Health and social care delivery plan: progress report

6 Cross Cutting

6.1 Supporting the desired improvements detailed in the Delivery Plan are a number of Cross Cutting activities including:

• Our approach to improving the services for children and young people through Getting It Right For Every Child.
• The National Health and Social Care Workforce Plan.
• A focus on research and development, innovation and digital health.;

6.2 Getting it Right for Every Child

6.2.1 In addition to actions contained in the rest of the Delivery Plan, we continue to be committed to the principles of our Getting it Right for Every Child (GIRFEC) approach. A GIRFEC Practice Development Panel was asked to develop an authoritative and accessible information sharing Code of Practice for children, families and the people who work with and support them. The GIRFEC Practice Development Panel concluded their meetings and engagement with stakeholders on 21 March 2019 with their final recommendations in relation to a draft Code of Practice for Information Sharing. Minsters responded to their recommendations in September this year^[34].

6.2.2 Development of a Child and Adolescent Wellbeing Action Plan is underway with significant engagement having taken place. A draft plan has been produced, with the final version being published shortly.

6.3 Workforce

6.3.1 The National Health and Social Care Workforce Plan was published in three parts between June 2017 and April 2018. Part 1 focuses on NHSScotland Workforce planning (June 2017); Part 2, published jointly with COSLA, focuses on the social care workforce, including those working in adult social care, children's social care, criminal justice services and mental health services (December 2017); and Part 3 reflects the requirement for a multi-disciplinary workforce supporting the new GP contract to deliver Primary Care services (April 2018).

6.3.2 Key recommendations from parts 1-3 have been taken forward, including the creation and population of a digital platform (TURAS) with workforce data to support and improve workforce planning and scenario planning capability.

6.3.3 The next iteration of this work will the production of a fully integrated Health and Social Care Workforce plan.

6.4 Innovation and Digital Health and Care

6.4.1 Digital technology is key to transforming health and social care services so that care is person-centred. Following a review led by international experts of our approach to digital health, use of data and intelligence, which will support the development of world-leading, digitally-enabled health and social care services, we published our Digital Health and Care Strategy^[35]. A National Strategic Portfolio Board has been set up to oversee this work. Work is underway to implement the activities under six key areas, or "domains". The Scottish Government has commissioned a review of the current financial landscape for funding digital and IT systems across NHS Scotland and, in time, social care. A national review of information governance is also under way to develop agreed and consistent standards for information management across health and social care in Scotland.

6.4.2 Key activities to date include the continued roll out of Attend Anywhere; the scale up of Home and Mobile Health Monitoring; and the commencement of work on a National Digital Platform.

6.4.3 During 2018, a Scale-Up Challenge was launched with the intention of supporting the expansion of video consultations in order to provide more people with the opportunity to consult with a health and care professional without having to travel long distances. Funding of around £1.6m was paid out across 14 bids for 2018/19 and 2019/20. By March 2019, Attend Anywhere clinics have been established within 13 of the 14 territorial board areas and the Golden Jubilee National Hospital. The number of consultations has increased significantly over the course of the programme and now stands at over 1500 consultations per quarter. Over 7000 consultations have been held to date with 98% of users saying they would use the service again. Service users indicated that on average they saved a 93 mile round trip, if they were based in NHS Highland. Of these journeys, 14% would have been paid for by the local Health Board. Work will continue to extend the usage of virtual consultations across Scotland.

6.4.4 Home and Mobile Health Monitoring, in particular the FLORENCE simple telehealth system (FLO for short)^[36], is used to inform self-management decisions by the patient and to support diagnosis, treatment and care decisions by professionals through simple low cost SMS text messaging. For example it allows for readings to be sent to clinicians by patients and sends reminders to patients to take critical medicines. Over 23,000 people have now benefitted from this with particular success being found in monitoring and managing high blood pressure and the benefits this can bring - particularly optimising medication management and reducing time for diagnosis.

6.4.5 Measuring blood pressure is the third most common reason for attending Primary Care appointments with 1.2 million appointments per year in Scotland for nothing but BP. 15-20% of appointments report "white coat syndrome" (where someone's blood pressure rises as a result of just being at a doctor's surgery) and remote monitoring helps reduce this in diagnosis. Blood pressure measures taken at home are more accurate than in a GP surgery and technology can help give patients control of their own wellbeing.

6.4.6 Over 10,000 people have already used FLO to manage their blood pressure in Scotland, with the system reaching over 20% of Primary Care Practices in Scotland - with some health boards reporting over 50% of practices using it.

6.4.7 As a result, a further Scale Up Challenge was launched by the Cabinet Secretary for Health and Sport in May 2019 to further develop the remote management of people with high blood pressure.

6.4.8 The establishment of a National Digital Platform is underway. This system will allow for a patient's health and care information to be available to the right person, at the right time, in the format that they need it in. Access will be based on the individual patient's choice. This approach will prevent the need for a patient to have to constantly repeat their health information to each individual health or social care professional. This work is being taken forward by the NHS NES Digital Service (NDS). The first use-case being developed will deliver a digital version of the ReSPECT form providing improved access to end of life information, both for carers and clinicians.

6.4.9 June 2019 has also seen the Scottish Government's TEC Programme working alongside Digital Scotland on an exciting project. Using the Scottish Approach to Service Design, four lead Pathfinders have been identified to look at shifting local delivery toward prevention and self-management. A successful launch event was held on Monday 17 June 2019 by Cabinet Secretary and NHS Scotland Chief Executive Malcolm Wright.

FLORENCE in action

Flo technology the icing on the cake for top baker Julie

A year ago, Julie Chambers, a mum-of-two who bakes everything from wedding to intricate novelty cakes, discovered she was living with high cholesterol and blood pressure during a routine health check.

Julie, from East Kilbride in South Lanarkshire, was referred by her GP into a Physical Activity Programme (PAP), which included a six week exercise course at a local gym - and use of Florence Simple Telehealth text messaging system, or 'Flo' for short.

"When I discovered I had high blood pressure, it was concerning," said Julie. "I've got to admit, however, that the prospect of having to go to a Doctor's surgery or clinic to get it regularly checked was enough to raise my blood pressure even higher! Between work and family I lead a very busy lifestyle. I felt like I didn't want to be taking up the valuable time of clinicians either. Being offered the use of Flo was a brilliant alternative - and I think the hassle free-nature of it, without having to commute and take time out of a busy day, probably have a truer reflection of my day-to-day readings."

Julie was equipped and taught how to self-monitor her blood pressure and texted readings from home - where she also works from - every day.

A digital system was specifically programmed. If Julie's readings were outwith prearranged parameters she was advised of what action to take via text message. Clinicians were also able to view real time information about Julie at any time.

Through the PAP, run by South Lanarkshire Leisure & Culture, Julie also established a regular fitness regime attending her local gym four times a week.

Julie said: "Regular exercise has really provided me with sense of wellbeing. The high blood pressure is now under control and I'm in great health.

"Throughout the process, I had the peace of mind that I was linked to professionals and supported through the Flo text system.

"I also liked the fact it was responsive to the data I was providing. My job is all about accurate quantities and ingredients. Inputting my readings and receiving confirmation I was on track was really reassuring."