No one must be left behind in the digital healthcare revolution, the Scottish Government’s director of digital health and care said at a conference in Glasgow yesterday.

Traditional forms of communication will continue to be used to ensure people are not excluded from important community health messaging, said Stephen Gallagher, director of digital health and care.

He gave the example of the familiar blue NHS vaccination appointment letters that were sent out to people across Scotland during the coronavirus pandemic, backed up by multi-modal platforms with appropriate online messaging and support.

He said: “As we move towards making greater use of digital technologies in our delivery, we must be mindful that not everyone will want or have the ability to access services using digital means. And so we must ensure that non digital goods remain available,” he said at Futurescot’s annual Health & Care Transformation event at Strathclyde University.

He added: “So starting with older people and thinking through that blue letter approach, something that would be visible, something that could be easily read, tangible. And then switching from that to a portal-based approach as we move down the generations, but also ensuring that we have a functioning helpline in place, so that when the digital option was available, that was also the option for those who didn’t wish to use that, to be able to call to arrange or to reschedule their appointment, if that was their preference.”

Gallagher said the ‘learning’ from that period has been invaluable for the NHS as it was able to gather data in real-time from online bookings, and track responses from the marketing campaign that supported the vaccination programme. Those lessons have informed the refreshed digital health and care delivery plan launched last year, and the health and social care data strategy published last month.

One of the key aspects of those new strategies is a move towards giving people access to more of their own health data – and to support greater self management of care. A ‘digital front door’ portal is scheduled for an initial release later this year and will be an enabler for “local transformation” for screening programmes and flexible appointment booking; it will allow also “a shift away from printed posted letters to more digital communications”.

He said: “This priority development will come with an element of challenge as we develop the right services to be included at the right time, starting with the more transactional services. That’s why important engagement and understanding of impact is underway in support of the programme to address key areas such as identity verification, and proxy access.”

Gallagher also touched on the creation of the National Care Service and the work towards a more “integrated system” of health and social care “in due course”. He said the existing legislation makes provision for information sharing, and ‘signalling that there will be secondary legislation on data standards and social care’.

However Donald MacAskill – chief executive of Scottish Care – warned during a panel discussion later in the morning that despite the inclusion of social care in the strategy, very little in reality has been done to ensure the care sector is fully integrated within health and care systems.

“One of the challenges is that if we are going to create pathways of continuity, then we have to have everybody around the table and simply having social care included in a policy document does not really include social care,” he said. Dr MacAskill said one in eight people in Scotland works in social care, and that there are twice as many people in a care home than an NHS hospital.

He added: “So fundamentally, if we’re going to create and claim with any right that we are this world’s leading innovative, technologically-based society, we have to be fully inclusive of all systems and, I’m sorry, but having been in this sphere for so long, we are not there.” He also said if we are going to innovate we have to address a “fundamental disjoint and imbalance” in health and social care where care workers are not valued. He said the fact a dog walker in Edinburgh can be paid more than a care worker who holds a person’s hand during the last moments of their life “belittles our nation”. He did however welcome the focus in government policy – which he described as an “excellent framework” – around the inclusion and accessibility agenda.

Dr MacAskill’s points about the exclusion of social care were echoed later in the day by Kathy Harrison, programme lead for the Data Loch health data project at the University of Edinburgh. She said how health data sets within the ‘safe haven’ were not complemented by social care data, with over 3,000 systems social care systems that could benefit from being integrated within the programme, adding: “We need to think about this as a single system, with a single lived experience.”

Professor Dame Anna Dominiczak, chief scientist (health), at the Scottish Government, outlined her work at the conference to speed up the end-to-end pathway for innovation and then adoption within the NHS. She said her big focus at the moment is on trying to reduce waiting times through innovation but that she wants to try and address some of the challenges around duplication of effort in health boards and to try and create a ‘once for Scotland’ approach where successful innovations can be appropriately scaled. Regional innovation test beds are helping to streamline that approach along with the Accelerated National Innovation Adoption (ANIA) pathway but she also announced that the NHS will work closely with the new Techscaler programme, conceived by Mark Logan.

She said: “I hope it will be announced in the next few weeks officially, but we are working with colleagues in economy in the Scottish government. And we will twin our test beds with so- called Techscalers, which are a product of economy and our chief entrepreneur in the Scottish Government, Mark Logan. And I think that’s extremely interesting, because there will be porosity between clinicians and things that happen in health and entrepreneurship.” She said she was keen to support ever closer working with industry and that the focus must be on nit just technology and innovation to support healthcare, but to support the wider economy through the creation of new healthcare products and services. One of the key things to be addressed is also supporting clinical trials, which have reduced in number across the UK in recent years, including in Scotland.

Artificial intelligence (AI), too, is an area which has a lot of focus but not widespread adoption, according to James Blackwood, the artificial intelligence lead at the Scottish Government, who spoke later in the day. Despite all the warm words around AI, and numerous trials, he warned: “We’ve not adopted a single AI product of note.” He said the answer to the problem was not data, but leadership and commitment, and called for a national coordinating body to ensure AI can be delivered at scale within healthcare.