It was John Swinney’s big NHS announcement to usher in the new year and answer critics of the SNP’s record on healthcare.
In December an NHS app, a “digital front door” to more streamlined services, would go live in Scotland.
What the first minister did not mention in January was that Denmark had introduced a digital system two decades earlier — even England’s had been up and running for six years.
He was also somewhat vague on what the app would offer. The ability to book GP appointments? See test results and diagnoses? Organise a vaccination? Sadly, none of the above.
It later emerged that at the start — project costs have not been disclosed — one or possibly two hospital departments, in Lanarkshire only, would be able to issue appointment notifications. Can those dates be altered? The likelihood is the app will direct patients to a phone number.
Some patients should also be able to see their “emergency care summary”, containing information such as recent prescriptions and allergy information, on their mobile phone. There is also intended to be a social care element, consisting of links to other sources of information.
In technology terms, it’s what’s known as a “minimum viable product”. An insider described it in layman’s terms. “In December, a very limited number of patients will be able to access a very limited suite of services,” he said.
“Expectation will need to be managed. You don’t want people to download it and think: ‘Does it only do that?’”
Contrast that to south of the border, where 35 million people are already registered with England’s NHS app, with an estimated £1.1 million saved by using the system instead of text messages in the past financial year.
Among a range of benefits, patients can see and manage scheduled appointments across hospital services, check test results and order repeat prescriptions from a pharmacy of their choice. About 900 GP surgeries are linked, allowing information to be sent and received securely to and from family practices.
In Scotland, prescriptions are still pieces of paper which have to be taken to pharmacies, even if the item has been ordered online — inconvenient if a repeat is required on holiday.
Dr Iain Morrison, chairman of BMA Scotland’s GP committee, said the lack of ambition and the slowness of progress amounted to a “national embarrassment”. His own Midlothian practice issues about 300,000 paper prescriptions, each one of which must be hand-signed by a doctor, every year.
“It looks like England has iterative improvement while we have complete stagnation,” he said. “We have gone from being one of the vanguards of IT in health, the first nation with electronic health records, the first nation to index-link with the CHI number [Community Health Index], to being a real laggard within western Europe.”
While there are pockets of modernisation — many health boards now allow pregnant women to track their care using the Badger Notes app — patient information databases are badly joined up behind the scenes. Opportunities to modernise, such as building on the Scottish Covid app, some suggest, were squandered.
“We have multiple different systems to communicate,” Morrison said. “Those systems are notoriously poor at speaking to each other and that is partially because some are running on antiquated software such as Internet Explorer 8.
“This has been decommissioned by Microsoft but NHS Scotland has special licence to allow it to continue.”
NHS England appears to have cut through bureaucracy to install its system, although it was not a financially pain-free process, with a less successful initial attempt abandoned after a £10 billion spend.
But when critics, suspicious that political ideology is at play, ask why the Scottish government is not simply adapting England’s health app, the answer is not clear cut.
However, some health IT experts, including those behind the very successful Danish model, suggest technology has moved on and that it makes sense for Scotland to roll it out differently.
George Crooks, chief executive of NHS Scotland’s Digital Health & Care Innovation Centre, said: “What Scotland has done is learn from England and is now taking a more advanced approach. It means costs are controlled but flexibility to expand and develop it is much easier. We are using cloud-based services and next-generation technology to do it.
“We will be able to recreate all the things that England can do at the moment. My view is that the way we are building it will potentially be more future-proof.”
Patients might ask what is taking so long. The Scottish government has been working on creating a single “digital front door” for health and care since 2022, with Humza Yousaf, when he was first minister, suggesting it would launch in spring 2023.
The level of resources and funding for the Lanarkshire launch has not been made public.
“There has probably been a lack of coherent leadership,” one senior medical source said. “If you make a brave decision, then you have got to follow through on it with a degree of consistency.
“That has been lacking, and that has been why things have gone in a bit of an incremental way and a stop-start approach.”
A tender for aspects of the work only went live on February 28 this year. Jonathan Cameron, deputy director for digital health and care with the Scottish government, suggests, however, that once the programme starts there is potential to build on it relatively quickly.
“Day one, it’s the first step and it is a controlled first step in the sense that we want to make sure it is right and we have the opportunity to really test it out before we go wider,” he said.
One problem appears to be linking GP surgeries. The main software supplier to Scottish practices went into administration in December, adding another layer of complication.
Yet it is estimated that 90 per cent of patient contact with the NHS is made through GP surgeries. Many of the inquiries concern hospital dates. “It is hugely frustrating when we have some patients who get letters for appointments that were two days earlier,” Morrison said.
“If an app is going to be in any way useful to the patient, it should involve the GP side,” he added. “It really strikes me that it is tokenistic if it is not going to link services across the NHS. If it is just secondary [specialist] care, it is going to miss a large proportion of the population.”
Moreover, by trying to link a wider sweep of public services is bureaucratic procrastination being baked in? With 15 health authorities, 31 care boards and 32 councils, information processes will probably have to be negotiated numerous times to provide access across the country.
Labour in England seems to be moving more swiftly to root out unnecessary administration. On Thursday, Sir Keir Starmer said NHS England would be abolished, bringing huge savings as management of the NHS returns to the Department of Health and Social Care 12 years after the Conservatives created the quango.
The move would end the duplication from two organisations doing the same job, freeing staff to focus on patients and putting more resources on the front line, the prime minister added.
Supporters said that it was time for the Scottish government to review whether it needed 30 NHS quangos — some of which cover relatively small areas — when it also has a centralised civil service health department.
When Swinney declared in January that there would be a health and social care app, he added: “This ‘digital front door’ will begin rollout from the end of this year, starting in Lanarkshire, and, over time, it will become an ever more central, ever more important access and management point for care in Scotland.”
With the first minister using the phrase “over time”, six years after England’s system was introduced, patients would be forgiven for being sceptical at the timetable for improvement.
