When Alistair Hann first outlined his vision for a national digital platform for health, he used a cartoon strip outlining two very distinct ways of building a car. Going horizontally, the top pictured a single wheel, followed by two wheels, the body and then the roof, whilst the bottom depicted a skateboard, scooter, bicycle, motorbike and, finally, the complete vehicle.
The point he was making was that although your end goal might be the car, it’s better to have something you can use in the meantime – even if different to what was intended – rather than components that are useless on their own.
Almost two years on from that blog post launching the National Digital Service (NDS), and the former chief technology officer (CTO) at Skyscanner has largely stuck to that diagram and what software engineers term the ‘agile’ development process, which is building and releasing products and making improvements as you go along.
In response to the Covid-19 public health emergency, the approach could not have been more useful as an NDS technical team led by Hann as CTO of NES National Digital Service set about developing the nationwide SMS/text message service for vulnerable shielding groups.
“That was a remarkable project in a way because the letters went out on Thursday and the service was live on the Saturday, it went up in no time at all,” says Hann. “That was a very agile way of project delivery because the first version was getting people signed up, and then it was, ‘Do you need a food delivery?’ and then, ‘Do you need one box or two boxes?’
“And it got more sophisticated over time as we found out that actually some people would rather have supermarket deliveries, but they were having difficulties getting slots, so we could then change it to something in their postcode that could say here are the supermarkets that could deliver to you. That was out of left field.
“The SMS service was not something we were planning on, but it was a good foundation in citizen communication, so I think we’ve learned a lot from it,” says Hann. “Sometimes when you’re delivering a service you think could this exclude people or lead to them not getting access to the things they need, or not everyone having a mobile phone. Actually, we now have some very concrete data on the people in the at-risk group, the various age groups in high level areas, and on how they would work with an SMS service, so it’s a two-way service unlike sending a letter.”
Hann and his team adapted and refined the system along the way, so it kept meeting the ever-changing requirements of the shielding community in Scotland, which numbered around 120,000 people, including children, who were at very high risk of severe illness from Covid-19.
Another urgent project from government was a request to develop an emergency eye-care referrals service. Because of the severe restrictions on community optometry services, many high street branches had closed their doors to limit the spread of the virus. NDS worked with colleagues in NHS Grampian and NHS Forth Valley on an eye-care product. The service introduced an open-source electronic patient record (EPR) for ophthalmology called ‘Openeyes’ onto the National Digital Platform, to enable virtual consultations with patients and to share the information needed to treat patients between optometrists and ophthalmologists.
Although Covid-19 led to unanticipated work for NDS, the core teams involved in much of it have now been able to get back to their original purpose. Set up by government in June 2018 following the publication of the Digital Health and Care strategy the idea was that Scotland would work towards building a national digital platform to join up sources of data and information that exist in a vast and disjointed healthcare landscape, and for it to be accessible to clinicians and citizens.
According to Hann it has three goals. He says: “The first is that the right information is available at the point of care; there are many electronic records across health and social care at the moment but unfortunately they get split up by geography and by area of care. A GP uses one system, a hospital uses another, a care worker might be using another, and a dermatologist something else.
“So, the primary goal was to deliver that single person-centred record. That was the first thing for clinical use. The second thing was to make it more predictable to roll out new applications, to build new things and make it easier to do that, whether in the NHS or for SMEs. And the third goal is around better data – because you’ve joined up all that data it’s easier to do reporting whether that’s for operational purposes or for clinical research.”
When asked how the Covid work has impacted on delivery timescales, Hann says it is not easy to quantify, as much of what they had been asked to do an in an emergency was part of the long-term plan for the platform. “It’s hard to say. We accelerated getting eye-care data onto the platform and then we did some work on SMS that we hadn’t anticipated doing until the future. It’s coming out in a slightly different order and shape to what we expected,” he adds.
Another project is building a system for the Covid-19 vaccine, which NDS is involved in with a number of partner agencies including NHS National Services Scotland (NSS), but for which he is reluctant to go into detail.
However, the benefit of having now delivered actual products ahead of an as yet unknown go-live date is that it integrates NDS more fully into the healthcare landscape and adds to the work it did before the pandemic hit to digitise the ‘ReSPECT’ process, which is designed to inform clinicians of a patient’s personal choice when it comes to future emergency care.
As for when the car will be driven into the showroom, wrapped in a giant bow, Hann doesn’t anticipate quite such a flashy occasion. “Unfortunately, I don’t think there will be a big reveal with fireworks. I think it is going to be a drip feed. We are going to be chipping away at this but each time it will be letting people do a specific thing that they really need to do.
“We’re beginning to see a few of those things, and there will come a time where it’s a bit of an avalanche with lots of them. And until every single thing is on the platform that will take much longer again, but the point is that early on people start being able to do the things that they need to do.”