play with. It is not a level playing field. I am interested to know about Scottish Government policy versus local delivery. Are there any barriers with health boards, IGBs, local authorities or even the third sector that might hinder the successful implementation of the Scottish Government's programmes? I am also thinking about the issues of people whose English is not their first language. How is the digital capability keeping up to support those folks? I will take volunteers who want to come in first to them or you particularly want to address that to anyone to start off with. Can you repeat the question, please? I am thinking about the way that there is sometimes a disconnect between what Scottish Government wants to proceed with and local delivery. I am interested to know whether there are barriers from local authorities, health boards, third sector or IGBs. We know that there are people who are early adopters and then there are folk that are not. Is there any disconnect that hinders the successful implementation of what Scottish Government wants to take forward? There is diversity in the success of the integration agenda. For example, the involvement of the third sector within IGBs is many and varied. If there are agendas coming at a national level, how those get implemented is very much dependent upon some of the politics around the integration process, how well involved the third sector is and how well the public is involved in IGBs. Those can be barriers. Equally, when it comes to different IGBs, they should be encouraged to come up with local solutions, presumably within a framework that is set nationally. Obviously, what works in Highlands will not be the same that works in Glasgow. What I would say is that, through our engagement, we have heard a real range of different experiences when it comes to digital. For example, the use of near me has been a great success in many cases. However, I would say that the experiences of citizens are that it is not always offered and that some professionals really like it and are able to use it in other areas. There is a workforce issue about the staff, the clinicians, skills and confidence in using, for example, near me, but whatever digital tool is required. Martin Wallace wanted to come in on this, Emma. A question about the challenges for community-based outcomes from that piece. It comes back down to national common data standards and principles to be able to link the data. It comes back to information governance and the kind of differentials between the city council's 14 health boards, four special boards and the third sector. There has to be something done—there is central policy, absolutely, but we need to look at how we actually use that process in an ethical and secure way to get the data that we need to actually join stuff up to deliver those community outcomes. I hope that that helps to answer that question. The second part of that was to say that we have, in the digital office, worked with the data professionals in the driven by data squad community to build up our principles and data document, which is in development at this moment to try to tackle some of those challenges. However, it needs to require strategic thinking across the whole of public sector to be able to make everybody join up and link up to that as a national data standard. Otherwise, we just will not get anywhere. I think that there are multiple factors behind the risk of disconnect between Government policy, ambition and local delivery. One of them is the executive lead, but digital health boards need to be brought into the strategy and have the tools and capabilities to be able to implement them locally. There is a very significant difference sometimes in the contracts range between different health boards and some of our major suppliers, which can have significant impacts on what is possible to be done at that health board level. There can, of course, be specific local pressures that mean that an organisation has to do a certain thing first before it does what the Government is recommending and has to do in strategy. The point that I made before is around the resourcing, which is allocated in such a way that some of those smaller health boards are at a disadvantage when it comes to being able to deliver on the ground at scale. Thank you for your patience. We are probably a little bit overtime, but we want to talk about public engagement and pick up on some of the things that you have said. Evelyn Tweed. This question is to Chris Mackay. There are still, obviously, some groups that are digitally excluded whether that is older people, those in poverty, ethnic minorities and others. How can we reach them? That was directed to Chris Mackay. I think that there is some work that we have done at the Health and Social Care Alliance already that we brought people into, for example, the digital citizen panel. I think that it is important to look at the people that are there but also the people that are not there. Some will engage, but others will not come forward. It is about going to where people are and talking to the organisations that are right at the co-face of those groups that are seldom heard, whether you are talking about the refugee community or you are talking about gypsy traveller communities or any number of different groups that are traditionally underrepresented. To some extent, it is about the approaches that we take as a national third sector intermediary. It is also about how we engage with our members who are on the ground within the third sector in communities, and not forgetting that exclusion does exist for whether it is to do with English not being a first language. It could be due to the devices that they do not have or the connectivity that they do not have. I would come back to an element of choice that is thought to be factored in and that people can choose not to engage them in a digital way. As long as that is an informed choice, as long as that is a choice that they are actively making with full knowledge of the implications of that, I think that there is definitely a lot of work to do around engaging with different communities to address the digital exclusion that exists. I want to comment on a couple of things. I want to very much agree with what Chris just said. DHI, as an innovation centre, does a lot of co-design with the people of Scotland, citizens, professionals and so on. We listen to academic insight on that, and there is something called the dominant discourse, which is effectively saying that the people in power set the tone and pick the place. There is nothing that we can do to bring citizens into boards and organisational structures that will not disenfranchise them or turn them into professional patients, if that makes sense. I very much agree with Chris that we have to go into their normal communities and go where they feel comfortable and engage on their terms, which means changing our language, asking more questions and listening more. That is one piece. The second piece is a success story, but on that point, as part of the contact tracing service delivery, we developed the ability of citizens to contact trace themselves. Part of that work involved us working with the University of Glasgow and with the Alliance, and the Alliance helped us to reach out into some of these communities that would otherwise be excluded. We found that we were able to design tools in such a way that, for many groups, they preferred the idea of contact tracing themselves digitally rather than taking a phone call from a stranger for a variety of reasons. In many cases, people did not feel that they would be able to pick up the phone for a variety of reasons. Through those methods, we have a very high uptake for people who are engaging with the contact tracing system, whereas otherwise, it may have left them behind. Evelyn, if you want to come back in, you have time for one more question, otherwise I could wrap things up. Do you want to come back in? Yes, please, just one last question. Obviously, there has been huge public interest in the Covid dashboard. The public have been very engaged with data. How can the Scottish Government build on that engagement? How can we get the public interested in understanding of the use and the value of health and social care data? That is a great question. I hope that, in some respects, that that is happening naturally as opposed to systematically. Where there has been interest in Covid-specific data, I think that it has also re-energised the appetite for the public around control of their own personal data. Of course, I think that it has become much more interesting to generally in terms of what data and what information in dashboards are available. In health and care, there is more to be done in terms of the transparency. In fact, at the concession this morning, I believe that Scott Heald was talking about trying to move away from perhaps some of the less transactional pieces of Excel and the PDF presentations to more truly interactive dashboards. I think that there is more to be done on that with health boards like my own and, indeed, across health and care. However, there is also a little bit of a journey here to make sure that we encourage and foster that interest at a citizen level. I might not jump too quickly away from PDF and other forms, but I say that as a non-technologist, because I think that there is a place for that as well. If I pick up the earlier question just in relation to Ease, for example, Ease of providing translated information, rather than wait for a potential elegant solution that may take some time, information in NHS Inform was translated to over 18 languages at a pace, albeit presented in PDF. There is something about making sure that we do it incrementally, recognising that there may be improvements along the way. I genuinely believe that there is a real strong, absolute interest for the public to be better informed. I pick at Christie's point around choice and informed choice. I think that there are options available to people to understand why those options exist so that they can make an informed choice. How to get people more interested in data is to allow them to see their data. At the back of the beginning, I think that Sandesh asked the question about ethnicity data, and how do you do that? If we could show people what ethnicity data we hold about them, then it is a great mechanism for people to check it and correct it if required. Same applies for wealth of other data, which we are starting to be able to provide access to through the tools that colleagues like Christopher and Charles are beginning to provide. I am improving the data culture and skills across all the public sector, and getting a balance between providing a menu of what data is available with different dashboards, but also publishing open data with open standards, so that people can manipulate and play about with themselves in a safe and secure environment for their own benefit, as well as going back to Scott Hill's earlier point in Committee 1 this morning about giving access to the citizen to get access to the data to see what we have got about them, but also to be able to make their own live choices out of it as well. I think that it is a three-prong attack. I am working with the digital director of the Scottish Government and Albert King's team on how we make a reality and option across all the sector. It has to be a multi-pronged approach, but I think that it could be done. I am thinking more about more personal data at this stage, rather than the big data. We always hear from people that they want to do something with their data, so accessing it is one thing, but being able to do something is a different thing altogether. Studies in the US showed that the single biggest transaction that people did using their healthcare portals was to access their ultrasound as a new parent, download it, print it out and put it on social media. It shows that there is a very tangible thing there, which is how I can use my thing and what is the motive value of that thing. It allows me to have good conversations and build relationships, so there is something about giving them means to use it and not just see it. Before we wrap up, I want to come back in on the issue of exclusion. Yes, thank you. Sorry to take you backwards in time. I work at NES, and NES is essentially a workforce-orientated organisation in which we look to support our workforce and development, train them and so on. I am a digital person and I am aware of the exclusion issues in terms of the workforce and the wider population. As a digital person, I have had to think about what digital people do and people who do not use digital, which is quite an interesting place to be. The conclusion that I have drawn around all of that is that we need to automate and do the things that Steve Bagley said right at the beginning of this, which is that we need to get the machines wherever possible to do the machines thing, the thing that machines can do. That needs to free up the time. Again, what has also been said in the part about exclusion is that we need to go to the people who are excluded. To do that, we have to free up the time of the front-line workers who interact with and provide the services to our citizens. The best way to free up that time is to take away all of those low-value administrative tasks. We need to look not just at the things that directly affect the services that will be provided to people, but we need to look at ways in which we can free up our workforce's time to not only develop better and more focused skills in and around the digital, but also extend that out to being able to then apply that to automate their services in order to be able to spend time with the individual citizens. That is really where we need to go with that. Thank you for allowing me to go back to that point, but I think that it was an important one. That is no problem at all. Thank you very much to all of you for the splendid contribution that you have made this morning. It has been very helpful to us. We will wrap up this session at our next meeting on 30 November. The committee will take evidence on sport and physical activity from a panel of stakeholders, but that does conclude the public part of our meeting today. Thank you all.