UK’s digital health landscape: Scotland, Wales, Northern Ireland

Increasing demand for health and care services in the UK is impacting the way patients interact with the NHS. Complexities around governance, restric­ted funding and a lack of interoperable IT systems are barriers to achieving truly integrated care.

Scotland

For many years the Scottish Government and NHS Scotland have aimed to improve the quality of care, enable shared decision-making with patients and integrate health and social care, supported by national eHealth strategies.

It was the 2011-2017 eHealth Strategy that really drove integration forward with the introduction clinical portal technologies that have not only connected up health services within a single Health Board, but also developed a regional portal across the West of Scotland for care staff across five Health Boards to access patient in­formation quicker and easier.


2018 Digital Health and Care Strategy aims to improve access to information for both ci­tizens and health and care staff.

This 2018 Digital Health and Care Strategy, which build on the foundations for im­proving care coordination, also aims to improve access to information for both ci­tizens and health and care staff by building a ‘world-first’ national digital platform and removing interoperability barriers.

Wales

The 2015 Welsh Informed Health and Care strategy builds on the previous 2003 Informing Healthcare strategy and national implementation programme that has delivered a national infrastructure and a strong technical platform, and developed a single integrated electronic patient record.

The document summarises Welsh eHealth progress well: “In Wales, new technolo­gy has been adopted incrementally and with the consent of health professionals, avoiding the pitfalls of the large- scale technology change experienced in other countries. This approach has favoured the adoption of common, standardised ser­vices using modern web-based technology.

Northern Ireland

One of the most significant eHealth developments in Northern Ireland was the launch of the Northern Ireland Electronic Care Record (NIER) in 2013 which was introduced to bring together key information from health and social care records, such as lab tests, x-rays, appointments, inpatient episodes, ED and Out of Hours attendances, discharge and clinic letters, from throughout the country in a single, secure computer system.

In 2016, the eHealth and Care Strategy was launched, aiming to deliver new ser­vices to enable the booking of GP appointments and ordering of repeat prescrip­tions online, and a web portal to help people ‘self-care’ and give them access to their own personal health records.

Increasing demand for health and care services in the UK is impacting the way patients interact with the NHS. Complexities around governance, restric­ted funding and a lack of interoperable IT systems are barriers to achieving truly integrated care, where services are centred around patient needs. Hos­pital waiting times targets are not being met, because demand is increasing but also due to unnecessary admissions where patients do not need hospi­tal services but cannot access care anywhere else (many patients struggle to get an appointment at their local GP because it is too busy).

In England, the Five Year Forward View, in part, is aiming to overcome these challenges by transforming local services through new models of care. One example of this is the role of multispecialty community providers, which are GP prac­tices coming together in networks or federations and collaborating with other health and social care professionals to provide more integrated ser­vices outside of hospitals. The role of technology in resolving this situation is to improve access to pa­tient information to make service delivery more efficient, provide electro­nic tools and apps for patients to take greater control over their health and wellbeing, and increase interoperability capabilities across both health and social care services to reduce pressure on hospital care teams.