Citizen engagement will be key in the development of a ‘digital front door’ to health and care services in Scotland, according to a government health technology leader.

A new streamlined approach to how people navigate their various health and care pathways, which will include a safe and secure digital app, was first outlined in Scotland’s ‘programme for government’ last year.

It is hoped the front door will enable users to update their personal information, manage who sees their data, access self-help information and guidance, attend appointments virtually, place prescription orders, view their health records, and request, book and manage appointments.

The digital front door  will also play a key technology role in aiding recovery from the pandemic by creating an enhanced service experience and reducing admin workload on services, which are key aims of the Scottish Government’s £1bn investment to make the NHS ‘stronger than ever’.

Six months after the commitment, Margaret Whoriskey, director of the Scottish Government’s Technology Enabled Care (TEC) programme, Digital Health and Care Directorate, explains some of the thinking behind the project. In her role she is the senior responsible officer for the cross sector Digital Citizen Board, chaired by former chief executive of the Care Inspectorate Peter MacLeod, which is overseeing the bulk of the new service, and says the group is keen to work alongside the public.

“Co-designing with citizens is really important, so we want to invest in a proper plan of engagement,” she says. “The focus will be on the experience for citizens and what are the outcomes that people want? There is no point in us creating an all-singing, all-dancing digital front door if people don’t want to use it.”

She believes that the pandemic has fuelled an appetite for digital channels as a primary option in accessing care services. “I think people are much more up for doing things in a more digital way, having been immersed in that world for a few years.”

This is evidenced, she says, in the surge of users of the video consultation service NHS Near me – with consultations increasing from some 300 a week in February 2020, to 15,000 a week in June 2020 and a peak of 22,000 a week in February 2021.  

The Digital Health and Care TEC programme is now keen to build on the momentum of the public and staff showing a “willingness to utilise digital tools both in health and care”, which means gaining a greater understanding of the digital tools that people want and need to be able to access health and care services.

And the consultation process will extend to health boards, local authorities, and social care and housing providers as the TEC programme sets out to learn from work already taken forward in Scotland, including NHS Greater Glasgow and Clyde’s citizen portal.

Development of the digital front door will also be informed by key innovations implemented during the public health crisis, including the Covid status app, which provides digital proof of someone’s vaccination.

The app, developed by NHS National Services Scotland (NSS), requires users to authenticate their identity digitally before they can access their records.

In a similar fashion, the new front door will allow people to confirm their identity before gaining access to a range of services.

So, why can’t the digital identification service that was built for the passport app be used again?

Whoriskey explains: “I think we need to build on that. The Covid status app is a very specific service and building it has generated a lot of learning, in terms of both the technical underpinning of the service and the ability for it to do what we need it to.

“But, it wouldn’t necessarily be the best fit for the full range of services that are anticipated for the digital front door.”

The Digital Health and Care Directorate’s international engagement team is also looking overseas for inspiration.  

Whoriskey says: “We’ve done some international landscape mapping and looking at evidence and models, particularly in areas like in Andalusia in Spain, Israel, Estonia, and working closely also with colleagues in Ireland because they are at a similar stage to us in developing citizen facing services.”

In addition, the team is engaging with contacts in England, who launched their own NHS app in 2018.  

The ‘digital front door’ is not to be mistaken for an app or website though – a common misconception.

“So there is a commitment in the programme for government for an NHS app,” says Whoriskey. “And we have been discussing with the cabinet secretary for health what that means in practice. We’re very clear that the digital front door is about transforming access to health and care services for those that want the convenience of having digital options.

“The term ‘Digital Front Door’ conjures up a range of interpretations. What we aim to achieve is a means by which people can go to a single place where they verify their identity once and this then gives them access to a range of health and care services without necessarily having to jump through additional identity hoops every time. 

“It will do this in a way that people’s information remains safe and secure and offers users much more choice and control of their data.”

The digital front door will be a “team Scotland” effort, says Whoriskey. “There’s a lot of experience and there’s a lot of work that has been done we really want to maximise the learning and the work that’s already there.”

Partners include NHS 24, NSS, the Sottish Local Government Digital Office, and the NES Digital Service.

Data exchange work carried out by the Digital Health and Care Innovation Centre is also “very important”, in terms of learning how health and care data can be used and transferred to create better services and better service experiences.

After carrying out a thorough consultation process, the team will look to develop a roadmap, before publishing their proposals.

Whoriskey is hopeful the first version of the front door will be ready for ‘release one’ in 2023, though she stresses it will be an “iterative process” with no “big bang” reveal.

And the digital front door is just one of several innovations that her department is working on, including Connect Me – a new remote monitoring programme scaled up due to Covid, and  digital mental health services.