 Good morning and welcome to the 24th meeting of the Health and Sport Committee in 2017. I ask everyone in the room to ensure that their mobile phones are on silent. It's acceptable to use mobile devices for social media but don't photograph or record proceedings. The first item on our agenda is a second evidence session on technology and innovation in health and social care. We have a cast of thousands today, so we will introduce each other in a moment. If anyone wants to speak or contribute, if they catch my eye or committee teams' eye, we will do our utmost to get everybody in. We want this to be a free-flown discussion, so if you can try to keep your contributions pretty sharp because we have so many people here and we will try to keep it as free-flown as possible. Given the subject matter, I know that some members of the committee wish to declare an interest, and I will begin by declaring an interest in the subject. There is a close member of my family who works in the health technology field. Brian Whittle, director of a collaboration communication platform that includes health service. I declare that I registered with the General Pharmacy to go to council. I will introduce myself and I will go round and people can very briefly introduce themselves. Neil Finlay, chair of the Health and Sport Committee and MSP for the audience. I am Clare Haughey, deputy convener of the Health and Sport Committee and MSP for Brotherhood. I am Brian McKinstry, professor of primary care e-health at the University of Edinburgh and a working general practitioner. My name is Tom Arthur and I am the MSP for Renfishers South. I am Juliette Spiller, consultant in pallidive medicine at the Marie Curie Hospice here in Edinburgh and I am representing the Scottish Partnership for pallidive care. I am Miles Briggs, MSP for Lothian region. I am Rami O'Cash, executive director of strategy and improvement at the Care Inspectorate. I am Alex Cole-Hamilton and I am Lib Dem MSP for Edinburgh West End. I am Stephen Whiston and I am the head of strategic planning and performance for our Garnabug health and social care partnership. I am Jenny Gullruth and I am the MSP for Midfaith Anglin Northus. I am David Chung and I am a consultant in emergency medicine at Crosshassing Kilmarnock and I am the vice president of the Royal College of Emergency Medicine. I am Alison Johnstone, MSP for Lothian. I am Aileen Bryson and I am a practice and policy lead at the Royal Pharmaceutical Society. I am Ivan McKee, MSP for Glasgow Proven. I am Chalyn O'Chwp and the Chief Technology Officer with the Digital Health and Care Institute. I am Brian Whittle, MSP south of Scotland region. I am Maree Todd, MSP for the Highland and Ireland region. I am Maureen Falkin and I am the regional manager of the information commissioners office here in Scotland. Good morning and we are Colin Smyth, MSP for South Scotland. Okay, thank you. We have got around an hour to 75 minutes for the session, so we need to get underway quickly. Colin, do you want to begin? Thanks very much, convener, and welcome to the panel. One of the reasons that the committee decided to carry out an inquiry into technology and innovation in health and social care is the fact that in almost every aspect of our work from healthcare in prisons to speaking to GPs about new models of care there was a huge frustration at the barriers that seem to exist when it comes to patient information sharing across healthcare professionals. Can I just get people's thoughts on why in 2017 do we still have such a wide variation of recording data within the NHS, a complete lack of integration when it comes to the various systems, and why don't we have a single platform for patient information? Easy question, who wants to go first? Can I answer? Yes. Can I attempt to answer that one? Fundamentally, it's historical. When we had the so-called internal market within health, I think that's when all of the unified systems were broken up and became quite disparate. Certainly my own research has been in health prior to joining the information commissioner's office, and that was certainly something that came to the fore when I spoke to health professionals across Scotland. It was trying to bring that back together again. What was the big issue? There tended to be, if that's how Glasgow is doing it, Edinburgh is not going to do it like that attitude in respect of technology, I would say, in that system. No, no, we're not going to use that system, we will use this system. It's trying to bring it back together again. I think that as well as the technological problems that you have, the elephant in the room is data protection. People often look at data protection as being the stumbling block and the obstacle to information sharing. I think that I would just put on record to say that the preamble to the data protection act currently and also the new general data protection regulation that's coming into force on 25 May next year, talks about the protection of personal information, but what a lot of people don't realise, it also says that it's set up to allow for the free movement of personal information. A lot of our work in Scotland, particularly in health, is saying to people, can you share? Yes, you can. Data protection acts a framework for safe and secure sharing of information and not the barrier that a lot of people think it is. Can I echo that? I think that the major issue is IT governance across very certain places. There's marked difference in the interpretation of the regulations from health board to health board. For example, in Lothian we have banned Google Chrome, whereas the rest of the country is still using this. I think we need to have a single IT governance for the whole of Scotland. It's crazy to have all of these different small groups making up their own mind as to what is and isn't acceptable. Yes. That was going to be my answer to that question, which is the distribution of decision making around investment in IT infrastructure is a big issue. If you look at Finnish, Estonian, Galician and other European countries that are progressing quite quickly in these spaces, they have a slightly more authoritarian approach with regard to setting a common standard and having a central voice that says, this is the way we're going to do this. In these countries you see the Prime Minister is chairing the data sharing committees and authority is put in saying, this is the way we're doing this. Is it better that way? I'm sure a play of people would argue either way, but their digital accessibility measures and the benchmarks across Europe are significantly further ahead than the other countries. I think a single IT governance structure is essential for what we need to do in Scotland for eHealth. I would make a plea that we have a significant resource into supporting that with clinical expertise, because what we don't do at the moment is we don't resource clinicians to actually provide their time to support the IT work that happens. We don't do that properly. Most of the work that happens in Scotland that improves IT resources and focuses on what patients need is delivered by patients, carers and clinicians who are doing it in their own time. If you want it done better and quicker, you need to resource people to do it properly and to work together with people who know how to do it in IT, because we have huge amounts of expertise in Scotland particularly around eHealth, IT technology and what can be done. You need the clinicians and the IT experts to work together with patients and carers to make it exactly what people need. Everyone else has said so far, but the material point to me is around that integration of health and social care information and it's great to hear that there should be no bar to sharing appropriate information, read and write access to all, because that's the biggest frustration from all the health and care professionals that I come across and our third sector partners. We want to radically transform health and social care. That's where we've got to address it and we have a plethora of systems at the moment that just piles on frustration, piles on mythology about data protection. We can't do this because of cold cut guardian. I've got to go through this board, that local authorities, data controller, so on and so forth. We set ourselves up to fail because we're tripping up over duplication, so anything we could do to simplify that, I know from my colleagues and the health and care coalface, they've welcomed that with open arms. Do you do stuff to simplify it? We're attempting to, within colleagues made the point, resources that we've got, we're attempting to bring our community nurses on to the same social care system in Argyll yn Bywt. That's taken a long time and a lot of culture and issues, professional issues around that. I look at the new GP contract that's currently being negotiated. I have practised nurses who can access the GP system. I have health visitors who can't. I have district nurses who can't. I have GPs who will share some of that information with social work colleagues. This is just bonkers and it's the biggest frustration we've got, so we are tempted to do that but we have limited resources to put that in place because I'm dealing with just primary care, independent business, social care, local authority system and NHS system. What would it take to get it to where you want it to be? It takes that single type of approach, single governance with a single agency driving it would be my recommendation. Does anybody around the table disagree with that? Nope. Okay. I have a different point that, again, if you're looking at international comparatives, it's not just about health and care. Benefit system, social security, these sorts of things are critical components. So there's a big opportunity to dovetail that kind of work. Okay, Rami. I think the evidence that we've collected suggests that the points that have been made are very much borne out in terms of the interoperability of ICT systems across health and social care. I think it's worth pointing out two things. First, that doesn't prevent effective systems from being put in place to support access to those systems for different professionals and there is some evidence of examples where that's working although I appreciate that that's a workaround rather than a solution to the problem. I suppose the second point relates to what Stephen says which is around the complexity of the health and social care partners that are working so it isn't just ICT systems in use in health boards or indeed within the 31 integration authorities. There are some 4,000 individual service providers for adults across Scotland who are their own organisations that are commissioned by integration authorities but aren't part of integration authorities. So there is a really complex landscape that I think needs to be born in mind when we think about what one system might really look like. David. I would echo everything that's been said. I think whether the reality of the situation or operationally the data protection is considered to be the biggest barrier and who owns the data. So let's say every single GP out of ours system in Scotland cannot access the GP's patient data for those GP's which is just insane. So you go and see a patient and you can't find out anything about that patient that you're going to go and see and therefore you do the safest thing which is probably going to be admit them to hospital whereas they can't even access care. So the question is who owns the data and I would say be more radical, let the patient own their own data. The patients already think we know everything about them. They come to an emergency department and we say oh well and they say oh that's all of my record doctors we don't know what's in your record, we don't know anything. You don't know, they think we're joking, they think we're lazy and we can't look because they're used to every other aspect of their life. Facebook know everything about them, Google know everything about them, they've consented to that data sharing. So we're hamstrung by that. So I'd say if you gave a patient option say do you want to have a smart card with your data on? People might actually say well I'll just take it and I know where my records are and then I can give it to you and you know what my records are and that's what I want to do. Different people are different and resources very much so even on more basic operational levels so there's been good software, been brought in which is good and then various bits of the healthcare system are saying to me well we'd like to have that but we've been told there's no cash fit this year so we've not got a portal for these results. You'll have to go and apply to get the paper notes and it's even a more basic level than development. And the third thing I would say if you're going to bring in a system please engage the front-line clinicians to the extent of just saying what do you want, what do you want it to do because a lot of the existing software has come from another country where its main purpose appears to be to collect data to bill as opposed to do a clinical job to do the best thing for the patient and share information to their benefit. Eileen Bryson, in your submission you talk about pharmacist access to the patient healthcare record would improve patient care by enabling pharmacists to play an even greater role in the provision of safe and effective unscheduled care. I should also say that I've visited a couple of community pharmacies on one with Eileen to see how that can work and sometimes how that data sharing puts a block to what the pharmacist is trying to do. Is anybody aware today or perhaps Eileen, this might be specific to you of areas in which that data sharing is working well and perhaps where other areas can learn from because if we're all agreed here today that you're all agreed that a national standard should be agreed, there must be areas that other parts of the country might be able to look at for best practice? Absolutely, you're quite right. I echo everything that's been said already and I think it's really interesting to hear everybody talking about how disparate it is how piecemeal it is and everybody's saying from the one sheet on that and where we do have it even when it is piecemeal and it's been piloted and tried and yes it is working but sometimes it's very clumsy and it's not smart working if the pharmacist has access to the portal they have to have the patient's permission each time they use it so when most prescribing dispensing is done ahead of time to help with work planning and for patient access that means that if there is a query on a prescription and up to 120 prescriptions could have a query on them maybe 1 in 500 GMC would say it has a clinically significant query or error Felly, mae'n gynhyrchu, a gallai gynhyrch yn gyd-garedd, mae'n gynhyrch ac mae'n gyrgylch i'r'llaeth, gan bach rhai mae'r cyfrifysg y dda i bach arwheddiadau, gyd-garedd o'r llwyddon, mae'n i'r cyfrifysg, ond mae'n gallu gallu yn i bach, ond mae'n wedi gweld cyflيةf aeth fynd ddweud i gael HS24, ond mae'n gweld cyflogaeth ditbyn? Felly mae'n ni'n gallu gael HS24. Mae'n gallu pethau'n gweld cyflogaeth, gallwch ar hyn o dda'r amser, oherwydd mae'n cysylltu eich gweld, ond mae'n gweithio chyfnodau ond mae fod yn gyfgolwydd ddwyllrio, ac mae'n wath o'r lleidiaeth a'r ydymai am hynod hynny o'r dal a chyfnodd adrodd fel nhw. Oherwydd, mae'n gweithio i heb ffwyr o'r gorau am replaiddau cyntafwyddolau. Mae unrhyw am ymgyrchur hwn o ymgyrchwm oherud o'r warfyr edrych oeddefnyddiaeth o hyffredinig from a GP practice and for lots of different reasons. That phone call doesn't come to a lit load lady who is totally distressed when in NHS 24 wanting to know how many tablets she needs to take at six o'clock at night. We can't do anything about that until Monday. Whereas, if we had direct access, we could sort that out and make sure that she gets the right dose, if she doesn't get the right dose she could very well end up in hospital again the next week. It's sometimes difficult to quantify, but the long-term aims and objectives of this, everybody is talking from the same sheet on this one, because there are short-term gains and there are long-term gains and we're missing out on them all. That's the issue. Particularly on the pharmacy issue, I mean I'm struck and I was struck when I was working as a pharmacist, as a hospital pharmacist at the differences within the profession, so community pharmacists have no access to data and hospital pharmacists have access to all of the data, so I could access medical notes, I could access lab results and it makes it impossible actually for community pharmacists to fulfil their obligations of pharmaceutical care. So for example I worked in psychiatry, there was a drug lithium which requires there's an obligation on the community pharmacist to check whether certain tests have been done how on earth can a community pharmacist do that without access to lab results? We have a situation where the same health professional can access different information depending on where they're working, so they're not able to work to access in community but they are able to access it if they're working in the GP practice and we have lots of pharmacists who are working in a hybrid model which seems to be working really really well because you know the patients really well, so everything that the College of Emergency Medicine said about out of hours is particularly where it falls down, so it is for continuity of care and there are patient safety issues and we've got lots of examples of where we could be putting patients at risk because of their monitoring of high risk medicines and not everybody having access to that information and that includes social care where we've had examples of lots of going around the houses to get information from social care which if we'd had at our fingertips would have helped going into a domiciliary visit, so small piecemeal things which together actually mean we're not getting the impetus and the traction that we need. Other people want to comment, Juliet? We'll come back to you. Thank you. It was really just to focus, you'd mentioned the out of hours issue earlier and I think certainly when you're looking at care of patients with complex conditions, long-term conditions and particularly patients with terminal illness, out of hours care, we know that's where it often falls down and one of the great things that we have achieved in Scotland is that we have the information summary which is a once for Scotland approach to out of hours emergency information and it's heartening that that is in place but we need to use it better. Now there are lots of pockets of expertise where clinicians and teams and patients and carers have done workarounds but nobody has time to pick their head up and look at what other people are doing and nobody has time to take their local practice and make it more widely known so again somebody with the overview to do that, to look at local practice and see oh that's working really well, I wonder if that would work in different health boards so you end up with lots of different areas of local practice and very disparate effects and one of the things that we know is that patients who have a terminal illness and die absolutely need to kiss and that's one of the visions for the Scottish Government is that by 2021 every patient who would benefit from a kiss in Scotland will have one. Now we know from the figures that Marrakeery has collected that we're just at about half of the patients who died in Scotland last year who had pallid of care need had a kiss in place so we're getting there but we're very far short of the mark but we also don't know what the quality of that kiss information is and when you look at secondary care when the patient hits the front door how many of those clinicians actually know that a kiss exists, know how to access it and actually make use of that information and quality improvement work that we did in West Lothian showed that of the patients who had a kiss only 4% of those that kiss information was accessed when they hit the front door of the acute hospital quality improvement work can improve that but all of all of these projects are happening right across Scotland and nobody's pulling it all together and that's a system that we have in place that could work dramatically well to change patient care now overnight if we actually resorted it and did it properly and that's not to mention what we need for the future so kiss is fine but we have pushed it as far as we can for the complex level of advanced decision making that we need to meet patients needs for the future in Scotland we need something much for sophisticated and much more accessible following on from that one of the main reasons that this isn't done is because the systems are so hard to use and so difficult and general practice systems are not fit for purpose i think is the single biggest complaint in general practice across the country we're dealing with windows xp we're dealing with internet explorer six it takes ages to do anything and actually completing the kiss is difficult because it's you have to go several different screens in order to do it is very very hard sending messages to to pharmacists i sit and watch this hourglass when i do my repeat prescribing i do write a prescription for five prescriptions and i sit hourglass sitting in front of me all over the country there are gps and nurses looking at this hourglass waiting for it to clear so they can do the next prescription it's disgraceful we are working with a four megabyte download speed a point four megabyte upload speed how many of you would accept that in your own houses nobody would and yet we are working with that day in and day out on the back of that what then i suppose the key question is what's been done about it are we seeing progress in this because you know we've only been in here 20 minutes and we get the picture we certainly get the picture and i'm glad you've said it like you have because that's what we need to hear so what's been done davis things are better in an issue where i work we only got portal in the last 12 months classical had it phases before but now we've got it in an emerged department situation it is invaluable and having the most up-to-date let's say clinicians opinions having access to ecs and kiss there as well it works it's much much faster and that's better so that's something a system which has shown some promise to give clinicians some of what they want and hasn't taken in any reasonably easy to use and thinking about well how do that and has everywhere got it that needs it because not everywhere has which systems have we got that people are happy with like you say okay and can we roll them out as soon as possible to also get people believing in it because everybody thinks i can't be bothered with another failed it thing i can't you know but where should i invest my effort in this because they're all rubbish and i just get told to use them and i don't want to so there's a cultural um sort of bias to overcome and if we think well these places you know use best practice and say can we make it happen somewhere make it happen as many places as possible and people will start to go do you know what actually that's all right i can see why i might i might invest some time and do a bit of training and other sorts of things in this extremely ad hoc extremely ad hoc why why where are the national programmes of rollout of successful integrated systems is there a plan when we speak to the some of the civil servants that come in and these they kind of shrug their shoulders and say things take time i think you might have hit the nail on the head there isn't a national programme it's a local places to have and everybody's got different priorities one chief exec might say the money is the bottom line another chief executive go this patient safety issues the bottom line and they're going to do trim themselves accordingly okay i've got a large number of people who want to come in on a number of issues here um i've got alex claire allison charlenor and ivan so far on this issue ivan yeah if you can indicate if it's on this issue then we'll go with that first ivan yeah it was basically just following up on on your question convener i suppose i've been interested to know what people think need to be done to move this forward because you're right we're hearing the consensus that it needs to be more horrible word for politician to use it more centralized um and um but it's how do we get from where we are to where we need to be does it require legislation does it require reorganisation does it require government to do something pulling stuff back to the centre does it require direction and resources what needs to happen to get from where we are to where everybody i think agrees we need to be charlenor so that point was linked to that i'm just going to represent some of our kind of global market analysis work that we do as a part of our day job and so if you have me talking about some other countries that's kind of why i'm here um if i was to reflect on some of these other countries and you know people will say one way or another for estonia in finland they did different in some ways similar on others but there's a there's some common things that they do um the first one is that's information sharing is not an it issue yeah it is a fundamental service design issue so it is not something that it managers can get together and fix and so when you actually see the people involved in creating the solutions for that uh they are a very mixed bag of people and they have as i said the very highest level of political mandate and leadership uh of someone saying this is the way it's going to happen um the second thing they do is they uh have a similar thing to scotland's kind of once for scotland's kind of thought process but they don't let that turn into a national it project where everything is created centrally distant from the use case uh you know and they construct it in isolation which is what we've seen in the UK a few times uh what they do is they instead say well what tools can we put in place what standards can we put in place and then can we enforce some of those things such that everyone is in the same playground playing with the same toys uh so that at least when people make diverse choices at the point of care because they're going to need to you need to satisfy clinical and patient requirements um you can do that in a way that at least attaches to a spine and that spine is consistent and and mandated and there is no choice but to to to aggregate that spine so those are the two main things that the countries that are leapfrogging ahead seem to do so for a technophobe like me that's a central system that you plug into with different elements that all coordinate through that central system yeah so so there is no there is no system there is no one package there is no one software solution that will do this by any stretch of the imagination and any thought process that you can create that is complete folly there are tens of thousands of use cases with tens of thousands of interfaces for different someone living with ms completely different someone living with the diabetes etc you have to respect that but what you can do is for example we talked about personally held data or the citizen having their own data there is no vehicle by which a citizen can hold their own data so someone a governmental role would be how does a citizen hold the version of their record right we can put in place something that allows them to do that that is open that allows a citizen to consent to the sharing of that data whenever they want to uh but doesn't um require them to use a specific interface based on a central government program so you can put in a lot of the enablers without necessarily mandating a very specific experience i'm pretending i know what you're talking about yeah i suspect there's a few others around the table the same um i think i do actually get the three so once the scottan doesn't necessarily mean one software system that everyone is forced to use yeah okay juliet so some of the things that have been happening over the last few years around uh palette of end of life care and anticipatory care planning have been quite exciting and i think what i would like to see is is a scottish government valuing strong clinical leadership to take the recommendations of a number of government commissions to find out what's happening and and and recommendations that come off those commissions and and actually then roll that out in a better clinical practice because that's the bit that we don't resource so we resource the commissions we resource the it know how to do that sometimes although it's usually very squeezed um but once those commissions finish sometimes nothing happens you know we end up with a report so for example i've been asking for two years for somebody to work out why all of the independent scottish hospices in scotland cannot link with nhsit systems they all now have rolled out their own electronic patient record systems they are all slightly different some of them use the same system some of them use different systems none of them can link directly from within that patient record to nhsit systems bunkers so i have been asking for two years for the scottish government to find out why that's happening and find out what's needed needed to sort it and they have just agreed a commission to do that what i am terrified of is that that commission will find out what the problems are and then nothing will happen off the back of that so we need very strong clinical leadership to make sure that that commission results in action now you can't tell independent hospices what to do but you can set standards and you can say this is recommendation and and you can make it in in their best interest everybody wants to provide good patient care everybody wants to do that as efficiently and effectively as possible so if you provide them with with the resources to to do that and the IT support to do that nhsit should be supporting independent hospices and care homes and social carers to access nhsit systems and the initial bit is finding out why it doesn't happen but the next bit is the more important bit and you need really strong resourced clinical leadership to make that happen a number of reports like this sitting on desks somewhere that say you have to do this in order to take this agenda forward they recommend yeah and we recommend you do x y and z but they are sitting in a civil servants cupboard somewhere or on a on a civil servants computer system could be when no action is happening is that is that too general or is that what's happening steven general i think it does come back to priorities and the number of priorities across health and social care is vast and absolutely that point about mandating what we have to do to share information to make it happen the assumptions that are made by our by our community our users that say well precisely that example i expect you to know this about me why am i pitching up here and you're asking me the same question for the 15th time why aren't we doing that and it's because we're not mandated to share the information taking absolutely account of that that the information governance is not an issue we can be addressed that it's it's topic because we're not mandated we're not told directed to do it by who should but by it's a number of agencies but there's no there's no policy trickling down that says you must share this information for the best interests of your client and user because it is in this myth of actually we can't do that because it's a huge data protection you demanded that you said we need this from you know government from whoever the health boards from i'll give you a little example we're working hard in a garland butte to integrate our gp out of ours community hospital acute services daytime care services with our out of our services and i have a number of practices who look at their out of ours records and say actually i need that vision record but i'm not you're not in my practice and i'm covering the service for you share that with me because i'm admitting your patient into your local community hospital they'll come back and they'll say well actually you know i might be able to give you a read access or but you know i'm not sure if i can do that i've got to go with my cul-de-cote guy and the clinicians just fall away why because there are independent practices with their own independent requirements for cul-de-cote guardianship so are they not allowed and are they not allowed to do that be a real sit down by i don't know statutory information commissioner guidance or whatever it's the way in which the the nhs is set up in with regard to gp practices is that gp practices are formally data controllers that makes them the legal entity for the personal information that they're using processing in in any shape manner or form the problem is that because they are data controllers there's nothing within the data protection act that compels anyone to give any information out other than an order of the court so it's for them to be satisfied that they can do whatever it is they're being asked to do and it's it's our experience in the information commissioner's office that by and large from the gp practices when we're out and about talking to people about integration of health and social care we're talking about can i say the named person and not be struck down the name person issues and we're saying to people well you can you can share it's it's about proportionate sharing it's appropriate sharing to the appropriate person and then looking to the data protection framework to allow you to do that and too often that is either seen as too hard and and people don't understand it you know it's consent is seen as the be all and end all that if i don't have your consent i can't do anything with this information and i can't share it and it couldn't be further from the truth so therefore between what you've said and what you've said if you two speak to each other after this you can sort it the well we could sort it for us but the problem is i would need to speak to every single to encourage you to do that because that's that's one tick we can put against our session today but seriously because if people don't speak to each other we wouldn't resolve these problems right i mean one of the main reasons that people are risk averse okay that's the main reason they don't understand the act they haven't got time to find out about the act and so they'll they'll default to what they think is safest okay and so that's why people are worried about sharing data and when you say it's okay if it's appropriate well what's appropriate these people are worried about what's been slapped with a 10 000 pound fine or something for having revealed information that they shouldn't have revealed and i know that the likelihood of that is very very small but you're talking about people who can choose one way or another which safest thing to do and they'll choose the safest thing to do in some ways it would be better if gps were not the data controllers that there was one data controller for the whole nhs and that would be so much better i think that an abundance of people here is aware a minute though allison is your point another point or you've been waiting very patiently for a long time is on the question of access to data so i think it is connected definitely i'll probably direct my questions to Maureen you know you suggest in your evidence and i think from what i've been hearing this is all about appropriate and proportional access to data because there must be some concerns i can hear what dr Chung is saying about should the patient be in control of if their own data and who has access to it i just wonder if there's any i suppose patients would have to be very well versed in the implications and i suppose safety around that you know imagine if you know commercial interests got their hand on some of this this data the impacts of that could be quite devastating so i just wonder you know what your views are on making sure that that access is proportionate because you mentioned in your evidence the fact that sometimes counsellors and you know non-medical professionals have access to patient data because of partnerships with a third sector for example you know how do we make sure that that the data is never accessed by those who shouldn't have access to it well i suppose that kind of speaks to what brine was saying that very often gp practices are just they're scared they they're not being i i do not believe anyone is deliberately obstructive i think people are genuinely scared and as you say risk averse and therefore the safest thing to do is just not not to share it i'll just hold on to all but i would say that the this idea of whether gps are our data controllers is currently being looked at by scotish government and we are working with scotish government on that because the way in which you determine who is a data controller is fundamentally down to who determines the purpose and who determines the manner of processing now that there's a lot to say that the health board via the regulations that sit around the gp practices have got a lot to say about the purpose and the manner of process they've absolutely got everything to say about the manner of processing a gp under the nhs can only process data using an it system that has been provided or sanctioned i say by scotish government so that's why currently it's either emiss or vision and if they want to use paper records then they can only use the type of form that the health board has determined that they can use so there's a lot to say that you're quite right the gp practice is taking on the data controllership responsibilities and liabilities for a lot of things that they actually don't have any meaningful control over so that it's being looked at to see whether the health board should actually be taking some of that control and liability and responsibility for the gp patient record as well that's what being looked at means in terms of a time line well the gp contract brian you can maybe correct me if i'm on the gp contracts in november so the working group has got to be reporting soon in order to be able to feed that into the kind of timetable of a green the gp contract so this month okay clear thank you can be in that thank you panel for coming on see i just wanted to pick up and i suppose it's a query on something that professor mckinstry said and it's been partly answered by more informed it was about gp it systems because you were quite vocal about the difficulties that gp it systems have who is it that owns those gp it systems individual health boards on those systems they bought them yeah so the gps don't own those systems and in terms of the actual set of i suppose the connectivity to the web and you're talking about how quickly it downloads and i'm as as as a little bit as mr finley when it comes to to it it's a it's in terms of of accessing internet and so on who's responsibility is it for for that part of the system again it's the individual health boards that these if you're using your own system i mean a lot of gps have given up in this long ago and they use 4g on their phone when they want to look up something say on you know we want to find out about an illness or something because it is just so slow it is quicker to do use your own phone on 3g or 4g to get this information for example we tried to introduce video consulting in lodian and we had to actually put in separate it systems into each of these practices because video could not run on the systems that we have at the moment so on the actual set broadband that they're accessing so the broadband that we access runs at very very slow speeds you can do it but we um it's it's very very clunky indeed you would never put up with it in any other sphere okay and is there an option for gps to upgrade that the way no you might do not not within the nhs so at the moment if i wanted a faster speed in my surgery i couldn't get it at the moment so um the only way i could do that is to purchase a separate broadband system myself which would not be linked to the nhs that would be the only way and can i just on and this is a specific question because it's an issue that i've come up against my constituency work about a a GP practice which doesn't have a an email system apparently so we can email is that something that you've come across in terms of gps not accessing what what most of us would be used to is as an everyday technology okay so um we actually surveyed practices throughout the UK on their use of email and only a very small minority of gps actually use email and a tiny proportion use it regularly there are two reasons for that one is most health boards um certainly some health boards do not permit general practitioners or doctors of any kind to use email for clinical reasons because they do not regard it as secure okay the second reason is that doctors are very worried about the possible workload implications of setting up emails such as email services because they are worried they will be swamped with requests and that's genuine that's what we find in our survey requests for what information they would have to reply to i mean the problem is you were talking about a system that is already and we all know this that is bursting at the seams and general practitioners are not looking for any more work at the moment i wasn't suggesting that me and give them more work i'm just it means then that instead of emailing them we then have to write to them so it doesn't reduce the work actually increases the workload because and increases the time that takes the information to be sought i know this sounds like a terrible thing to say but it's a lot harder to send a letter than to send an email very interesting thank you i do thank you for being straight up on that and i think that raises a number of interesting points as well um sorry alex thanks for coming to see us today just as a book ends that discussion i would like to make a direct request to dr spiller that she liais with clerks as to what government or other commission recommendations are sitting in civil service drawers so that we as a committee might cross examine that and interrogate the Scottish government as to what they know or what they've had recommended to them over the course of the last few years and what we might use to implement to make this practice better it strikes me that in particularly in the case of community pharmacists i've done a lot of work with aileen that that actually there is a solution to a much broader crisis that we have in terms of staffing in our gp sector in the sense that our gps are on their knees at the moment in terms of workload and capacity and the community pharmacists could provide much of the solution there in terms of some of the prescribing work that they could do better enhance if they had ready access to patient records so just as a book and comment on that my question if i can take the discussion on to a another aspect of innovation and technology in health and social care around this time last year i had a constituent who had spent several hundred days in hospital beyond the point at which they were declared fit to go home because there was not an adequate social care package available for them in the community that was 400 pounds a night it was costing nhs lothian to retain that patient in well in a state of positive health in a hospital where they didn't need to be because there wasn't means to give that patient a bed check at night to to check for incontinence i spoke to the chair of the integrated joint board and as soon as i alerted it with to them he said well there were technologies available that could actually perform that that late night check without the need of having to employ a member of staff to come in and i love the i love that we have technology like that but i'm very concerned that if we can't get the basic it right as we've just discussed in respect of information sharing and the cross fertilisation of different it systems how close are we to being able to roll out a technology like that which was finally offered to my constituent before they were allowed to go home who would like to start us off shanna so i mean maybe i'll raise a slightly different example but you can read across and maybe one that brian is very familiar with around blood pressure monitoring remote blood pressure monitoring um if you take the sheen i think it's three in seven practice nurse appointments involves blood pressure checkups yes every year in scotland for nothing but blood pressure checks so now what we're talking about here is that we have the devices okay we've long had devices that medically regulated that anyone could use with a very small amount of training that could automatically upload those readings into nhs systems from anywhere so brian's done a whole bunch of work and we you know a lot has been pushing hard on this very very simple thing for about 10 years yeah and how many people in scotland are using this remotely well it's just starting to take off actually we've got 1300 people in lodi and now using this technology and we're hoping this is going to rise sharply it finally seems to have taken off at long last but the issues are fundamentally do we trust the patient to collect something about themselves and contribute that into the system and the answer is we don't well so you know at a system level patients are much better at checking blood pressure than doctors and nurses but but that's but that's the truth they are much better than doctors and nurses a check but that ever just isn't reflected in our cultural approach to that premise and so equivalently the technology is there to do all sorts of things like this we just don't for some reason at a system level place trust in a citizen to be able to do these things and soon as the data comes from out with our control immediately it's suspect immediately integrity of it is low um so a lot of the data protection changes and a lot of the trust measures that are in those things actually are an enabler for these sorts of things I'll just write it quickly a lot of a lot of a lot of this is the systems behind the collecting the data and there are ways of doing this and systems using Lodian collects it and sends it by a doc man which is the usual way that gps get their lab results and their hospital letters and this sort of thing it's been extremely unpopular general practitioners something like 40% of GP practices and Lodian have taken this up and there are others looking for it so if it's if you get the formula correct then people will will take this up I think I guess points at what stage do we say you know I'm just just to be facetious here by 2022 we will not be having routine blood pressure checks in a GP office because at some point someone has to say that's not good enough and put something in place that says by a certain date everyone has to adopt this we need a hate target or something said but it's not just about not trusting citizens of their own blood pressure nobody trusts anybody else with the data and the other health professionals so the duplication which is in the system routinely is horrendous and that's what we say about working smarter so yes we need lots of extra resource for these big IT projects which are the enablers of the culture but there's lots of things which we can be doing within what we've got already and we don't make use of that sorry Rami I meant to bring you in earlier as the point past story at the point past okay thank you sorry about that Steven telecare you should give example of telecare rather than telehealth applications and certainly the technology enabled care initiative has I think driven some a lot of that aspect forward and and there's now 1800 people in Argyll and Bute who are using telecare systems to help that type of thing to keep people independent and at home I suppose the material issue about it is that's a funding stream that's going to come to an end this year and how has that to be embedded nationally took to go forward equally it's using and this is where I become a bit of a luddite analog technology rather than digital so there's a big transformational cost to shift it onto the digital platforms which is key because then people then we then we are able to link health and care information together and responses and that supports very much community resilience going forward so the responder to that sort of example you gave there could well be a neighbour who can help in that way because they've been trained and supported in that partnership environment or a voluntary agency not necessarily a health professional or even a care professional at that point because it's it's somebody working within their community neighborhood responses so the telecare aspect is is one of those really big material wins to help us manage demand on the service colleagues already flagged the demand we're creaking on our services unless we radically transform the way we deliver services and I get your point Brian about email traffic into primary care but to be honest if we don't change the way we deliver and operate our services we can't even offer people online appointments yet you can get them I don't need to say do I we can get them everywhere else why can't we do that because our colleagues at the front line are on their knees and worried about that change so that's a mandated change and we have to radically change that and I have seen small small evidence of that happening I've seen practices actually using the telephone system to provide the first line of response triage that workout redirect the calls differently but that's only telephone actually video conferencing consultations we don't culturally grab that and the material issue to me is why don't we do that because we don't train the people who are coming through the system in what technology can bring we expect people almost by osmosis to understand how it can be used and applied and that's where we're going to fail if we don't pick up the pace on that in the next three or four years and give our clinical colleagues space to do that I think that's an important point I mean the evidence that we've collected from our joint inspections of health and social care partnerships over the last number of years suggests that the investment in telehealth and telecare has had very positive impacts for people particularly managing risk for frail older people supporting them to live independently at home and also bringing some peace of mind to those people their carers and their loved ones which is important but the pace of change is not being consistent in all parts of Scotland so there are partnerships where that pace of change has accelerated much more rapidly that may in part relate to the point that Mr Cole Hamilton made a moment ago it is worth saying around the pace of change around the digital world and technology is reflected in the new health and social care standards which were published in June which set out the expectation that people will benefit from technology which may be able to support them to live independently so whilst I appreciate that publishing a set of standards doesn't ensure that everyone experiences care that's consistent with those standards it is an important policy driver at partnerships thinking about how they will put in place measures to support people to live independently at home when they can do so and when they want to. Alex Henry Thank you convener I'm really struck by the answers to my question I had a fascinating afternoon with Dr Chung and his colleagues at the Royal College of Emergency Medicine who opened my eyes to the fact that problems in A&E targets and no not a result of an inadequacy in our emergency departments but in fact an interruption in flow throughout the health service caused by the fact there is not adequate social care provision in our communities which means that people are staying in a hospital for longer and it means it's impossible then for doctors in A&E to admit patients to the wider hospital because there are no availability of beds if social care is the weak link in this chain which I think we all are all agreed that it is then I'm astonished to hear Stephen Weston talk about funding coming to an end for the roll out of social care I'm also astonished to hear a challenge to talk about there being a cultural resistance to trusting patients and trusting the technology around this and I want to ask the panel how do we get past both of those things is this is this something that we need to take on as a parliament is there do we need to mandate health boards better on this and is this a piece of legislation Sean? I'm rambling on about this but yes there are very tangible things you can do if you can learn from other countries in this space the first one is a technical one and I'll not get into the depths of it but in some of these other countries they have a principle of creating data once okay so what they say is you can have your own database you can have your own system you can have your own software package you can have this huge diversity as long as you share it into a central bridge and there's one bridge and everyone has to connect to that bridge and that's a that's a technical solution that is entirely feasible now that's the spine you were describing earlier so in Estonia it's called x-road digital health London has done it across all the trusts across London and so that's that's coming to being now it's one bridge that everyone connects to including the patient who can connect to it see who is looking at their data withdraw consent if they feel someone is misusing their data or not in line with their wishes so that's your patient empowerment that's your citizen rights that's your data protection win so that bridge is a very technical piece but that's the leadership that says someone needs to say here is the it plan which says there is going to be this bridge okay everyone has to connect to that bridge but everyone can have their own stuff and we're not going to try and control every single thing you do as long as you connect to the bridge and that's where the standards are set so that's the the technical requirement to get all these different things speaking to each other one bridge and that's not a health and care bridge in Estonia it's a banking a post office a benefits as soon as as soon as they did health and care everyone wanted it because all of a sudden you're under fill informs every single time you want to do anything all of a sudden you're not having to agree one organisation to another organisation two years of information governance wrangling to get data shared between the two because everyone just connects to one thing right so so that that is the solution that these countries are rolling in you mentioned digital health London how much does a spine like that cost so it's in Estonia it was three million pounds is that all yeah so it's not about the tech no i mean i i colleagues laughing but you know i'm looking at other it systems that this government has employed to failure and they've cost significantly more than that interoperability is not a technical issue interoperability is a political organisational semantic and then technical issue that that that last bit at the end is actually the easiest bit it's it's agreeing the common definitions that everyone's going to work to so when we say blood pressure ever understands what we mean by blood when we say paramedic everyone understands if you if you agree all these things the technical bit is the easy bit um so so it's the political drive in these other countries that has done this and then the technical solutions follow very quickly once you agree those those those those other ways it's why there's so many it projects fail i could rant for a long time about that i'm not sure you want to maybe i shouldn't ask you answer that it just seems if it's also easy why does it end up such a complete bloody mess but anyway um scratch as opposed to well some legacy well no so the estonian system sacrifice the finish system had all the same legacy systems we have and they've done the same thing and the galeasian systems doing the same and in in holland as well mary i don't know if i was the only one around the table who was shocked to think that gps might not use email at all i presume you mean gps don't use email to communicate directly with patients that's all i want they can all use email that's all i wanted to clarify no they just that they don't use it to communicate routinely with patients and i think the major issue is a concern about overwhelming the only cost to seeing a doctor is the difficulty in making an appointment and if you lower the cost then you will increase the workload that's simple economics simple is that thank you convener and good morning there has been a much discussion about the relatively better performance and e-health of many of our european partners um and i was intrigued to learn that the european commission has been consulting on uh how we can promote and further integrate e-health across europe and particularly um potential for cross-border communication um and that strikes me very interesting particularly with relation to the e-hit card but of course we are in a kind of situation when there was a great deal of uncertainty regarding brexit i just specifically on the opportunities um that could be missed um as a consequence of brexit for further integration i would be keen to hear some comments and then more generally what guests believe are the potential risks that brexit poses to the further development of e-health in scotland who would like to go first i can mention certainly on the research side um if you look at uh for example there's a call coming out for 2020 um looking at scaling up blood pressures absolutely up our street scotland already leads the whole of europe in this i would regard debt generally and we could really do this but the big concern a lot of people have now is that despite the fact that we are allowed to apply for these things that european partners are wary about taking on uk partners because they think that that might reduce their chances of getting funded is that something you've experienced already we don't know we'd like to think the reason we're not getting funded is that and not not just because our applications are very good brexit will not make any difference i'm afraid for data protection just in case anyone thinks so that'll be out the window once uh want to be um the general data protection regulation will be transposed into uk legislation um and so long as we want to continue to trade with europe and if that trade involves the the sharing of personal information we will have to have a data protection regime on a par with europe so it will continue just in case anybody thought that was going away i guess the point with these new data sharing norms that's starting to pop up around europe is that our companies will not be able to take advantage of those markets if we don't do similar things um and so uh you know i say this because estonia gets a lot of press because uh they have created a little cottage cottage industry where they are giving out estonia will give you their x-road system for free it's it's an open source you can literally go onto their website download everything you need about it and we can build their own without paying them anything because they've got hundreds of SMEs that then will then offer services to us to say we know exactly how to optimise the clinical systems on the back of these sorts of bridges um and that's their tactic you know um so there's a so there's something in here that says this um in a brexit a post brexit situation uh if we allow ourselves diverged technically from the rest of the market then the stuff we're selling won't be that interesting to the rest of the market um so the risk then okay if i can just clarify if the european union of 27 moved to water situation where there is greater interoperability between various systems would that be the case then that for eu nationals of one country traveling on another there if they required medical treatment that could be provided with greater effectiveness and efficacy than for countries who are out with that integrated system really is um a story of an american lady who wanted to access uh she didn't have a medication and asked her pharmacist if they could help the names are all completely different and different doses all sorts of things um and she just said do you have access to the internet which all of our pharmacies do not have either and and they with her password he this pharmacist could then access her medical information including her hospital records or consultant notes absolutely everything that was necessary to find out what medication she was on and actually give her continuity of care that sounds very simplistic you say it like that but that's not in the european union so on that consultation we thought actually going back to some of the comments that have been made we have so many issues at home trying to get interoperability between our own systems that we didn't actually look at addressing that it's too big a question for us as an organisation but obviously it can be done i would have thought something as simple as access to the internet would have been part of your pharmacy license to operate a pharmacy so how does a how does a pharmacist then keep up with the latest information regarding pharmacy issues they would do that outside working hours they won't have time during a normal working day when they run off their feet in a community pharmacy to actually be keeping up to date and downtime to do that but is that an expectation that that we have on pharmacists that you will do that in your spare time of course of course yes we have a continue professional development that has to be done i find that unacceptable personally i find that unacceptable not having access to the intimate net obviously will hamper certain IT enablers and you know some premises will have it and some premises don't and that's a corporate decision not to let their staff have access to the internet which means it's a bit like the email situation with the doctors it's a stumbling block for certain things depending on what IT solutions are being thought of so if someone presented with a condition they can't look up and find out the latest information not on the internet in some places but they should have that information anyway it's not going to be an issue on a day-to-day practice basis that that's not going to be an issue but some systems would work through the internet to allow you access to health board information or various other sites and you can't access that on a day-to-day basis yeah Ivan you want you to come in yeah people might not be able to answer this question and it may be you want to take it away and come back with some data or point us in a direction where there is some data but we've talked about a number of examples where the lack of joined up IT systems causes difficulties for patients in terms of the service levels but clearly there's cost impacts there as well and we talked about 1.2 million blood pressure readings that could be done at home and uploaded and that obviously much reduces the amount of resource that's required within the practice etc so it's just if anybody had any examples or was aware of any research on potential cost or efficiency savings that are there to be had by us joining up IT in a better way and that might be savings today or it might be that we don't need as much resource as we otherwise would have needed in the future the use of technology would be for example in diabetes scotland has got a marvellous system called sky diabetes where all information is uploaded centrally twice a day from general practitioners podiatrists all over the country and so there's a single record kept this has had a dramatic effect in some areas for example on the diabetic foot and amputations have dropped dramatically over the last few years and it's considered that this is at least in part due to the fact that this is a very joined up system in diabetes. Yeah I suppose I'll look for some numbers on this as in how much money it saves us. Well I couldn't tell you. Yeah that's yeah. I've got a number for a european example but again the Estonian example but their economic analysis basically says that they as a population of 1.2 million people through having that bridge and avoiding duplication of data sharing and data input save 800 years of effort every year for 1.2 million people. We spend 100 years just booting up the computers in general practice. So I'm not sure what that would translate to in in in pound signs but you know we're talking huge administrative savings to be made for you know huge staff staffing budgets associated with just repeating the same processes over and over and over again. I think that's the material point. It's the productivity gains for our staff reducing the burden of work on our staff. David gave an example of how long he's got to wait in his team to find information or make a decision which is not based on all that information being in front of that clinician and I know from our staff that they're repeating assessments, they're repeating things and it's just a waste of their time and there's such a frustration to the patient or the client at the other end of because you've asked me this question already well it wasn't me but I just need to check because it's not on my system. We would free up so much resource in our staff in time term so I'm not surprised at the the years level that you talk about it would be that factor and remember we've got an increasing demand so how are we working more efficiently to cope with that demand at the moment? We're burdening our staff with systems that don't done that. I suppose I'm just trying to dig down as anybody any actual numbers on this because at the end of the day that's what we need to look at. Not numbers as such but there was a small study done in England on 140 community pharmacists who got access to records and about 92% of them said they used them to stop signposting a patient to somewhere else 56% of that was to a GP appointment so all of those GP appointments were immediately saved so I think that's what I was getting at on the productivity. There was just 1% going to A&E and 22% going to out of hours so it's the impact on out of hours in GP so again it's the duplication that we've all talked about down the line. One actual, so Nesta did a study of this when you give a citizen the ability to contribute more actively into co-management of care and they did us a kind of literature review of all the different studies around that and on average it's a 7% saving with regards to outpatient primary care and intermediate care solutions just by giving the citizen a more active role. I know question because we really are pressed for thing. Thank you. What seems to be described here as a disparate IT systems under quite a bit of stress and what seems to happen within these sort of outdated systems is we upgrade them by bolting on software and the sort of degrading of that effectiveness for systems that are not designed for current requirements in health so I suppose the question to finish up is do we continue along that line or do we establish a bill protocol with sort of sustainability and you know scalability and start again? There you go. I'll tell you what we'll do then. Given we're nearly finished if we maybe just go do a round table of the guests today just go round and you can have your say as for your last 30 seconds or minute and I'll go round up then you can maybe address that but some of your wider asks of what you think the main things that we should be reporting back in terms of our committee report on this topic. So we'll start at this side. I think for me obviously it's the apparent obstruction that data protection seems to cause and I think a lot is down to, I mean you spoke about disparate systems and bolting things on and the government policy that comes down tends to be the same, it's a bit disparate. So when we're called in to assist from a data protection perspective then very often right hands don't know what left hands are doing in terms of that policy within health in particular I'm thinking and one of my biggest concerns has been that you have this information sharing project or initiative and you have this integration initiative happening over here and the public don't get it, the public are not being engaged as a whole and so all that the public see is all the disparate bits happening and then all of a sudden they feel my information is out there that we took a call from a member of the public in relation to the SPIR project, the extraction of data from GP records. We sat on the steering group for that, an excellent privacy impact assessment was done for it but this fell down because this member of the public went along to the GP practice, looked at a poster and missed all of the public information campaigns, looked at a poster, contacted that telephone number and didn't get the answers that he should have got from that telephone number and instead fortunately because I had been involved in it I was able to say get on to the website, look at this, this is how it works, look at the privacy impact assessment and talk him down off the ceiling as a result and for anything that's going to happen in an integrated way sadly whilst everybody in here can see the benefit of it the public don't often, all they see is big brother and so if anything is going to happen for me what has to accompany that is the public engagement alongside it. I agree with that and I think my kind of summary would be share data once so that as a principle create data once sorry as a principle and then reuse it many times that bridge concept is seems to be critical in the progressing countries. I think that GDPR data production is an opportunity not a barrier which is to say that if you want to centre care on the citizen then why are we balking at the idea that they have some sort of consent based authority in the system so that that's an enabler because then when that person takes their record to the pharmacy the pharmacy can just look at the person's own record that they hold and share it in that way rather than but a disparate system of back office systems that try and connect to each other and try and exclude the patient. Eileen? Yeah absolutely I think so with your solutions with Bridger. Great this sounds really really good but I think you need to look at consent in more detail because we don't actually have an overall system for consent and I understand that information commissioners submission and the concerns around that patients expect it to be confidential and the governance is really important but patients expect healthcare professionals to have the information that they need to treat them so we don't have a system we have implicit consent we have some explicitly have gaps all over the NHS which stop the system running smoothly and I think the patients need to own a lot more of that and going back to what was said earlier really important that we do design the new systems that it's the patients, the public and the practitioners that are all involved in that and not just the IT specialists. David? Pretty much the same so enable a framework that's probably part legislative part technical so that data can be shared through consent so a patient say why I'm signing up to receiving care social care healthcare whatever as part of that bargain really explained to me that these information is going to be shared and I'm going to give my agreement in advance because trying to do it when somebody is unwell and going to say do you have your consent for this this this this and this is absolutely not the time to do it it's proven they can't give consent then legally so it needs to be done before. Okay Stephen? I would echo exactly what Aileen and David said is the key bits for me but I would also say that we absolutely have to step up our mark about the training and cultural requirements to support our professional clinical colleagues at the front line at the moment they struggle with understanding what the transformation agenda can bring if we're going to embed this and make it drive forward we need to bring that to the full. We've talked a lot about information sharing and systems used by professionals to share information and that's important but it's only one part of technology and digital health and care and I think it's important not to forget the many emerging sometimes quite simple technologies which are able to support people directly to either live in their own homes or to live in residential care homes and the evidence that we've obtained around that suggests that there's some really quite small simple interventions which allow people to live well, live independently and live with a real sense of wellbeing and fulfilment and technology can play a big role in that so information sharing is important but it's not the only part of what we need to do. I agree digital healthcare literacy not just for patients and carers but also for staff and social carers is absolutely crucial moving forward I would make a plea for a once for Scotland approach to emergency anticipatory care planning communication of information because we have a real opportunity I'm engaged with a UK wide project at the moment looking at exactly that and the Scottish government is is engaging with that work and it has in fact resourced some of the work to look at setting the standards and developing a clinical archetype that would work with the spine exactly in the way that you're talking about but that would be a UK wide approach to accessing the kind of information that makes a difference to the patient at three in the morning when they don't want to be admitted to hospital or they do want to be admitted to hospital and know exactly the kind of care that they want but in the crisis are unable to say what they want so so that's a huge opportunity and that's one that we absolutely need to resource and engage with. Rationalise IT governance, boost bandwidth, improve GP systems and promote telehealth. Okay thank you very much it's been a very interesting session this morning I might thank everybody for coming could I finally invite I think it's morning and Stephen to go for a cup of coffee and sort out that issue and and I'm saying that in all seriousness and report back to us how you go on and trying to resolve that issue that emerges this morning okay we'll suspend briefly to change the panel thank you the second the second item on the agenda is consideration of one negative ssi the committee will take evidence from the minister for public health and sport uh this item has been tables of motion to annul this instrument has been lodged the motion will formally be formally considered item three we welcome to the committee ailing cambo minister for public health and sport Mary Stewart team leader health protection division and Lindsay Anderson solicitor all Scottish Government can I invite the minister to make a very short opening statement thank you convener and thank you for the opportunity to discuss with the committee Mr Balfour's motion to annul the functions of health board Scotland amendment order 2017 and as you've pointed out I'm joined by Mary Stewart team leader from the health protection division and Lindsay Anderson solicitor from the legal directorate this instrument is required to empower NHS boards to provide free abortion services in Scotland to women who normally live in Northern Ireland in developing this instrument we have consulted with a wide range of stakeholders including third sector organisations and NHS experts in Northern Ireland abortion is permitted in only very limited circumstances and therefore hundreds of women travel to Scotland and England each year to access services here this creates an inequality in it inequality that is significantly addressed if these women do not have to pay for treatment it is important that Scotland alongside similar provision being made by the UK government enables the women who travel here from Northern Ireland to receive clinically safe NHS treatment without being charged I recognise that abortion can be an emotive subject and that there are a range of views held in Scotland and indeed in this room about it in a similar manner to the UK government we believe abortion should be available as part of a standard healthcare service for all women women in Northern Ireland who need abortion services face considerable challenges in accessing them it is right that Scotland plays its part in providing clinically safe and legal care for women who have made this decision and in light of these remarks I hope that Mr Balfour will consider withdrawing his motion okay thanks very much minister could i invite Jeremy Balfour to ask any questions that you may have thank you thank you very much for having me and I also agree with the minister's closing remarks that this is an emotive subject where people will have different views on and the questions I have this morning are not in regard to the issue of abortion itself it's someone for the issues behind that and I suppose the first question I have to the minister is in regard to the cost of this and we are all very aware and to see in the end of your debate earlier on today that our NHS in Scotland does have cost pressures and there are pressures already on hospitals doctors etc I wonder whether we have any comment in regard to what the cost this will be here in Scotland and how much will it cost the number of people who we think might come from Northern Ireland to Scotland to use this particularly if we are offering it as a free service compared to going to England as some people do at the moment the second question I have is does this set a precedent in regard to treatment so again for example if in Scotland we find a drug that maybe helps children who are three or four years old in regard to cancer but that drug is not funded in Northern Ireland are we then going to say because we because people in Northern Ireland don't have that we can then fund that and I do wonder whether it's an issue around precedent here of other jurisdictions and I suppose the final question is in regard to parliamentary jurisdiction and that is whatever our view on the subject the Northern Ireland Assembly has taken a view on that and I just wonder whether we are interfering in other people's jurisdiction and also in regard to why just Northern Ireland there are other countries within Europe who also have a similar view to that of Northern Ireland and why are we limited simply to Northern Ireland why are we not seeking to expand it to other central European countries as well so those are the three questions that I would have community to the minister thank you thank you I'm not sure if mr balfers had the chance to look at that but it's set out in the the business regulatory impact assessment the cost of the policy we believe will depend on the number of women who choose to travel to Scotland and we've set that out as being estimated as being between 17,000 and 98,000 around that 100,000 mark however it's important also to recognise that the Scottish Government will receive consequentials as part of the new spend required to fund the equivalent policy in England that was announced by the UK Government and that will be used to fund the services here in Scotland in terms of capacity we're confident that Scottish Abortion Services will be able to meet treat women from Northern Ireland without having a detrimental impact on the service to women in Scotland and of course that will require continual monitoring and that's something that we will endeavour to do in terms of Northern Ireland interfering in the devolved administration assembly in Northern Ireland this remains a matter that is within Northern Ireland itself as a devolved matter what we are doing though if a woman chooses to travel to Scotland that they are provided with the same service and care that women in Scotland have and receive without being charged that's the difference if women from Northern Ireland choose to come to Scotland that they are given up that same care and support that they would get if they had been a woman in Scotland and in terms of the point around north republic of Ireland you know of course this is around within the republic of Ireland is a separate country in its own right this is about tackling inequalities faced within that kind of UK context and just as the UK government announced that they would be seeking to ensure that women from Northern Ireland receive that care and support that women in England receive that we want to do the same in Scotland we want to see Scotland play its role so there's something very different and distinct around the women from Northern Ireland and the women from Republic of Ireland and you know in line with what the UK government are doing in England any members wish to ask any questions on that do you have an estimation of how much the Barnett consequential is so likely to be specifically on this we i don't think we have that information at the present however that is work that will be on-going and will continue to work with the UK government that you know i think this is we have continued to work with the UK government on this but we set out what we anticipate this cost would be for a Scottish context and any funding that we get from the UK will of course be used to to fund the service in Scotland and will continue to work with colleagues in the UK government around us to provide that as care and support for women who are travelling making that journey to have a very difficult procedure no one else no thanks mr any final comments you wish to make remarks you wish to make no no okay thank you we now move on to agenda item three which is the formal consideration of motion s5m 08451 in the name of Jeremy Balfour MSP asking the health and sport committee to recommend that the functions of the health board scotland amendment order 2017 be annulled to set out the procedure Jeremy Balfour will first speak to and move the motion if he wishes to proceed with it then there is an opportunity for members to debate the motion and the minister to respond following debate mr Balfour will be asked whether he wishes to press or withdraw his motion understanding orders this debate cannot last longer than 90 minutes i don't think we'll last that long could ask Jeremy Balfour to speak to and move motion s5m 08451 in the light of the minister's answers i withdraw the motion thank you very much are members content for Jeremy Balfour to withdraw the motion okay thank you very much as agreed we will now move on to into private session