In the world of health and wellbeing, technology enabled care (TEC) is a relative newcomer. Scotland launched its TEC programme in 2014 in order to embed and expand technology at scale and demonstrate that it can be a cost-effective way to help improve national health and care outcomes. So, how did we go about it?
First of all, the programme was built on experience from Scotland’s national telecare development programme and telehealth activities. These earlier activities provided a robust evidence base and key learning points, and meant we were able to develop a focused programme and identify precisely what we wanted to deliver for the people of Scotland.
For the purposes of the TEC programme, technology enabled care in Scotland is defined as: ‘where outcomes for individuals in home or community settings are improved through the application of technology as an integral part of quality cost-effective care and support’. The ‘technology’ within this includes telecare, video enabled services, home & mobile health monitoring, and the use of online digital platforms and tools to enable greater self-management of health and wellbeing.
That earlier experience enabled us to align policy, financial resources and the strong, strategic leadership necessary to move on to the next stage. The Scottish Government made available £9m investment in Year 1 to 23 organisations, which enabled more than 25,000 Scottish citizens to benefit from TEC, laying solid foundations for further development.
The TEC programme is now at the end of the second of an initial three year programme. It has delivered important progress and momentum at local level has been accelerated. There has been a significant increase in the number of people benefiting from TEC and some approaches are starting to deliver at scale.
The nationally driven programme has also enabled learning of what works at local level to be gathered and shared as well as clearly identifying cross-national issues, such as the switch from analogue to digital telecare, and providing an infrastructure for web-based video consultations – all of which are contributing to the broader goal of a digitally-enabled Scottish public sector.
Scotland's progress has been supported by a clear policy directive, with delivery monitored by our national TEC programme board. Membership of the board includes influential and senior representation from across the government, health, care, housing and third sectors. The chair of the board is the chief executive of NHS Ayrshire and Arran, and one of three recently appointed implementation leads for regional health board activity in Scotland.
The board is supported by the Scottish Government's head of TEC & Health & Care innovation, with the leadership and facilitation of business change provided by my own organisation and team within the Scottish Centre for Telehealth and Telecare (SCTT) in NHS 24. Some practical examples of our large scale developments are below.
The shift towards large scale TEC has been achieved in Scotland by closely aligning policy, senior strategic leadership, evaluation, business change and programme management methodologies with collaborative communities of local practitioners. Good evidence is now emerging of how technology can help improve outcomes as part of a cost-effective approach to care and support. TEC is proving itself on the big stage.
This cost-effective, evidence based treatment has been implemented ‘at scale' in Scotland to support effective business change and improved access to psychological therapies.
In March 2014, SCTT successfully secured £380,000 of European Funding for the three year MASTERMIND Project. This involved working with a consortium of nine European Union member states and 14 sites to evaluate the implementation and impact of online CBT for people suffering from depression and/or anxiety. The project introduced CBT to over 6,100 people, as a result of which we are now rolling out the service to all 14 territorial health boards across Scotland with predicted referral rates of 18,000 people next year as part of the Scottish Government's TEC programme and mental health strategy.
Similar to many other digital transformations, a number of challenges had to be overcome. These included technical aspects, clinical governance issues, attitudes and engagement of clinicians, procurement and variability of existing service provision across the health board areas. These problems were gradually and systematically addressed through a focused and engaging implementation process, co-ordinated by SCTT.
25% of people in Scotland have one or more chronic diseases and management of these conditions currently accounts for 70% of total NHS expenditure. The use and integration of proven technologies such as HMHM into routine care enables people living with these conditions to better self-manage and live more independently.
For patients and professionals, the remote transmission of data is now being used Scotland wide to support diagnosis, improve treatment/medication compliance and is already delivering improved efficiencies in terms of reducing unnecessary hospital contacts/visits and travel. Collectively, HMHM adoption is leading to better outcomes and better targeted use of valuable health and care resources.
A national implementation programme, led by SCTT and funded by the TEC programme, has worked over the past 18 months with IJB leads, health and care professionals and service users from across 12 different health and care delivery organisations to scale up HMHM into routine care.
Through redesign, 50 different care delivery pathways have enabled more than 6,000 new citizens to benefit and access HMHM. To support this, a national service model has been developed by SCTT and partners (www.sctt.org). This has been enthusiastically endorsed as a significant milestone by clinicians and key decision-makers.
HMHM was the winner of the 2017 Holyrood Connect Award for Digital Health and Care, and is an outstanding example of the real benefits that can be derived from digital health and care - translating evidence and learning into positive and effective change.
Moira Mackenzie is head of development in the Scottish Centre for Telehealth & Telecare, NHS 24.
Scotland's Digital Health & Care Conference takes place in Nov 2017 - https://sctt.org.uk/save-date-digital-health-care-conference-22-november-2017/