Coronavirus (COVID-19) digital health and care response: 2021 update

Introduction

Our experience of the COVID-19 pandemic has demonstrated the importance of working in partnership to deliver health and care services that are person-centred, innovative, accessible and resilient. Using co-design approaches to work with people is a key aim of our approach in Scotland.

For the people who use digitally enabled services, they allow additional ways to access support. For the health and care providers, digital solutions support service delivery and continuity.

In March 2020, following the WHO declaration of COVID-19 as a global pandemic, the public health advice in Scotland, as in other countries, was aimed at reducing contact, transmission and hospitalisation. The advice to members of the public was to "stay at home" and people who were particularly vulnerable began shielding. Many routine healthcare services were put on hold and many staff were redeployed to support the NHS Scotland COVID-19 response.

The disruption throughout 2020 and 2021 required staff who were not working at the point of care to work remotely, and service providers needed to adapt as we managed our response to the pandemic. The important role of digital tools, the use of data and digitally enabled services has been highlighted from the beginning of the Scottish Government's response to COVID-19.

Specifically, the Digital Health and Care Directorate team have worked in partnership with organisations including NHS24, NHS National Services Scotland, the Digital Health & Care Innovation Centre, NHS Education for Scotland, National Digital Service and Public Health Scotland to oversee the delivery of the core COVID-19 response elements around shielding, Test and Protect, the Proximity App and the vaccination programme.

Key areas where digital has supported service continuity and new solutions include primary care; mental health; remote health monitoring; social care; care at home; supporting individuals shielding; and peer support and workforce solutions.

Being able to use digitally enabled services requires people to have access to devices, connectivity and the skills to use the device. The importance of digital inclusion has been underscored and, along with the raised awareness across all policy areas, resulted specifically in the Connecting Scotland initiative. The objective of this Scottish Government initiative, managed by the Scottish Council for Voluntary Organisations, is to increase the number of individuals and families who are digitally connected.

This experience has demonstrated we can deliver services in new and sustainable ways.

Learning from the acceleration of digital solutions during the pandemic response is reflected in a variety of recent publications. For the purposes of this report, the following were of relevance:

• Re-mobilise, Recover, Re-design: the framework for NHS Scotland (May 2020)^[2]
• Framework for Supporting People through Recovery and Rehabilitation during and after the COVID-19 Pandemic (August 2020)^[3]
• A Vision for Technology and Digital in Social Care – Scottish Care (August 2020)^[4]
• Coronavirus (COVID-19) – Near Me video consulting service: evaluation 2020; summary report^[5]
• Coronavirus (COVID-19): mental health – transition and recovery plan (October 2020)^[6]
• Diabetes care – Diabetes improvement plan: commitments 2021-2026^[7]
• Recover, Restore, Renew – Chief Medical Officer for Scotland Annual Report 2020-2021^[8]
• A changing nation: how Scotland will thrive in a digital world (March 2021)^[9]
• The Seventh Citizens' Panel for health and social care – Healthcare Improvement Scotland, Community Engagement (March 2021)^[10]
• Protecting Scotland, Renewing Scotland: The Government's Programme for Scotland (2020-2021)^[11]
• Securing a positive healthcare technology legacy from COVID-19: Health Foundation (March 2021)^[12]
• DHI's Response to COVID-19 Pandemic Emergency Years (2020-2022)^[13]
• Embracing digital: is COVID-19 the catalyst for lasting change? (2021) Imperial College London's Institute of Global Health Innovation, sponsored by EY.^[14]

There are many lessons evident from these reports which are applicable for all public sector organisations responding to COVID-19. They include:

• Understanding the service – data and digital tools have key roles in the provision of high quality services.
• Collaboration – working in partnership builds sustainable services.
• Communicating and engaging about the need for change is challenging and essential.
• Continuity – digital solutions have a role to play in maintaining service continuity.
• Scale – digital solutions accelerated or implemented in response to COVID-19 can be part of remobilisation planning.
• Users – understanding the needs of and involving the people who use services to develop digital pathways will result in more robust services.
• Routine – (where appropriate) models which incorporate digital options should be considered part of business as usual.
• Learning – a one-size digital solution does not fit all: consideration of the service objective, users, local context, and digital inclusion is essential.
• Sustainability – as the imperative to use digital options to provide access to services recedes the momentum will decline. The benefits to all stakeholders, of options such as a hybrid or blended models of care, must continue to be assessed and demonstrated.

At the time of writing this document the situation is improving. The majority of the adult Scottish population have now been vaccinated against COVID-19. The significant disruption to our daily lives is receding. Health and care organisations are planning for winter 2021 and, in the longer term, for recovery and renewal. The organisations across Scotland that have used digital technologies to maximise the opportunities to work differently will continue to do so with greater assurance and creativity.