The Digital Front Door service for health and social care in Scotland will take an iterative approach to development from its first deployment in Lanarkshire in December this year, policy leaders have indicated.
Available to citizens as a digital means of accessing their health and social care information, it is envisioned that the system will take a gradual approach to testing, refinement and adding new services during a phased national rollout.
The much anticipated system – which will be the first time citizens in Scotland have had access to their online healthcare records since the Covid passport during the pandemic – will take some of the learning from that process, in terms of using patients’ community health index (CHI) numbers as the spine for the platform.
“We are starting small, but we want to move quickly,” said Jonathan Cameron, deputy director for digital health and care at the Scottish Government. “So day one is going to be focused around digital post. It’s going to be focused around access to the information available in the emergency care summary, so that’s [things like] allergies, medications.”
“We’re also going into this with access to care information in Scotland, to really make it easier to navigate on NHS Inform [Scotland’s national health information service]… and that ability to get access to information more easily.
“The core to it, though, that’s coming and eventually everyone in Scotland will use will be Digital Identity Scotland, and that’s the real core component that we’re unlocking and that’s why we’re taking this forward.” He said once some of the core components are in place, it provides the functionality to start adding other services. “It’s going to emerge and evolve – and there are other things that we will look to add.”
Cameron was speaking at Futurescot’s Health & Social Care Transformation conference in Glasgow on Tuesday during an expert panel with colleagues from health and social care in central and local government, as well as NHS Lanarkshire, which will be the test bed when the new system begins a phased rollout from December.
He was joined at Strathclyde University’s Technology & Innovation Centre by Greg Thomson, the digital front door programme director, Lorraine Taggart, head of information management & health records at NHS Lanarkshire and Ruth Griffith, policy manager for digital health and care at COSLA, the umbrella organisation for local government in Scotland.
He added: “We are not losing sight of this idea that at the heart of this is the individual; the person matters, and it’s their health and care and opening that up will really benefit [them], really take that stress and pain away, and will really just support that whole understanding of what treatment they’re going through or what’s next for them.” He also emphasised that, unlike the NHS App in England and Wales, the service will aim to include social care records and information from the outset.
Initially, it is anticipated that Digital Front Door will use a digital mailbox system, through which patients will receive communications from NHS and social care services. In terms of a ‘business case’ benefit, there are potentially significant savings that can be made by using a digital system for those who prefer it to actual letters sent through the post.
It is not known exactly how much is spent on postage per health board in Scotland, but an FOI request revealed in 2023 that NHS Tayside spent £7.64 million on postage over three financial years from 2019 to 2022. There are 14 territorial health boards in Scotland, so the savings are likely to be substantial.
Beyond eliminating that “simple cost pressure” of sending a letter, Cameron added: “There’s very clear evidence that the individual will have better health outcomes if they’re in control of their own information and control of their own care, and they’re not feeling that stress of having to chase up where that next appointment letter is, or where they are in terms of that information that is available about them.”
In terms of how the system will work, it is envisaged that the digital post will not immediately be a two-way communication platform, as that will be a longer-term goal, but the intention is that ‘personalisation’ will play a key part in securing support for the service. Cameron said: “We just need to make sure it works. We need to make sure it’s safe. Certainly, I would really be expecting that as early as we can, that you get that two way process going, as soon as possible. That’s really important.”
Lorraine Taggart confirmed that patients are already keen for digital communication.
“We’ve had a lot of feedback from patients over the last few years, asking us, ‘Why do we still receive letters and post, you know, surely there’s a better way?’ So I think there’s a great appetite from patients to go down this route,” she said.
Although Lanarkshire will be the test region for the service, Thomson confirmed that the Scottish Government will be working with all health boards, health and social care partnerships and frontline organisations during the year ahead to get the messaging right and to establish a ‘service readiness’ workstream with key partners.
Health and social care reform
In the morning session, Christine McLaughlin, co-director of population health at the Scottish Government, outlined the overarching health and social care reform agenda, which aims to ensure people live longer, healthier lives in Scotland. However, she was candid in saying that progress, in life expectancy terms, has “stalled” owing to a combination of factors, including austerity, Covid, as well as widening inequality between the richest and poorest in society. Long-term, there needs to be a shift to more community-based care, to alleviate pressures on what the current NHS can provide, but there will be an ‘operational improvement plan’ published shortly to set out how some of the immediate challenges around waiting times can be addressed.
She said: “So, everything that we think about in relation to health and social care reform, everything we think about in terms of what I mean by ‘digital first’, the message I would give you today is about thinking about the solutions that we might put in place and how they’re going to help us with that position, not just doing things for the sake of it or because there is new technology, but because we’re thinking about how it’s going to help with how that overall picture gets us to having a healthier population.”
She referenced the recent Infix solution which is being rolled out across health boards, and is expected to improve operating theatre efficiencies by around 20 per cent, as among the type of solutions required to drive performance and effectiveness in the NHS. She said it will not be a case of ‘digital by default’, as not everyone will want or even have access to technology, but that it must be part of the mix to improve services. On Digital Front Door, she said that it is a “really significant moment” for health and social care in Scotland, and is a “firm commitment” to delivering services differently – and better – in future.
She said there were also gains to be made by using existing technology more productively – for example, Microsoft 365 is not being fully utilised to maximum effect across the NHS – and that artificial intelligence will be an important tool going forward, albeit that systems are “safe” and protect users.
She said: “All I would say, from a policy perspective, is artificial intelligence is going to be part of our tools that we have available to us and it already is. I don’t think any of us can really be sure where it’s going to go, but it is really important that we embrace it.”
International perspectives
The conference also heard from colleagues from Denmark, rated by the Organisation for Economic Co-operation and Development (OECD) as number one in digital health readiness globally. Morten Elbæk Petersen, director of the national Danish e-Health portal, Sundhed.dk, said that last year both that platform and the MyHealth app in Denmark had a combined 55 million visits, which for a country with a population of 5.9 million represents a “a lot of traffic”.
He said the systems are used by both citizens and healthcare professionals, and that it gives patients access to their care records, lab responses, medicines, vaccinations and appointments; it also allows access to “trusted persons” to view patients’ healthcare records, particularly when it comes to looking after elderly relatives or children. He said that during Covid, the government was able to move very quickly with a vaccine passport, because it already had the underlying digital infrastructure.
And when it comes to clinicians treating patients, there is a Sundhed button on their screens which they can click to get direct access to the healthcare record, and which integrates with more than 170 different data sources across the country. “It’s fast, it’s easy and it’s also very secure,” said Petersen.
“So, data is collected and stored in local, regional and national databases and EHR [electronic health record] systems in the healthcare sector, and they are not stored on Sundhed. We only integrate.” The platform is a cooperation between the state and 98 municipalities, he added, and is governed by a politically appointed board and a steering group of representatives from each of the partner organisations.
“In this dimension about democracy and health, it is very important when we talk about confidence and access to and sharing clinical data, it’s a model that ensures that data is handled within a democratic city, and that data is owned and used by the general public and nobody else, not Amazon or Google,” he said. There is also a citizen user panel of 3,200 patients and healthcare professionals who “take part in a dialogue” before developing new digital services.
The success of Sundhed, though, has been driven by its “simplicity,” added Petersen. “We know that simplicity is the best way to make digital inclusion happen,” he said. “Sundhed and MyHealth are easy and useful, and when people feel safe, they feel secure, and they feel even more empowered and able to take care of themselves.”
Similarly to Scotland, Denmark is moving more services into the community and homes, and digital will be key to that. “Sundhed already provides that digital front door, but there are AI-based opportunities to be explored, to develop and strengthen this position in the future and to support the ambitions of the health reforms.” In time it is envisaged AI will enable chatbots to provide generative assistance to Sundhed and MyHealth app users as well as strengthening self-service models of care.