S4M-09222 NHS Scotland (2020 Vision)

The Deputy Presiding Officer (John Scott): The next item of business is a debate on motion S4M-09222, in the name of Alex Neil, on an update on delivering the 2020 vision in NHS Scotland.

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Stewart Stevenson (Banffshire and Buchan Coast) (SNP): I started my employment in computers in the 1960s, and have spent an awful lot of money on technology over the years, but I come to this debate not as an evangelist but as an iconoclast, and I will disagree with a vast amount of what has been said—I hope in a constructive way.

I will start with something on which I suspect members will agree. Let us imagine a person called Shona, who lives in a remote, rural location. She is well stricken in years and a bit overweight; she has a sedentary lifestyle and she has had a heart attack. If Shona were near a hospital, she might get treatment in one way, but she is not. If we can create helpful connections between her and her medical advisers, that is great.

The telephone was first demonstrated in 1876 and, today, we can use that same piece of copper wire that might have been in Shona’s house for 100 years to do much more, using the internet and technologies such as Skype that cost her nothing and build on existing infrastructure, to connect her to people who can help her. That is great. If a specialist somewhere in Scotland or elsewhere—New Zealand was suggested, but I think that that is a little extreme—is able to talk to her about her experience, that is likely to be helpful to her and cost-effective for the health service. However, that specialist needs access to her medication records, her previous medical history and information about her positive and negative reactions to various drugs if they are to give good advice.

I am just a simple soul. I would get the Lloyd George envelope out of the cabinet and just scan the files in. I would not interpret them or convert them; I would just get an image. Once that has been done, it would not matter where the information was and, if someone went to the wrong hospital, it could still be read. I would do simple things like that, and forget all this complicated techy stuff.

Shona needs a little bit of technology. That is probably something that she can manage. If she has some way of recording what she is eating and the exercise that she is taking, and she is getting advice based on that that can help her to move to a healthier lifestyle, that will be good. That is the kind of technology that is worth investing in.

Of course, Shona might live in a remote, rural location without broadband. Plenty of places in Scotland do not have broadband, but 999 houses out of 1,000 can get satellite broadband for £35 a month. It costs £70 to put someone on a treadmill to test their cardiac response and their breathing so, from the health service’s point of view, it could be well worth putting in that satellite connection. Talk to the Minister for Energy, Enterprise and Tourism, get some money out of that budget and just do it.

Of course, many treatments are cheap, but even to send a GP to Shona’s door for a single visit is probably the cost of a couple of months of broadband connection. We should just do it and be very simple. If Shona gets good advice, she will eat better, take more exercise and get fitter, but she will also feel involved in the management of her condition. At the end of the day, that is the most important thing.

At the health service end, we need some of the big technology and infrastructure that makes it work. We have heard reference to the disaster of the NHS communications network down south; 20 years ago, there was a huge disaster in the London Ambulance Service when an attempt was made to put radio location in and it made things worse, not better. The bottom line is that, if we contract a company to deliver technology, we should not be surprised if it delivers technology. We need to contract companies to deliver health benefits and pay them only if they do.

If we are going to have a project, it must be a multiphase project because, as a project develops, the specification changes. If it does not change, the people who are using it are disengaged from the project because, as we engage in our project, we learn more and change our view of what we need. Therefore, we always have to have a phase 2 in which we put all the change. We accept no change in phase 1, unless we displace something from phase 1 to phase 2.

The one thing that we must do in projects is manage the relationship between the time, the effort and what is delivered. If we fix the time, everything else will work in. If that means taking function out to fix the time as we go along, we should do so and put it into the second part of the project.

Innovation and failure are necessary bedfellows because, when we innovate, we are doing something that we have not done before and we cannot be certain of outcomes. Let us stop being afraid of failure and let us not go for the uniform solution at the outset. If we are innovating, let us innovate small scale so that we can detect failure, fix it and limit the damage. We will get to the point of deploying it big scale later.

Let us also avoid ISO standards like the plague. They reflect yesterday’s needs and constrain future innovation. Do not do it. They are about processes, not outcomes.

Shona wants us to have IT project managers who get a modest wage for turning up and get paid only when the health benefits are delivered. We must let Shona decide whether they have been.

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