Good morning and welcome to the 22nd meeting of the health and sport committee in 2017. I could ask everyone in the room to ensure that their mobile phones are in silent. You can use your mobile phones for social media but please don't. Take photographs or record proceedings. We've received apologies from Jenny Goll Ruth and Miles Briggs. The first item on our agenda is the selection of a new EU rapporteur for the committee. Felly, rydyn ni wedi'i gwneud unrhyw o dwod iawn perloedd yn unrhyw ffordd o'r perlu iawn. Yrgyn complaintsen fawr i chi, Deiol, ddim yn bach i'r ffaintwaith yw i'r hyn. Rydyn ni'n fawr i chi i nhw i chi'n fawr i chi'n fawr i chi felwmaeith, ond ynddechrau'r rhai fawr. Rydyn ni'n bach i'r fawr i chi'n fawr i chi eich holl o'i rhawn i'ch hyn o ddod. The second item on the agenda is a round-table session on phase 2 of our inquiry into sport for everyone. We have just over an hour for this session, and we have a number of guests today, and you are very welcome to the committee. I will introduce myself, and then we will go round the table when you can introduce yourself. My name is Neil Findlay, I am Lodien's Labour MSP, and I am the chair of the health and sport committee. I am Clare Hawke, and I am the MSP for Rutherglen. I am Alan Johnston, from Semscot, the Sport Social Enterprise Co-ordinator. I am Tom Arthur, and I am the MSP for Renfisher South. I am Catherine Byrne, I am policy manager at Chess Haughton Strike Scotland. I am Malcolm Dingle-Smith, from Sport Scotland. I am Alex Cole-Hamilton-Lymden MSP for Edinburgh Weston, and I am my party's health board. I am Alison Johnston, MSP for Lodien. I am Kenneth Evans, chair of the Scottish Association of Local Sports Councils. I am Ivan McKee, MSP for Glasgow Proven. I am Brian Whittle, MSP for South of Scotland, and I am the party's sportsman health education lifestyle and sport. I am Alison McCollum, from Public Health in Scotland in the Borders. I am here on behalf of a range of partner organisations that are submitted jointly. I am Mary Todd, MSP for the Highlands and Islands, and I apologise for my late arrival. I came down from working in this morning. I am Mike Martin, volunteer Scotland and disclosure services manager. I am Mary Collins-Smith, MSP for the South of Scotland, and I am my party's sportsperson in public health and social care. We will try to keep the discussion as free-flowing as possible this morning, so please indicate if you want to come in. Members will ask a few questions as we go. Claire, do you want to begin? Thank you, convener, and welcome to all of the panel here this morning. I was going to kick off with just asking if you could provide us with some examples of where sport has made a difference to communities or to individuals, and what was the evidence that had made a difference? Who would like to start? I am speaking as the chair of the Scottish Association of Local Sports Councils, but I am also the treasurer of Berwickshire Sports Council. One of our principal aims is to support athletes at varying levels from the very local level to international level, and we award them grants for that, depending on the level that they are. We then ask them to supply us with information as to how successful they have been receiving that money, and we also support clubs who are requiring upgrades to their facilities, and we get feedback from them as well as to how successful their project has gone. Where do you get your money from? We get our money from Lift Borders, which is a leisure trust. There are four councils, sports councils in the Borders, Berwickshire, and Tweeddale, and they are all given a percentage of the money from the pot, depending on the size of the population in the area that they administer. Directly from the local authority? It goes from the local authority to the leisure trust, and in the leisure trust, and we give it out after that. Anybody else want to come in? For the health conditions or with a stroke, it is often not sport that they are aspiring to participate in. It is being physically active because it is hugely important for them in the secondary prevention of a further stroke or heart attack, or an exacerbation of their lung condition. We know that there are enormous barriers for these people in being physically active. Just last week, the Scottish Household Survey produced evidence that only 39 per cent of people living with long-term health conditions are able to be physically active against a national average of 79 per cent. Just to highlight to the committee today that sport, whilst important, is very much a subset of overarching physical activity, and how important that is to many people living with long-term conditions. I echo that as well in terms of the sport social enterprise network that I represent, which has about 140 organisations. It is as much about the physical activity and the intentionality to make a difference to people's lives. It is hard to pick out one particular organisation, but it is about the intentionality to get people active to make a difference to their life. It is also about the affordability issue to make sure that people and families can afford the activity. I want to continue on that theme of physical activity and the importance of widening access to that. In addition to the sports activities that my colleague has referred to in the Scottish Borders, we have a number of different initiatives that are promoted through partners to engage with some of the communities that might not be as readily able to access opportunities to be active. That includes people who have long-term health conditions and specific referral routes for them, but also many more community-based activities in village halls, in local centres, which are very much appreciated by people who do not have access to local leisure facilities and transport being a particular issue in the rural areas. We hear a lot of very positive report back about the improvements to people's wellbeing, the reduction in social isolation and the increase in confidence, and that applies across a whole wide age range, including older people. I think that understanding of sport and physical activity has been closely interlinked is really important, because some people will be physically active and then move on to become more engaged in informal, structured sport of some kind. For a lot of people, it is an increased level of physical activity that really has the major impact. At the national level, we are seeing the growth in the big programmes, the governing body club membership and active schools membership, and we are seeing the physical activity benefits that that brings and the health benefits that come from that. At the micro level, we are going to see a lot of interesting work, for instance, the Dalrai community sports hub that worked with 10 unemployed people to build up their skills and to see that those 10 people, five of them, went on to college, three secured places, several of them started volunteering and a couple of them got jobs now as a result. That large-scale health benefits, but we shouldn't also ignore the smaller benefits that are coming from communities looking at new and innovative work. There is a lot of work going on at the moment that you will be aware of in terms of sport for change, and I think that sport for change is a good way of demonstrating the difference that sports clubs and community clubs can make. Things like employability, social inclusion and projects addressing homelessness. The sport for change research that has recently been undertaken and the work through Sports Scotland that will take a leadership role can only be better for the community and the population and their health. As a committee, we are carrying out an inquiry into sport for everyone and we are keen to be able to highlight what good pieces of work are being done in places. What is the recipe for success in getting people physically active? Will you take on board Alison McCollum's point about physical activity in sport? Yes. For the importance of community-based support, we have around 60 groups across the country providing physical activity in a variety of forms. They are very much led by the local community and they meet local needs. They might be providing, for example, a walking group. They might be a gym-based exercise class led by a qualified exercise instructor who can support people specifically with health conditions. They may sometimes be seat-based exercises for people with disabilities and will older and frail people. One of the keys to success there is very much in that local support, that peer-based support as well where people can go to groups with other people who are experiencing similar health conditions for them and importantly build up social networks as well, which is vitally important in keeping them attending on a regular basis. Alison McCollum. Thank you. It is really similar to follow-up on a theme. We have found that one of the opportunities that has given communities more chance to work out the kinds of physical activity they would enjoy themselves is through participatory budgeting. We have had a pilot for participatory budgeting in the Burnfoot community in Hoig, which is an area of long-standing high deprivation. It was really quite astounding without too many conditions put around the funding, many of the applications for that funding were related to physical activity-related opportunities for particular age groups or within certain settings. That included things like a boxing club breakfast for kids in school, to purchasing bikes and cycling classes for children who would not have had those opportunities within their family. I think that there was a principle behind that for me that was quite striking about the importance of giving local communities resources to make the kinds of choices around what initiatives they would like and not constraining the range of activity that we think is preferable for that particular community. Brian, do you want to come on those? Thanks, convener. To go on from what I failed to say last week around this, we're seeing sport for all. We've got to be really careful here because the majority of people that are physically active are not doing sport. That's kind of what I asked the question from last week about what do we mean by sport. A lot of physical activity leads on to sport, but the majority of people, as I said, doing physical activity are not doing sport. I think that with that in mind when we're doing our investigation here, we've got to bear that in mind, is that sport for me is competitive physical activity and the majority of people don't do that. If you're doing Jogg Scotland, for example, is physical activity, it's not sport. If you're doing Aquarobics or you're doing a class at a gym, that's not sport, that's physical activity. So is it your view that if there's no competitive element, then it's not sport? Correct. Sport is competitive activity. You know. Show me an example if that's not true. I play golf badly, but I don't play competitive golf, so therefore I don't play sport. I would disagree with you. Do you try and beat the course every week? I wonder what others would say to that. Tell Mr Whitley's wrong. I think Sport Scotland would certainly take a slightly wider view of sport and say that, for instance, in Jogg Scotland, if you're running a 5K every week, you're potentially competing against yourself to bring your time down and that you may well do that for yourself to sport. It is true that different people will view sport differently. The Household Survey says that 52% of adults and 66% of children have played sport in the last four weeks. So to say that it isn't the majority, I'd say it is the majority of people, but I would agree the answer for absolutely everyone, particularly when we begin to look at getting the inactive active. In terms of Claire's question about what is the secret to it, I mean again, I think the answer is there's no secret, but picking up on some of the points others have made, particularly in schools environments and active schools, we're seeing much more of a move towards talking to young children and young people about what is it that they want to do, making sure we involve the children and young people in the planning of the sport. Similarly with the community sport hub model, it's very much not an imposed programme from above. It's about understanding what works in each different community and I think you heard that from Glasgow last week. There are barriers to sport that we should recognise, that particular groups face, whether that's people with disabilities, whether that's older people and the work that needs to be done with each individual sport to understand for their sport what are the barriers to that and what can be done I think is part of the work and that's certainly work that Sport Scotland has been undertaking, but it's still certainly more to do in that area. Alex. Picking up on Brian Whittle's discussion about the physical activity of sport. As a surfer and a scuba diver, these are sports to me, but I don't compete in them. As I'm sure anyone who runs this table as a runner will run for pleasure and for fitness, and that's a sport, you don't go to any other section of the department store to buy a running gear other than the sports section. I think the competitive edge here actually speaks to a wider issue because I know that I remark on one of the comments we heard at the start of the meeting, it was with long-term conditions only engaging in any kind of physical activity and that chimes with any experience we had in our sort of field trips particularly in the Millennium Centre of my constituency when one of the people we were speaking to about why they weren't engaged in sport was the embarrassment that they felt they were overweight and would look silly and attractive, but also this slight anxiety about the competitive nature of sport and I think we all have horrific childhood memories of being forced to compete and coming off badly and that being a barrier. So I would sort of contend to Brian that competition has its edge, but the elite aspect of sport can be quite inhibiting and I'd be really interested to hear whether the panel view that there is an elite barrier to participation in physical activity or perceived barrier anyway. Okay, there aren't many official reports that have sentencies that start as a surfer and a scuba diver, but we'll give you that. Brian, please come back. I'm going to comment on that. I'm actually trying to help here in that particular, the competitive difference of sport, especially at a young age, is actually what I think is a massive barrier to the long-term participation and that's kind of where I am. I'm trying to go through with this. You'll not be surprised to say that. I don't mind listening to your opinion before I tell you why you're wrong, but I think that we highlight an issue here, convener, in that our investigation hasn't been nailed down to what we actually... There's a variety of opinions around the table of what sport actually is and I think that's an issue here for me in terms of what we're actually investigating. Being physically active is what I... For me, that's what we need to be. Can I come to an issue about funding and where we should be putting that money? Because we've heard from Alison about money that goes to community projects, right the grassroots, and throughout our deliberations we've heard that criticisms of Sport Scotland overly concentrate on the elite level at the expense of the grassroots sport activity. That might be a legitimate criticism, it may not be, but I'd be interested to hear the views of the panel as to if we are putting the money in the right places to get more people active. Yes, Alan. I mentioned sport for change earlier and there is a large piece of work there in looking at sport and physical activity and you've got organisations like the Robertson Trust that are looking to fund activity that isn't just about that sport and elite in picking up on Mr Whittle's point about the competitiveness which is really important but there's also the fun and social interaction that you're getting organisations like the Robertson Trust in Sport Scotland. I recognise that it's been important to fund. Yes, but what we're trying to get at is are they putting enough money into that area or is the balance wrong? At the moment they're not putting enough money into that area but I'd like to say that they're trying to address that at the moment. Ivan. It's a great discussion that we've started off with. I suppose that I'd just like to get some reflections from the people around the table on what the objective is. That's clearly the proportion of adults meeting the physical activity standard. Could it stop you there, Ivan, to bring you in after this? Sure, I think that people wanted to come in on that funding problem. I'll bring you in in the next one. Kenneth? From Salsk, because we work with all the local sports councils throughout Scotland, of which at present there are 38, one of the big things that we continually hear from them is that because of the pressures that are put on either local authorities or leisure trusts, the amount of money that is going into these sports councils is getting less and less every year. Some of the sports councils are very good and have addressed this by looking at different ways of raising funds through going out and trying to get working with companies, sponsorship and whatever, but there are one or two who have just decided that they just cannot continue to keep going in the way that they would like to go to support athletes and clubs, and it just comes down to the pressures that they are being put under. Alison. I'm not sure if it speaks directly to your question, but from a public health point of view, it won't surprise you to know that. I'm particularly interested in looking at the inequalities focus in this, and I think one of the tensions that we are aware of locally is that the sports clubs and the trusts are very much responsible to maintain the facilities and premises that they have oversight of, and that that sometimes narrows the opportunities then to engage with the wider community and provide opportunities for a whole range of different community groups. So there's something about the overhead costs and the needs to keep membership levels up and all of the maintenance of that infrastructure, which is obviously important, but I think there's a tension there sometimes with what we're trying to do and engagement with physical activity for the whole population. I think that's something that's not insurmountable, but it's probably quite hard to quantify where the balance of the resources goes because it's easier to identify what gets spent on sports facilities than it is to identify what particular funding goes into physical activity promotion because it's so diverse and it's being used, it's being accessed and promoted through a whole range of different funding streams and initiatives, which might not be badged as being directly about that, but it's a way to build skills, encourage volunteering, combat isolation. So there's a lot of unintended benefits coming through a lot of other routes. Do you see any deliberate policy of skewing funding to areas of most need? Not sufficiently at the moment. I think that's very difficult to do and it would be good to see more of that coming in in the future, definitely. Just on the funding issue, it's a systemic issue in the sense that it extends from NHS care and beyond. So people after, for example, a heart attack or a stroke or a diagnosis of a stress lung condition are provided with NHS rehabilitation programs and physical activities, a core component of that, and we know that when people can access rehabilitation and complete those programs, they're far more likely to be physically active once later and able to sustain the benefits of that. But the provision of that rehabilitation is very patchy across the different health boards. We recently conducted a survey of pulmonary rehabilitation provision across the 14 regional health boards, which found that capacity is only about 9,000, but we estimate around 69,000 people across the country would hugely benefit from that. Malcolm, do you want to come in at this point? I think that we're unsurprised to learn that probably I have a different take on sportscotland spend. In terms of performance versus elite, the entire performance versus grass-roots sport, the majority of our budget goes on grass-roots sport. Having followed the committee's evidence, what I've heard is a lot of references to active schools and community sports hubs and the good work they're doing, and that is sportscotland-funded programmes. In addition, we do put money directly into clubs and to coaches, so we put direct club investment into 122 clubs. We put funded 3,300 coaches directly last year with subsidies to undertake coaching qualifications. We put money out through awards for all in facilities. I think that some of the evidence I've heard you take has been around whether it is money going directly into clubs versus money going into governing bodies and local authorities for staffing posts. I think that there's a balance to be struck there. I think that we can underestimate the amount of value that an individual supporting a club can put in. Sometimes, particularly volunteers who are time-limited, the ability to have a professional provide them support is of more use than direct subsidy. Finally, it is also important to note that in terms of overall public spend on sport, we are only 10 per cent of that budget and 90 per cent of the sport's budget is through local authorities. Can I ask Alison Collin and Brian on this funding issue that you want in? I'll come back to you then. Alison, is that funding? Not particularly. I'll take Brian first then. It's fine.  I wanted to point out that Ayrshire and Armar are doing a really excellent programme just now around stroke rehabilitation in the community, around exercise programme. I think that there's some fantastic evidence around cutting the number of re-emissions. I just want to point that out. I was actually to take a point from Malcolm there around... We seem to be focusing on the Sports Scotland fund and actually the overall sports budget, predominantly through half a billion, was through the councils. I wonder what the committee's views are. Have we actually looked at that as well in the round, rather than just focusing completely on the Sports Scotland budget? We have several times taken evidence for various people who are raising issues about cuts to local government, and there's been a huge impact on grassroots sport and sport and the ability of trusts in local government directly to fund. It's important that we look at that round, because the inequalities are going to be focused probably more directly through local government, to be more targeted. Ivan? It's kind of related. It's to go back to what we're trying to achieve, and it's clearly in the national performance indicators that there's a metric proportion of adults meeting the physical activity recommendations, and that number's been kind of in the low 60s for a number of years. I suppose the question I've got is the organisations around the table. Do you see that as your primary objective, or one of your objectives, or is that an objective that we shouldn't be focused on at all, or are there others that are more important? If you think it is important, what are you actually doing with the resources you've got to move that forward? Clearly within that, you talk about 37%. Don't meet it, and hard to reach in disadvantaged groups. That percentage is obviously going to be higher, potentially much higher. So how does that figure in your focus as well? Anyone like to kick us off? Catherine? Yes, it's hugely important to us. We've just launched a three-year initiative where we're going to focus particularly on enabling the people we support to be more physically active in different ways. We'll be testing new local community support. We'll be piloting new ways of reaching more people and addressing some of those inequalities that Colin mentioned. Just to reiterate again how important physical activity is for the people we support and not only helps them regain their lives, some people can be literally trapped in their house without sufficient support to be physically active. But people who are able to be physically active are far more likely to be able to participate in their community, to build a network around them to self-manage their conditions. Importantly, less likely to be admitted to hospital and to have to visit their GP repeatedly. So savings there to be made as well for the NHS. Better coming quickly on the savings to the NHS which is always a welcome message. We've heard quite a bit about rehabilitation but I'd also like to highlight how important physical activity is and increasing that particularly for the most inactive in relation to prevention because we know that there's a tidal wave of long-term conditions likely to come at us if we don't do something soon really given the population profile in terms of ageing given the increasing prevalence of obesity and overweight in Scotland and the continuing low levels of physical activity among many people in different types of communities. So one of the things that we're beginning to get more into in the Scottish Borders is to look at the role of physical activity as a preventative measure and we're looking at introducing a diabetes prevention programme to really target groups of the population who are likely to be much more at risk and physical activity is one of the main ways in which we can engage with that population and have some impact. We've had a very promising pilot in quite a small scale but that's already shown some quite significant gains in terms of clinical improvements for those individuals and a lot of very strong reported improvements in their own health and wellbeing and their social connectedness and sense of control over their own lives. So I think we see that as an area of where there's a huge scope for development and obviously having an inequalities focus in that would be absolutely critical. Anyone else that would like to come in? I'm welcome. Yeah, thank you. In terms of the physical activity levels at 9.30 this morning the latest health survey statistics released which you're right despite me still no statistically significant increase in adult participation. There's a small increase. There is a statistically significant increase in children's participation showing an increase up to 76% of children reaching the recommended level. A particular increase since 2008 in girls' participation interestingly from 64 to 72%. In terms of the sport bit though and as I say we absolutely accept that we want to see that increasing we want to see that moving more than it currently is. What's interesting to us is that when we look at our large scale programmes we are seeing growth in those large scale programmes in sports participation and I think this shows that past structured sport the picture is looking pretty positive that's against a backdrop of an ageing population a backdrop of changes in lifestyles and changes of culture so we do need to look at how collectively we work to address that how we adjust the design of sport we're seeing more sports clubs more opportunities going back to Brian's point about what does and doesn't count in sport we're seeing sports clubs certainly offering a wider variety of activities and things that are more likely to attract people in through the door I could remove off a whole list of examples but I think you've heard a lot of those from our partners See they talk about large scale programmes what can examples are there So active schools we're talking up to 290,000 children taking part in that governing body membership 170,000 members of sports clubs one of the programmes that appeared to be really successful was Jog Scotland yet that had its funding chopped so Jog Scotland is being funded but it had it chopped it's now being funded via SamH so it's being funded via Sports Scotland as well it has received funding from SamH so that was at a reversal of the cut it was a decision taken to put the funding in initially it had been funded directly by Scottish Government that money had moved to us there had been a reduction in that funding there was always an intention to reduce that funding and an understanding that that funding would reduce that was because we were looking at the sustainability of the programme we've been working hard with Scottish Athletics to look at that we believed and our conversations with Scottish Athletics had been that by the end of the last financial year they would be in a position to carry on without that funding we'd put a little bit of extra money in as a kind of stopgap measure at the beginning of this year it became apparent that they weren't going to be able to continue it without that funding so we put funding back in nothing to do with political pressure a number of politicians certainly wrote to us to say locally they'd had discussions with our local clubs local Jog Scotland groups who had said that they were providing a valuable service that it needed the money to carry on and identify that same gap so we welcome politicians taking an interest in local sport and raising the same issues that we were hearing from Scottish Athletics so the question I have to ask then is had that intervention not been made would you have reinstated that money anyway if the intervention by politicians hadn't been made or government or whoever was putting pressure on the conversation we had with Scottish Athletics was that the money was needed to put it back in Alison Can I just carry on for a moment on that the fact that there's been very little change in meeting the latest physical activity recommendations I mean you've spoken about a small increase in adult adults meeting it and a more promising increase in children but we seem to have been stuck more or less since 2008 you know what do we have to do to increase that figure because otherwise you know there's a recommendation there that far too many people aren't meeting do you have any suggestions as to what needs to change yeah I think my view is it needs a really concerted effort across partners on this and that isn't just about sport it comes back to this sport as a contributor to physical activity but it's not the only part of physical activity that we'd be looking at active travel we'd be looking at active living we'd be looking at dance, we'd be looking at play these different parts of physical activity need to come together and at the moment there is a temptation to put the entire responsibility for that one to sport but actually our view would be that it needs all public sector organisations and other third sector private sector pulling together if we're actually going to make a real impact on that goal okay thank you can I ask another question of sport Scotland the school estate your audit showed that around 61% of available indoor space in secondary schools is used during term time and that drops to 43% during holidays outdoors is even lower there's a weather impact there but 40% of outdoor space is used during term time dropping to 28% in holidays seems a bit sort of you might expect that more spaces might be used more during holidays and also there's a real difference 73% of the space is used as regular extended let's and I think those things are quite difficult to access for community groups you're looking at people making bookings getting that amount of money together up front and the proportion of casual use is pretty low but 26% so why is usage so low this is a huge asset for us how can that be increased I'd say a regular extended let will generally be held by a sports club for instance and it doesn't necessarily require up front payment but I think you're right what the audit showed was that accessibility was high that the ability to book facilities at some time is high that something like 98% of secondary school facilities are available at some time for community booking but what isn't necessarily the case is that isn't a consistent availability and obviously schools are run by local authorities or in some cases by leather trusts or other operators outside of school time and I think that's where the challenge potentially is that what we're seeing is that it's about the management systems it's about the how are we booking those systems how can somebody book a casolet it's not as easy to book a badminton court in a school in some cases than it is a badminton court in a leather centre and that clearly is a problem if you're trying to encourage accessibility that comes down to working with each local authority to working with each operator to look at how that system of management can be improved rather than just assuming that schools aren't available it's about how they're managed I would say you were saying previously if we're going to tackle physical inactivity it has to be about partnership working but we don't seem to have quite cracked that yet when it comes to access to that estate those may be part of the reason that usage is low during the holiday period is because janitors for example are on holiday surely it can't be in this day and age we must be able to get together to have a model that makes these facilities available all year round so partly it'll be about availability but it depends again on the model to which the school operates so for instance quite a lot of the schools in the Highlands are run by Highland Leather Trust Highlife Island who I think you've taken evidence from and that model certainly allows you to get around those problems of the janitor because you're effectively using a much larger staffing base who are able to move between locations rather than relying on the janitor unlocking the door I think you'd find that model of having a single janitor who's responsible for unlocking the door is a decreasing model is something we're seeing less of but it is about working and it is about working across local, different departments within a local authority with whoever is responsible for running the schools whether that's a Leather Trust whether that's a different operator and understanding what the community needs are to understand when is it useful to have that facility open certainly it's not necessarily always useful to even during school holidays to have that facility open during the day for instance when the school would potentially be available but potentially there isn't a demand I like that question Alison we have hospital wards closing and airlines being grounded because they can't manage holidays and you're expecting janitors to be sorry the naivety of it in the evidence Alison, your evidence there's a mention about the school estate being managed well in your area for access I'm not in any great detail because it's not an area I know so much about but I am conscious that when we have had several new schools built the arrangements have been much more flexible so it's been factored into that to encourage much more community use of the range of facilities so I think that's probably something going forward Brian Just to follow on from that convener, if we take that question back a level I just wonder if there's an agreement around the table in tackling health inequalities the most likely place to start would be at school because we have a captive audience there I wonder if that's something we would agree with and that if we're going to invest in tackling health inequalities that would be obvious place to start and then the impact then of the withdrawing of funds for free swimming lessons presumably you would agree that to be able to participate in swimming you'd have to be able to swim of course now we know that if kids go to secondary school they're able to swim so my question then is again back to the school of state if we're going to tackle health inequalities is that the place we should start I think just to be aware of some of the limitations of that in a rural area because there are lots of opportunities in schools to improve health and to reduce inequalities I think we also need to think about the family context and the community context as well so in Scottish borders if children were given more access not all of them have ready access at the weekends or outside of school to swimming pool facilities just because of the nature of the geography and the accessibility of those types of facilities so for me I think the approach should be very much more about emphasising the importance of physical activity for all members of the community at all ages and stages and not only on children because I think the family is a huge enabler of that and helps set some of the patterns school can have an impact but unless we've also got parents who are very directly engaged in that and indeed extended family with grandparents also then it may be quite limited and also we do then seem to be writing off quite a large proportion of the population who are no longer accessible to us in schools and whose health could be improved significantly within their lifetime if we do some other things often quite simple things I think just very briefly to say obviously in curricular school activity sport activity isn't a responsibility of sport Scotland and I think that takes me back to the point I made earlier which is this has to be about all partners pulling together and that is something you'd have to take up with education Scotland and with local authorities and that's where we need to see this importance across all different bits of the public sector getting round the table and discussing how to increase physical activity and to increase sport some of which happened at the national strategic group underneath the Active Scotland Outcomes framework but again when you're looking in terms of this inquiry and the evidence you take and the recommendations you make it's that understanding that sport is a pretty complex landscape with a huge number of different partners involved in different aspects of it OK Colin Thanks very much I just want to come back on the health inequalities issue Alison raised it earlier in one of our answers can I ask the panel to come across inequalities in the work you do for example do you see there's lower participation levels amongst whether it's volunteers or rehab or particular sporting activities from people from more deprived areas what have you done to try to tackle those inequalities and do you actually even measure those inequalities do you know for example how many people who come to your activities are from the most deprived areas is that something you actually measure participation simply about the number of people overall or are you actually measuring where those people are coming from Yeah I mean in terms of social enterprises that are rooted in the community I don't think they'll gather a lot of stats but it's more anecdotal I'm afraid and a lot of people are looking for things like social impact which is a different dimension I suppose but most social enterprises are about working with deprived people in communities and sometimes it's because there's a lack of activity in that particular community there could be an affordability issue so certainly for social enterprises it is about addressing inequalities and making sure they have access to the physical activity Anyone else want to come in on that point in relation to it yet Alison I'm certainly one of the main barriers that we've identified and asking communities what is it that gets in the way of them being more active tends to be cost and often your small cost can accumulate when you have more than one child or there's a bus fare involved as well as the entry fee to a facility so I think it's important not to underestimate that although we even with some subsidy of costs it can still place an enormous barrier in the way of participation in things and for that reason I think it's interesting to look at how important the growing interest in walking as a social activity and we've talked a bit about jogging and jog Scotland and some other sports but I think the past for all initiative programme has been really significant in engaging people from a whole range of different types of backgrounds in walking and making use of the environment around them whether that's in the city or a rural setting and certainly in the borders we've got at least 70 volunteers who are supported by one part-time coordinator and that has very strong profile in the borders and it has a lot of engagement with a wide range of groups including people with dementia increasingly so we find it hard though to gather the type of statistics that would help you evidence from which particular postcode areas those individuals are coming from because people don't necessarily want to be monitored when they come on something which is seen as being about enjoyment and pleasure and being active and similarly with our sports and leisure trust I think they also have difficulty in gathering information in the format that would be helpful from a public health point of view to be able to look at those health inequalities but the evidence does show that we know that that's where the greatest inequalities are likely to be and we do know within a local area which are the communities most affected by inequalities and low activity so we can put the different sources of information together but we're not always able to say that those particular users are the ones who are affected Colin mentioned volunteering and is there are barriers there in relation to people coming forward from the private communities to volunteer or the number of people who are available to assist in setting up organisations? That's not really my expertise I'm afraid so I work within the disclosure service side of things so there is work that we're doing we take from the PVG data if you like that we get through what we're looking at and it is a wider organisation at the minute but I can't give you any detail on that my friend I think I'd agree with Alison it depends on the programme how appropriate it is to ask different levels of information from participants if you walk through the door of a community sports club if you're inactive the first thing you want to do is not be asked a whole range of monitoring questions but it is interesting so for instance active schools what we did was we looked at the schools that have the most pupils coming from the lowest 20% of SIMD areas and what we found was participants in active schools is 11% higher in those schools than in the national schools overall which one possible reason for that is that the majority of active schools activity is free so is potentially appropriate whereas in other areas more young people might be going to activity outside of the school environment so there is work going on in some of our other programmes like community sports hubs there are lots of great examples of individual programmes looking at providing activity particularly for those who can't afford activity normally so an example here in Edinburgh at the Jack Kane centre where holiday programmes were provided for free but not only were they provided for free but meals were provided to tackle the holiday hunger those at risk of holiday hunger but in terms of monitoring we wouldn't have that data at a national set for that particular programme but where we can gather it and where we are gathering it certainly with a programme like active schools we're seeing that the way we are delivering active schools is working in those communities Mary Thank you convener I couldn't let the morning go by without mentioning that it's women and girls in sport week this week and we've seen a huge rise in participation in certain sports in Scotland so we've seen karate and dodge ball quadruple in terms of the level of participation and cross country tennis and rugby union double in terms of the level of participation in the next five years in the last five years so does anyone round the table have any ideas on how they've achieved that and how that might be transferable to other sports and I think getting women active will have a massive impact on the whole family's activity level and society's activity level Anyone wish to comment on that? Welcome, please I think so those particular stats relate to the active schools programme and participation in those sports within active schools and again we've done a huge amount of work through a programme called active girls that work with every secondary school peak department for instance to get a better understanding and take a really participatory approach to planning girls activity also looking at who is coaching those lessons and getting more young women involved in coaching helps to drive up the number of women and young girls particularly that then see the role models that they can then take after and can approach and as I said all those other stats do definitely show that closing gap amongst children particularly girls versus boys in terms of the level of those meeting the physical activity standards which is great to see and then within the club sector and the governing body sector we're seeing a lot of sports that have been traditionally seen as male dominated and where that potentially a decade ago wouldn't have been seen as a problem that governing bodies are really focusing on that and through we run something called sport which means every sport takes a look through all its policies all its procedures, all its culture and says which are the groups that are underrepresented in our sport and why and again taking that approach really not just for gender but for disability for social economic inclusion for age is an approach that we think we're now seeing a lot of sports develop activity in a way that suits the audiences that weren't previously attending their classes or their clubs I think it's crucially important to be able to identify better where the gaps are and how we can best support people who are less likely to participate in physical activity or sport and tackle that as early as possible whether that's from the point of perhaps NHS care for the people that we support or where people are visiting perhaps their GP with health related issues Alex My question speaks to your question about volunteering Brian was absolutely right when he says that we have a captive audience in schools and in classrooms but not every young person is adequately engaged in schools and classrooms and actually I speak from my perspective both as a youth worker volunteer, youth worker many years and chair of the cross party group of volunteering that over the last decade or so we've seen a slow decline in youth work in this country particularly around the closure of the community education department at Strathclyde University but also in the erosion of local authority budgets behind both detached and sectional youth work. In my experience it is detached and sectional youth work which leads the hardest to reach young people to sport in the first place and I would like the views of the panel as to whether that's a rather bleak assessment or whether there are examples of best practice where youth work is flourishing in this country Alison I speak for Scottish borders but I think we have got a vibrant youth work sector in the borders we have a youth borders organisation which act as an umbrella to work with the network of more local youth work groups who are in close partnership with our community learning and development service within the council so that all is under the umbrella of our community learning and development strategic partnership and I think we've just been through an inspection which has spoken quite highly of some of the examples of good practice that they've seen there, physical activity and a range of opportunities and skill sets that we would hope to offer to young people not just for the benefit of their health but for a whole range of other positive outcomes Is the budget there going up or down? I couldn't comment I would be surprised if it's going up but I don't think it's going down drastically I would be extremely surprised You can maybe let us know that Anyone else like to comment? One of the indicators that's set for us by Sport Scotland is to encourage more young people to be involved in sport We have taken it slightly wider than that because not everybody takes part in sport or wants to take part in sport but we need councils to be able to run these sports, we need member clubs to be able to run as well and we actively encourage young people with different skills whether it be social media journalism or whatever to be part of these councils to know how it is to run sports councils In fact we are now in a position where we have young people involved in more than 12 of our local sports councils doing great work for the people The trouble is that if you look at sports councils they are at the moment the average age because it's nearly all volunteers that's doing it will be 60 plus and it's great to have that different view from them 18 to 25 year olds is the main age that we're looking at we bring a different perspective what needs to be run what needs to be done with sport in the areas that are there so we actively encourage people to become involved in that side of things Anyone else like to come in? Yeah, no Just briefly Again, not well positioned to comment on funding for youth services within local authorities but I think where what we used to see in the past was a real distinction made between hand and sport on the other and I think what we're seeing much more is an understanding that sports coaches can be youth workers and that youth workers deliver sport and that we shouldn't necessarily draw a distinction between them at a strategic level what that means is that we work with Youth Scotland but we're then seeing examples of Scots rowing or delivering a programme in the furhill basin on the canal in Glasgow which is looking at engaging young people who are disengaged with education for and taking a youth work led approach to how that programme runs Thanks for that My experience of youth work is that you can reach the hardest to reach young people by establishing positive relationships that's the relationships that are at the heart of youth work and irrespective of what the activity is that's being undertaken it is that the relationship that germinates that interest, that engagement that staying power of the young people who perhaps have never had any of those things can commit to and I think you know it's important, I'm glad to hear that that distinction has now been blurred because it was perhaps a barrier if you felt that sport was coaches with the sole arbiters and sole deliverers of sporting education whereas actually you've got some amazing detached youth work going on there starting street football, street hockey late night boxing which introduced young people to sport who would never have had the courage or the social inclusion to come and join a club or try out for a team That was a statement, not a call Question You could also say, am I correct? Am I correct? The volunteers we could tie now the volunteers into perhaps Commonwealth Games legacy and how much of the Commonwealth Games legacy was linked to raising the number of volunteers because at the end of the day if you're going to raise the number of participants you have to raise the number of volunteers and I'm thinking specifically about a programme that works particularly well which is the club together programme and for the benefit of the panel that was basically putting an apart time 15 hours a week that paid for position within clubs that was funded partly by correctly from wrong people I think it was Sports Scotland the club themselves and privately funded and it was about £7,500 a year and that has again correctly from wrong increased by about 400 volunteers into the sector and about 3,000 athletes so the question is around the link between the volunteers increasing volunteers and was that part of the Commonwealth Games legacy and perhaps that impact whoever the club together certainly Scottish Athletics ran the club together programme it was a very successful programme it looked at building the capacity of clubs and part of that was about the fact that if you're going to grow the club you need the people to be running the club whether those be coaches or the administrators or the safeguarding officers or the treasurer or whoever it is to be able to increase that capacity and deliver extra sessions and do the fundraising required to support all of that and that was a very conscious approach that Scottish Athletics took ahead of the Commonwealth Games to say if there is going to be a legacy we need to have the capacity to take in the new participants and they've seen good growth across a lot of athletics clubs across Scotland and yet the question around more widely around volunteers and the legacy of the games certainly, for instance, active schools we've seen a 50% increase in the number of volunteers in the last five years I think the ability to link that directly to the Commonwealth Games is always a bit of an attribution question so we certainly would say that the I think Scottish Athletics used the phrase legacy is what we do every day it's about all the different bits of sport that are built into increasing the numbers of people coming through the door at sports clubs across the country and making sure that the infrastructure is in place to deliver that I think that my question now is that 2012 was similar to this it was all about increasing the number of participants I'm just asking the question and increasing the number with the target of increasing the number of people participating activity was the need for volunteers properly taken into account and I think the answer to that I would say is yes I mean it was something as if you gave a great example of a sport that took that approach and I know that's not an isolated example of sports that took that approach a large number of sports understood that if they were going to increase the number of people playing their sport that what they needed was more volunteers and as I said we're actively qualifying a huge number of volunteer coaches every single year so I think if you're going to support sport to grow you need to support the volunteering arm a bit and we do that certainly in a number of ways both through those coaching subsidies through providing training to clubs to ensure they understand how to manage volunteers because I think that's an important element and I'm sure Volunteer Scotland might have more to say on that but around it's not good enough just to have a volunteer walk through the door and then leave them to it to support a volunteer once they're in place Catherine, then Clare Just asked about Scotland obviously don't have sporting volunteers specifically but just to make the point that recruiting and retaining volunteers is a challenge to all organisations across various sectors we're one of the biggest volunteering organisations with a workforce of around 1600 people but even then we have to re-recruit about another 400 people every year because of the massive turnover we've invested hugely in supporting, providing training for our volunteers but key for us has been in identifying the motivation for volunteering in the first place and playing to that as a strength very much so people are looking for particular skills and experience and we try and give that to them we're working at the moment with Queen Margaret University they've got a new degree course on physical activity and wellbeing and we're going to be working with some of the second and third year students and with volunteer spaces where they can help some of our services to be physically active and participate in community based activities Clare Thank you convener, the panel will be aware that the committee have looked at the PVG scheme in relation to sports and sports coaching in particular youth football and I wanted to ask Ewan McMartin about that and whether the PVG scheme has had any impact on volunteering or how volunteers can view that If we look at the numbers we have somewhere in the region 266 sporting organisations that access free checks PVG checks through ourselves and that's including the governing bodies so you've got the clubs that obviously feed into the governing bodies so I've got somewhere in the region in relation to sporting organisations alone but what is clear in the last year certainly since January this year up to September we have seen a marked increase up to 200% increase in the number of applications for PVG so the clubs are known to know that they have to do it clubs are aware that they have to do it and the volunteers are aware that they have to go through the process and they're more than happy to do it Some of the organisations that we could look at given the situation they were found themselves in last year but SRU and themselves are over 400% increase in applications for PVG in the same period compared to last year January to September What do your organisation put down the increase in PVG forms to? I think there's the basis of the media coverage and what's actually had to happen is that the organisation should be doing a what a regulated role actually is So sorry, are you suggesting that perhaps there were sports groups that didn't know that they had to do this? I think that we are certainly working with a lot of sports on sport organisations to help them understand what they should and shouldn't be looking at the PVG check Are you monitoring exactly who it is that's putting in these applications? Yeah, we regularly keep them and I can provide the numbers to the panel and there's no problem with that that actually shows you where the number convener would be very helpful because you've raised a bit of a concern with me now that perhaps there were organisations that weren't complying with PVG I think there was a lack of understanding and certainly there was a lack of understanding and it hasn't become apparent So if there's a lack of understanding who's responsible for ensuring that sporting groups and clubs do have an understanding The understanding is their responsibility but we're organisations that support the needs of Scotland but I can provide the detail to let you see where the numbers are I'd be very keen to have a look at those You said you've had overall 200% increase in PVG applications and from the SRU you've had a what increase, 400%? SRU is in the region of 400% There hasn't been I would contend a 400% increase in participants No, I wouldn't have thought so And are you seeing similar increases across other sports? There's similar other sports, sadly there's large increases I think that it's an awareness now it's becoming more apparent and organisations are trying to get their house in order So if they are registering people for PVG who weren't previously registered then and they are doing that properly with your guidance therefore people who have no need to be PVG checked are not being PVG checked We can only contend that there was a large number of people who should have been who weren't Potentially, yeah That is very concerning I think we need to get much more information from yourselves about that as to where these applications are coming from where the big increases are and why organisations were unaware that they had to PVG checked people who were presumably taking part in regulated activity Yeah, that might be the case but certainly the numbers are going to provide the numbers not a problem Yes, certainly Given the information that you've given us just now Mr McMartin how many of those PVG checks were not passed how many people I don't have that number in front of me but it's a really important piece of information for the committee to have quite quickly I wouldn't be able to tell you who No, I'm not asking for individual names I'm asking for numbers under each organisation I'm somewhat surprised that we are finding this information out in this way and I think the committee really needs to follow up on that and why that information has not been volunteered or whoever This is the only way when we've picked up on and dissected the data that we've had in this year Had Clare Hawke not introduced that line of question and we wouldn't have known in that information Was it the intention of Disclosure Scotland to write to the committee? I would certainly Okay, we will most certainly be writing and seeking that information and anybody else wants to raise any final issues Okay, thank you all very much for your attendance this morning and we'll suspend briefly for a change of panel Let me see something about it The second item on the agenda is the first evidence session on technology and innovations in health and social care We've got a number of guests this morning and like the previous panel I'll introduce myself and then we'll go around the table and you can introduce yourself Neil Findlay, Labour MSP for Lothian and the chair of the health and sport committee Good morning, I'm Clare Hawke I'm the MSP for Rutherglen and the deputy convener of the health and sport committee Professor Patricia Connelly, Strathclyde University I'm the director of the Strathclyde Institute of Medical Devices Tom Offer, MSP for Renfisher South I'm John Brown, the director of policy for the Scottish Life Sciences Association It's a trade body representing 140 companies in Scotland that do life sciences including eHealth Hello, I'm Andy Robertson I'm the director of IT at NHS National Services Scotland We're on most of the big national systems that support the health service in Scotland Good morning, I'm Alex Cole Hamilton, I'm Lib Dem MSP for Edinburgh Westin Alison Johnston, MSP for Lothian Elaine Gemmell, head of project development at Scottish Health Innovations working with the NHS to help commercialise innovation within the health service Ivan McKee, MSP for Glasgow Proven Sahed Dean, digital health and care strategic leader at the Alliance Good morning, Brian Whittle MSP south of Scotland Good morning, I'm Christophe Dumle I'm a consultant and physician at GP and a professor of eHealth at Edinburgh and Napier University Rhetod MSP for the Highland and Island Good morning, my name is Alex Matthews I work for PA Consulting where I lead a digital work on health and social care in Scotland I'm Colin Smyth, MSP for the south of Scotland Sorry, I was remiss before we began I should have said that we may have some declarations of interest from members and I would like to declare an interest myself in that our close relative is a works for a company involved in e-technology Anyone else, Brian? I'm the director of a technology company creating communication platforms for organisations including healthcare although I don't take any enumeration anymore and I have very little working with that company just now Anyone else? Okay, thank you Anyone like to ask the opening question? My colleagues? Brian? I've got a very general question in asking the question how easy is it for new technology to make its way into working practice in the NHS? Okay, who would like to begin? Yes So I think there are several routes in Scotland there is the SLA in their help with the health improvement Scotland there is through the universities if you're a knowledgeable small company you can get in with technology or a very large company in the right clinical connections and the academic groups can do that the problem goes I think beyond that as soon as these technologies start to get proved or CE marked, are you ready for market then the barriers to uptake are then very very high so I think we're quite good at setting up the initial research programmes and I think we're very bad at implementing our own technology in the country Alex? Under certain circumstances it can be incredibly easy to introduce new technology into the NHS in Scotland we've got some direct evidence of having worked with NHS education for Scotland to do just that where we implemented a live system to help manage education and training of training doctors in just four months so my answer is that it's incredibly easy to do but it just needs the right conditions to be put around it Christof? I'm a little bit surprised about this answer my experience from years and years in the NHS is actually that it is more like Patricia was already saying it is not really that easy and the more complex the technology the more complex it's going to be because simply due to the structure of the NHS what is lacking is some kind of comprehensive policy approach so what we have in the moment in Scotland I would think we need to talk about that and we need to be more detailed in our planning and what we want because technology is moving forward rapidly and while I appreciate that you might have been talking about certain specific technologies that indeed could have been managed in four months time key technologies that are relevant for tagging for managing patients for managing pharmaceuticals and stuff we don't have the right technologies and we have a very difficult process in the moment to trial these things and implement them which has also economical implications John? Five years ago now the health innovation partnership in fact it was Ms Sturgeon who launched it when she was cabsec for health and my organisation was given the job of delivering that time we've partnered about 180 companies with over a thousand clinicians now these clinicians would be the early adopters the kind of self selected themselves but the outcomes of that are now starting to come through to the procurement level and I'll not say it's easy I agree with the remarks that Christoff has made but there is a mechanism to help where we find one of the barriers after that is that even when the NHS may buy the new device and we've got some specific examples of this NHS procurement in one case bought 30,000 devices which were better in terms of patient outcome and cheaper than the existing products and then silence they're in the warehouse in Lanarkshire and to get the information across we call that issue treatment adoption and spread you can do all the research and prove that it works and have a bunch of eager clinicians but unless you do adoption and spread across the board the result can be a bit of a damp squib so who if they're still lying there if they're still lying in a warehouse who's held accountable for that who's held accountable for that there are huge ways to public money we're talking to they are not complex devices they're basically they are drain tubes for surgery with a novel way of adjustment instead of stitching them into the patient's body there's a very clever way of doing that without information not being available the fact that people have always used the old ones the fact that the suppliers of the old ones are quite keen not to have their market taken away and they have so who's accountable for that we've had a meeting with the NHS director of strategic sourcing so is he accountable and he's very interested in that no but being interested is he the person who commissioned that contract and therefore is accountable for that decision being made because it's someone else I don't work for the NHS but I think the answer to your question is yes thank you Tom in the example I'm using these things cost pennies well maybe £1.50 it's a piece of low-tech but very very useful innovation and it's patented and the NHS is very good at saying right we'll buy 30,000 of these but then adoption and spread is the issue how do you get the information out whatever it is it's maybe a simple piece of plastic or it might be a complex e-health system is that one example that you've given repeated in many other areas yes I could give you other examples can you write us with more examples of that sorry Tom the clinical application said this is a normal method how is this impacting upon patient outcomes presumably patients are losing out indeed we've got evidence from the NHS the NHS has an assessment organisation called the Scottish Health Technology Group and it assessed this device and wrote a positive report it was cost effective the patient outcomes were better and they recommended it for NHS procurement and we were delighted with that and thought that's it but okay Elaine you wanted to come in on this and then I'm going to come to you even there's a number of people wanting to come in on this so I come at this from a slightly different viewpoint in that I stand beside the NHS and we look at the innovation that happens within there so what we're doing is looking at innovation that actually originates within the NHS and looking away for that then to be out in a much wider basis I think what we find is the willingness to innovate and the facilities to make that happen are very very good within the NHS and we can go and we can work with companies and we can bring all the expertise to bear I think we're and perhaps John alluded to this once there's a product available that's looking to be rolled out in a wider basis I think at that point it becomes more difficult because it's actually an area where the dissemination of success isn't rolled out as well as it could be the sharing practices aren't rolled out quite as well as they could be and I think if this was attacked at perhaps a more national level rather than a geographic level it might open up some of those barriers okay I have a few people wanting to come in Alec and Ivan and Marie Marie is it on this issue because you indicated very early is it on this issue? It's really just a comment so we don't often as politicians hear a plea for something to be centralised but that was a common theme throughout the evidence that was given was that the variation at health board level was causing a challenge on the ground and that actually centralising commissioning and distribution would be a good thing that's a real challenge for us as politicians so I just wondered if you would like to have a comment on that I think within the community there is a very real appreciation that there are lots of people that can play a very important role in this I think that if there has been any criticism levied in this particular environment it is that there is some confusion over the roles that each of the organisations play I think that each of them have a very important role to play and I think that what we would look for is some kind of co-ordinated effort to define roles and responsibilities to facilitate the organisations coming together and working in a complementary way When you talk about centralising many people envisage committees and large structures in the centre I think the problem of the centralisation at least making some sort of similarity across the NHS really goes to the front line staff many of us will have experience in devices for the community devices for home or patient monitoring and there tends to be an enthusiasm from certain groups who can see the cost savings or the time savings there tends to be what we call pilotitis everybody wants to pilot a little bit of something I have to say you tend to find real kickback from the front line clinical people partially because I think digital medicine and e-health and personal monitoring is very challenging it challenges both the clinician and the patient and it monitors both the clinician and the patient and so without a mandate to do things what happens is a community group may try something and several say nurses in the group don't want to use it, it never gets adopted because there's no uniformity and it's very difficult for them to get the business change mechanism because for example I've got a device that saves time in wound care but unless you're on electronic nurse management and you're managing your day saying I don't need to see that patient the results say these are okay or it's diabetes or blood pressure then it's very hard in the current system paper based and take your bag out for the day to make the changes so these are some fundamental changes in terms of everything from diary management to who picks up the result and who monitors what's happening so it's centralisation and similarity but in a different kind of way More pilots than Ryanair would you say well maybe everybody has these things Elaine did you want to come back in? Yes I think it's also very important to make sure that you're looking at the requirements that what is implemented is implemented across the board it's very easy to implement something that would only be suitable at a very small geographic area if you then open that up to a much wider area and it's managed in a coherent way you can make sure that the solutions that are input in place are actually solutions that will be suitable across the board rather than just in small niche areas Andy, did you want to come in? It's an organisation that spends a lot of its time doing the centralised activities I think to Alex's point earlier on there are certain conditions when new innovations and new technologies find their way to NSS that makes it a lot easier it's this kind of national level sponsorship in bodies and the connections are made back into all of the different health boards that we'd be looking to deploy these types of technology so we've got a proposal I think that we put it into the submission to the committee in and around a service that might support a single process and a funnel if you like for new technologies to find themselves to the front line and providing the type of support that that these types of initiatives require it's been able to it's been able to get beyond procurement law it's been able to get beyond governance, the funding the implementation, the support models that come with that the on-going funding of the tail often there's funding for the initial deployment of a new technology but we've got to then run that as part of the health service you need to be able to see the next 5-10 years with the funding to support that type of technology and helping the boards themselves who daily struggle with just the sheer volume of demand on them to implement change doing them day job so I think there's a role for support from a central point of view I don't think we're saying central organisations should deliver these new technologies but certainly a role in supporting the boards but what you've described appears to be a very cluttered landscape of a numerous hurdles that have to be gotten over before something actually gets to patience now given that we're talking about technology are we not in a place where it will be yesterday's news by the time it goes through that whole torturous process well it's a lot of the controls that are in there are in for fairly good reasons in terms of value for money sponsorship, willingness of boards to deploy we've heard an example from John there that there's no point in us going by in new technology if there isn't the willingness of the health boards to deploy that new technology we can't control that but we can certainly support it but those things take time I'm not sure I'm not telling you if you don't know it's an extremely complicated organisation the number of different clinical disciplines there are the 22 health boards 170,000 employees 3,500 different locations on the end of our network it's a very complicated organisation so I can understand why people would have the impression that there are many hurdles but it's because of that level of complexity and the governing structures that sit underneath it that make it so and could all of that be radically streamlined? I think we could Is there a willingness to do it or is there evidence that that's happening? I think in places Alec touched on this earlier and I think it's probably wrong to build the impression that there is nothing there's nothing new happening in the world of technology in the NHS, I think that's extremely unfair what we're currently working on on the number of things on the number of fronts I don't think anybody's suggesting it No, no, but it's that impression that perhaps committee members could come away with that there's nothing new making it to the front line and I think that's not true Christophe and then I'll come to you Ivan I mean, I think one of the biggest problems we have I understand all you're saying any but the problem is simply that new technologies evolve they evolve on a global scale globalisation and I mean I understand that the NHS has all of these problems but these technology developments they will not wait for the NHS so we need to find pathways that help us to evolve to develop these technologies also for economic reasons in Scotland and then implement them into the NHS we cannot take these technologies on grass road level into the NHS and wait until they evolve on the speed of the NHS because then it's exactly as you said it's yesterday's news this will never work, we tried it in the past it never worked and throwing 200 pilots clinicians who are up to their neck in high levels of demand and with technologies that don't integrate with the current platforms that are there and introducing a level of change that interferes with operational delivery so I'm not saying that we need to get that balance right and perhaps to Neil's point that there is opportunity for us to look at how do we streamline this and make it more effective than it currently is I'm not pushing back on that need Elaine, then I'm going to bring Marie then Ivan I think just when you touched on how long it takes to develop these technologies and how quickly they change, I think you also have to look at how long it takes for the regulatory approval process for these devices and technologies to be implemented at this point in time it takes an inordinate length of time to have an examination of a technical file for example so you could have all of the evidence ready to have this on the market as a same work device and you may be six to nine months to have a notified body come and do the approval process Marie No, no, okay Ivan First I just wanted to touch back on the initial interaction with John Brown and yourself around about this new devices that are stuck in the warehouse and the initial reaction, I think this gets to maybe part of the core of the problem but the initial reaction was who's fault is it, who do we blame who bought this stuff that nobody's using surely the person that bought this stuff is doing the right thing by taking the risk which is the key part of innovation the problem isn't there how do we engineer that and if we go back and blame the person that bought it then nobody else is going to buy a new ever again and that means we don't move forward that mindset is critical in my experience to moving the innovation agenda agenda forward second point I want to be making people may or may not want to comment on that but if there are innovative technologies there is an example there that I'm assuming saves money, I'm assuming makes processes better and more efficient I'm assuming that they can get through their lists quicker and the health board managers would want to deliver on if they're under that pressure there's no shortage of health board people come around here and tell us they haven't got enough money resources to do stuff there's ideas there or products there that make things more efficient you think they've fallen over themselves to adopt this stuff so there's clearly something missing in that chain of how people see their role as health board managers or directors or their awareness of what's going on or their ability to execute stuff and running with it and I suppose the last thing that I wanted to throw out there was a question round about some of the stuff that Elaine was talking about perhaps innovative ideas if somebody can maybe map out for me the path if I'm a health service employee working on a ward or whatever and I've got a good idea and that might be not necessarily in its high tech probably not, just let's reorganise let's do something a bit differently instead of doing the process reorganise the way things are laid out here or change something in terms of information floor or anything how do I get that good idea through this process who do I talk to, what do they do with it where does it go then, how do we try because unless you've got that innovation that contains improvement bubbling up from the bottom and people feel they can have good ideas that are then taken forward frankly you're not going to innovate you're not going to make improvements I've only got 43 questions to answer on that I've been waiting for 15-20 minutes to get in but everybody's wanting in and that's the issue okay so if I could talk about the last question first Scottish health innovations were set up specifically to work with the health service to identify innovation that happens in there we've been in existence since 2002 and when we first started we would speak to people and ask them about innovation and they would tell us they didn't innovate so that wasn't their job over the years we've managed through evidence to set up a pathway for them to get these ideas through on our board we have four of the major health boards represented and we work with each of the 14 health boards under a service level agreement so we have a relationship with each and every one of the R&D departments within the health board so any employee that has a good idea their first port of call would either be to their own management who would direct them to R&D department or in some instances they would come directly to Scottish health innovations what we would then do is we would evaluate that idea to determine if it was something that was useful if it was innovative if there were other things that perhaps answered the same question we would point people in that direction but if it was truly something that should be developed for the better patient care or better way of doing things what we then do is we pull together a team of people that can help take that innovation from the first idea right through the whole process and we help both with advice and with resource and eventually with finding partners that will then take it on to the market Choose the, you want to directly raise the other I'm happy with that if you have any comments on any other stuff that I raised as well I talked about a thousand clinicians working with 200 companies and these are the early adopters but they are busy clinicians who see the point of the innovation and want it and are happy to work collaboratively the other people who get it are the top management of the NHS Paul Gray, the chief executive has had a career in Government IT he really understands these issues but I think that one of the blocks or the barriers in management support for innovation innovation is not on the job description of senior managers in boards not yet and for example one thing that needs to be done is that rather than work on the good will of these thousand clinicians who are doing it off the end of a very busy workload in many places the healthcare system funds a bit of clinician time on innovation with collaborators that's not done yet in Scotland you have to rely on altruism or some clinicians who are interested in innovation for its own sake and they find it really enjoyable to work with companies to develop new products but you cannot depend on that to have a system that will pick up innovation and implement it across the board anyone else like to comment on that? Christof Let me add one thing to that I mean we are speaking a lot here about the NHS and what we can do with the NHS and these kind of structures I think it is very important to also consider parallel universes so for example in the moment there is a lot of discussion in information technologies mobile technologies about new technologies, communication technologies such as 5G these technologies are the future on a European level they are being pushed forward there will be early prototypes in 2020 in America this is already on the way now these technologies they will be essential to the way we are going to treat patients over the next decade over the next 20 years and I think we need also to talk about this I think it is good what we are doing in the moment talking about the NHS how it is not working how we get innovation out of the NHS but I think we also need to look into the next couple of years into the future because otherwise we will be here all a little bit on the back foot England invests double digit million figures in this technology we have not a penny available in Scotland in the moment so we are completely cut off of this and I think these kind of things need to be discussed because you cannot look at health technology as a single standing issue because in the future we will treat more and more patients outside hospitals this is a fact and when we do this there needs to be connectivity between the point of care which will be shifting out of the NHS into the patients home and we need communication technologies to connect in order to deliver the next generation of healthcare and I think this is very important rather than to discuss what has happened over the last years and how we are very stand and so on I am very interested in how decisions are made in adopting tech within the health service Alison Johnson and I attended a fascinating visit to the cancer research centre at the western general in Edinburgh and there was a guy there testing drugs and he had a new machine not like a fish tank and it cost a quarter of a million pounds but it allowed him to do his job 67 times faster than he used to do it before in terms of the number of drugs he could test in any one day which is fascinating and I suppose it led to a question to me as to what what is the parameters that are put around decision making like that what is the fulcrum over which a decision is taken to invest in this tech and this innovation is most effective and I'm conscious that we don't operate in a vacuum here, we've got tech companies who are lobbying clinicians and decision makers to choose their brand and their machine and extolling the virtues of their machine but can I have some views from the panellas to how those decisions are currently taken what are the parameters that are used to decide it and how are we getting it right Patricia, did you want to come in earlier can you come in and also raise your earlier point I wanted to follow on from Christoff actually and say we have to be very cognisant of what's going on elsewhere if we think that Apple now have a complete medtech division they're promising glucose sensors on their watches etc and so there are developments coming commercially that patients want to access and we're going to push this very very hard and I know that Justine Ewing mentioned push doctor in her submission and if you look at even that push doctor for £20 on your phone you get a face-to-face consultation with a qualified GP and a prescription if you need it and then I read every weekend about the locum problems all over Scotland and the millions and millions of pounds that are being spent on locums and I wonder why can we not take some subscription for patients through NHS 24 to push doctor it would probably get rid of much of the actual go and see patient problems now these are commercial developments and I know it's a bit taboo we're rightly very proud of our NHS but we have to look at where companies have developed the right solution and not do it from scratch much of the home monitoring will come on to that as well I think on that side the other thing we're falling behind in is our innovation pipeline we are not funding our devices and our medtech development in Scotland as we should be and I work with people in Hong Kong, Singapore around the world in the US who are building up large wealth packages because they're developing companies and research projects together and it really has fallen behind here I think on the decision making to come back to members' questions I think at some levels if it's a very large piece of equipment like a surgical robot then you can make application to the health boards and they have to have very good cost savings arguments if you're a big company you can maybe do that and I know maybe worth talking to people like Medtronic et cetera on that on the more day to day stuff for the SMEs it's whether you have a clinical opinion leader and whether you can push through the clinical barriers, the natural resistance that people have to changing the way of working and if you imagine a big organisation trying to roll out I don't know a piece of HR software in the NHS everybody gets to try that software and say oh I don't like it I'm not using it in my job and we have this situation where we have a very complex clinical management need but we also have everybody empowered to say ye or ne to new things that are coming on the technological side and I think that becomes very very difficult and it is a natural human thing and I understand the push back on it Alison is it on this point? No. It's a hit. Come from elsewhere I have to recognise that the third sector is a major innovator in both digital health and care. There's few examples if any of them working with or connecting into the NHS and social care and part of that is because I don't think it's really seen as a partner it's seen as a safety net whereas actually it's a provider of a third of social care services there's a huge amount in terms of clinical research and a way to address that would be to give it a seat at the table and that includes some decision making and part of the fold and not something that is an afterthought. Andy, did you want to? I think that the answer to the question is it's highly situational and it kind of depends on the technology it depends on the linkage into the clinical community normally if there's a new piece of technology it will be picked up by the clinicians and if there is a national level organisation that's round about that then you've got a better than average chance but the governance essentially sits board by board in terms of the adoption of new technologies that's the default position if anything is decided to go national there will be a layer of national level governance will be put in place to oversee the deployment into board by board but once it's made it through that threshold you need that initial threshold to be picked up by the people who are willing to sponsor it through the health service push it to become a national level programme and then things become a bit more straightforward at that stage there's a rough guide to lobbying in the NHS about how to get your product through the system you just gave us it there Alex I just want to add to Alex's question whilst I'm not going to comment on the process of decision making I think one of the complexities that needs to be recognised is that in saving clinician time for example quite often that's very easy to identify and very easy to recognise but actually translating saved clinician time into an actual cost saving is very very complicated to do so I think at the heart the issue is the ability to take that kind of clinician time saving and be able to translate that into a better balance of health and social care that actually achieves a shift away from hospital or residential or locality based care into people's homes and for people to take more responsibility for their own healthcare and start to self treat, self diagnose and engage a little bit more in the way that they look after the care themselves Alex I'm grateful for that because of this committee MSPs around the table are all too aware of the efforts that pharma companies go through to try and lobby us in terms of trying to exert such influence as we have on the government in terms of its dealings with SMC and getting licensing for drugs tech in the health service is commodity based as well it's about selling goods to the health service so I wonder and in fact the convener of this committee about lobbying of parliamentarians but I wonder if the panel could tell us about how pervasive lobbying is within the health sector from tech companies who are trying to sell their equipment to the NHS and how effective that is and in terms of the situational aspects that you describe Andy where your second question I just want to say a very brief word on the first adoption and spread your example is adoption the issue is spread and as long as it's board by board that's not going to be easy it's going back to the point that Andy made and having what we've labelled a once for Scotland approach would be a great step forward if Greater Glasgow and Clyde the biggest health board in Europe technology A really saves them a lot of money why do the other 13 get to say that we're not interested and that happens so this issue of spread once for Scotland it might be great if Greater Glasgow and Clyde are wrong they might be but they'll have evidence for their decision and that's the sort of thing we get all the time which leads to siloisation and we're a tiny company the NHS in Scotland looks after a population that's less than the size of Yorkshire and doing it this way is not optimal at least in terms of the uptake of new technology but as far as lobbying is concerned if you're a big global company with a big budget you can afford to do that one of the things that drives me is the Scottish economy and Scottish companies and they are nearly all small companies they can't afford lobbyists they develop stuff they work with clinicians they do what they can to spread the word about what they're doing I agree with you that the hard lobbying by big pharma and that we've got big pharma members can be counterproductive and sometimes they deserve that but for most Scottish companies trying to develop a home market so that when they go to the US and their salesman is asked how many of these do you sell in your home market and the answer is none but why should we buy it for small companies and most life sciences companies in Scotland are small or medium sized they do not lobby because they can't afford to rather they work with clinicians to try and get the message across Okay Alison Thank you convener it's on the the question of sharing the electronic patient record and security Professor Thumiller you spoke about how essential connectivity would be in the future if we're going to be treating more and more people out of traditional clinical settings and obviously there have been concerns raised around the security records in your submission you speak about bad press related to unauthorised data dissemination the case of the Royal Free in London passing on rich patient data to deep mind I know that PA consulting received some negative press a couple of years ago regarding uploading data sets on to a Google tool and potentially uploading patient data to offshore servers and I know that you maintain you safeguarded that data appropriately the concerns that people have Professor Thumiller you speak about well the fact that central databases are susceptible to malignant attacks and that a comprehensive merger of all existing information on to one centralized database will be almost impossible and you also speak about a tendency for uncritical and uninformed procurement with excessive spending on technology consultants and it seems to me there is a lot that we're asking the NHS to get its head around it's almost like they need to be in the vanguard of digital security do we actually have the staff are we training them appropriately or are we always going to be running to catch up Can I answer there? Yes, of course I mean thank you for the question indeed all of these things have been there and we all know that they have been around with regard to the security I'll remind you into the WannaCry attack and of course these are the risks and the issues about centralized databases I mean the question is if we are talking about the electronic health record what do we have in mind what are we looking at I think the future will not be the electronic health record because we still have and will always have and even more in the future so we'll have distributed databases they grow everywhere like mushrooms they grow in the different NHS trusts they grow at your GP they're growing at your dentist in your pharmacy your physiotherapist I mean this is the problem so it will always be a kind of a distributed database rather than a database that is sitting in one computer and this is not too bad actually because it gives you a little bit more protection just imagine all of that data would be in one supercomputer machine and this one supercomputer machine even though mirrored into different locations would be on the attack you will have a huge problem so you don't necessarily want that hence why we will see more and more distributed healthcare and consequently distributed databases and we need modern communication strategies extremely important I cannot stress enough how important the developments around these new technologies 5G and so on are the other question that you raised on how much staff and effort and so on do we need I'm not telling you anything new when I tell you that the NHS is an organization which has come into the years it is 70 years old it is almost working the same way it worked back in the 40s and of course we need to think about new strategies how to manage that so we have to look into how the big technology companies like Apple how are they doing these kind of things big organizations like Apple like pharmaceutical companies going into the health market industry 4.0 these organizations don't want to sell technology devices these organizations want to provide services in the future so we have to get our head around the fact that in the future many services will be provided from third parties and it just will be integrated in organizations such as the NHS so we need a new strategy a new structure that is inevitable I agree with Professor Thunlar in terms of the way in which the electronic patient record needs to be distributed that's precisely been the policy we've been pursuing for some years we don't have there is no one big central database for the health service as it currently stands and WannaCry which I came to this committee to explain details of WannaCry behind it that wasn't anything to do with databases and how it was distributed it really wasn't so we've been pursuing pursuing a policy for some years now in terms of those technologies in particular it's very difficult for us to pursue the kind of things that 5G will bring to bear when there are some parts of this country don't have 3G and there are some parts don't have fibre of the cabinet and we really need to pursue these common denominators to a certain extent with NHS just in terms of us trying to keep up the other companies and other countries that are investing we put 2% of our NHS revenue into IT if you go to the US where Apple and some of these bigger companies will be pursuing there it's 6% and above and so we don't a point that I wanted to make generally we're kind of struggling to keep the lights on with the complexity we've already got innovation brings another layer that will have to be funded and will need to be supported from a change management point of view but I think I'm happy to explain what we've done in terms of the architecture of the systems in Scotland we haven't pursued the big brother type of approach in terms of big centralised database and we are trying to pursue we're trying to move things to cloud but it's complex and it's going to take us time sorry I did see you smile Riley when Andy said it wasn't the database issue for that attack it's true the problem was actually that the files, the Microsoft files were not updated, the update patches were not loaded in that context it was a database problem but it was not caused by a technical issue it was caused by human error if you want so on because you did not update it but the point is what you just made I agree with you with the spending on IT but on the other hand the absolute figures in the NHS that is spent on IT they are quite significant on the other hand where I started to agree I think we cannot say we cannot think about 5G when some parts of Scotland don't even have 3G because that would mean we would always live in the past Scotland could never evolve to top technology because we simply don't have 3G in some areas this is something which I would dispute because we need to basically play in this upper league in order to give chances to our SME technology companies because they cannot develop we don't have the infrastructure not necessarily an NHS issue because this goes into digital this is where the problem lies we are sitting here with a very high emphasis on health while we are talking about digital health so we also need to talk about digital I mean where is our infrastructure how can we convince the telecom operators to provide these technologies the power wide area they have it in England why is that and so on so in a way that holds us back Alison you wanted to come back in Just to ask Mr Robertson on that 2% do you think that's inefficient does that have to change does that have to increase I think it's inevitable it needs to increase the digital transformation of the health service and that strategy is under development right now is during December I think we are at the stage now where you're going to have to invest more to get returns in your business so it's not to say that the NHS has to spend more but I think we have to spend more on technology and innovation to fund the inevitable service transformation that has to take place Brian I think to speak to the first point I think what I'd be interested in is the comparison between adoption of technology in the Scottish NHS compared with a global marketplace because technology's never developed just for our marketplace but with that in mind we've developed a DHI in Scotland that was specifically designed to enable the adoption or the testing and then the adoption of new technology into the Scottish NHS I just wondered if the panel have any ideas on whether that's being productive or if there's something else they should be doing or working differently John I'll answer that last one first if I may we've been tracking the work of all of the innovation centres over the last six years that three of them are in the life sciences area including DHI and we talked to our members in digital health one of whom Site Kit which is based on Sky Campbell Grant its owner was part of the DHI board at the beginning I just I want to speak carefully because I know I'm on the record but let's just say that the innovation centres have not delivered the economic benefits that the Scottish Government wanted them to deliver five years ago and there are reasons for that to go into in detail but there is another aspect of this German and that is the Scottish economy and the MSPs point about other healthcare systems Site Kit based on Sky and Edinburgh office developed about three years ago an e-readbook and for some of you you'll know the post-natal document that new mothers get is the red book Site Kit developed an e-readbook tried to sell that to NHS Scotland the lead clinician loved it but procurement was an issue Campbell is now selling that very successfully to English health trusts they seem to have have managed to get themselves in a place where they can take on innovations like that and Campbell has now opened an office in London a lot of software engineers down there and he's a proud scott and he comes from Sky and I don't think he's going to movies company to London soon but as our submission says if we don't crack this one within the next few years I don't think we'll have a digital health sector left in Scotland because they'll go where the market is Maybe you could write to his follow-up information on why those innovation centres have not delivered the submission Christof? We have dealings with the DHI I think the basic idea about the DHI is good but to us and I want to be careful here also to us at the university on the university level and we are involved in global 5G research so myself I'm the convener for the health vertical at IEEE which is a worldwide engineering association with more than a million members and I also am also the convener of the health vertical at the 5GPPP which is a European initiative so we are linked into this and the contribution so far to any 5G work at Napier is zero zero from the Scottish Government zero from DHI and I know that Strathgleit is struggling as well I said earlier on in England the spending money that comes from the English Government to English universities looks completely different we are talking a first wave of double-digit million figures with a prospect to hundreds of million over the next year is being distributed over three universities in Scotland the investment is zero I hope this is going to change Cleol Thank you I just want to pick up on a point that was made earlier by Patricia Connolly and I suppose that it sums up a bit some of the discussion that we've had today about you can procure a lot of this new technology but actually getting people's staff clinicians on the ground to use it can sometimes be challenging even if we adopt a once for Scotland approach so if we have so many local variations and we do it even within health boards I'm thinking particularly some surgeons operate in one way and some surgeons operate another way even in the same department how do we get clinicians on the ground to accept and adopt new technology and use it in their practice for the benefit of the health service and the patients Patricia I think there is a real issue in business change and I think that's what needs addressed We've been doing some work with John Jean who advises the Prime Minister's office in the UK on medical technology he chairs the DHI I should say at the moment as well but he's very medic savvy and been around the industry for many years and we've been looking at some of the things that are coming up and I think people are busy in the NHS you go into community and you want to save time and put in more monitoring that patients can use for themselves then there's nobody to do it really expertise I mean I would almost create a team in Scotland that worked with the universities from the universities to bring their technologies and their companies forward and go in and analyse the situation and spend some time and money in changing let's say with management at home, diabetes chronic care, pick it out but send in a business change team as well as simply the clinical and when it's implemented well in a small community roll it out mandate as the way to do things once you've proved you've got those cost savings in the area we've talked about this I'm sure Christof and others many many times how do we get over this barrier and I think it's going to take a different type of look and I would get other providers like the apples and Googles et cetera involved in the fact there may be obviously some incentive for them some funding to come from them they will make the money in lots of different ways from adverts you know not directly from selling services so I don't think we should be too afraid if people are happy on social media and in different types of monitoring to interact with some of the big providers to start thinking outside the box about how we do some of the savings important to understand that there will be certain requirements that have to be satisfied and I don't think you can underestimate how important it is to have the end users part of the development process so what you do is you have them at the ground invested in the innovation as it moves forward what you then have is an invested stakeholder who wants to see the success of that innovation what you then have is key opinion leaders that can then take that and can roll that out to their colleagues and they can underpin all of the I'm really sorry I interrupted but you're using a lot of jargon there these stakeholders end users and plain English ok that apologies people who are going to use the technology need to know why it is useful for them what is it going to do for them what improvements is it going to have for them if they are involved in the process of developing that rather than have a solution imposed upon them they are much more likely to be invested in using that so you're talking about clinicians here you're talking about patients for this particular question I'm talking about clinicians I'm talking about the people that will see a benefit from it how do we actually do that I suppose what the committee is looking for is some answers so we talked earlier about there being lots of people in the innovation landscape that can bring lots of different skills to bear I think it's important to realise that the NHS also has an important role to play in that so they should be part of a development team so while there is technology out within industry within SMEs they can bring part of the jigsaw puzzle but the clinicians, the NHS working from the inside out also have a role to play to show how important it is in bringing that technology what will be required the infrastructure, the training how it will fit in with their current practices whether there's going to be changes required to cure pathways if they're actually in at the beginning of what you have is technology that develops in a way that's going to be useful for the people that are actually going to use it to pick up your point about patients with people with access services they need to be at the heart of this as well so that we're building solutions that address real rather perceived needs so that's called co-design about involving people and actually creating those services, understanding their needs not building something no-one is going to use we've got a great example of that cocter or GP, we've collaborated with over a thousand citizens and practice staff in creating three innovative GP digital services which are there for potential implementation we also in terms of adoption need to look at the awareness of digital health and care amongst public, what do they know about it in England where they've made pervasive access to GP digital services it's still very low take up and that's because most people there didn't know those services existed what marketing is going to happen in terms of public awareness and changing the way people think about how they access the NHS and what are we going to do about the digital skills of people to access those services a fundamental statistic is a third of people's long term conditions do not use the internet how are we going to bring them on board and how are we going to do this in a way that doesn't increase or enhance health inequalities so I think we can look at structures we can look at clinicians, we can look at the NHS and we can look at people we're not going to solve this problem Alex Everything that I just said I just wanted to add to that that one of the points that we started to land on from Claire's question and from some of what Patricia said earlier increasingly the technology that we need to deliver better health and social care exists is becoming increasingly commoditised and as a result is becoming easier and easier to actually buy the focus onto some of the things that we've been talking about so decision making, technology selection and then the work to develop and implement it and deliver the business change around it and one of the things that we see most commonly actually is that the skills and capability and actually the capacity of people to do that work aren't readily available within the NHS and other health and social care organisations so for me the key is about making sure that those skills and capabilities are firstly made available so that you can do the work to select and implement the technology but also that they're being built on an ongoing basis so that increasingly health and social care organisations can actually take responsibility for delivering technology themselves which is something that doesn't happen as much to ensure at the moment Briefly, Christo I think it's a very important point that you made I think this is extremely important so it is clear that the NHS as such does not have many of the skills that are needed to come up with the technologies we are talking about here and we are envisaging so we need to really somehow build these collaborations with skills that we have in Scotland we have excellent universities we have departments that have skills that can be more than useful to the development and to the implementation we are not making use enough of these skills and resources that we have and I think this is one of the very important things that we have to do we have to bring the skills, the resources that are there here in Scotland together to manage these processes exactly as you said John It's an obvious question there are two barriers and I'm afraid I'm going to use a bit of jargon one of them is we call autonomy a doctor can take the decisions that she or he thinks are the right ones for the patient no matter what and you may say but this new way of doing it is much better it costs half that doesn't matter this one works, I know it works and I am not going to change my mind that's not an insurmountable barrier but you've got to know what's there to work out how to get past it another one to be a service redesign many new technologies and innovations need the whole process to be redesigned and I would add to what Christophe has said that not only do we need expertise about taking on innovative systems but the previous chief executive of the NHS Scotland said to me this is like trying to redesign and rebuild an aircraft while it stays flying and doing the service redesign while the service is still helping patients is a very tough job but in terms of solutions I see very well why you're looking for solutions one thing that we've toyed with is that boards should be given dare I say it an aspiration I'm not going to use the word target somehow or other the adoption and spread of innovations should be part of what boards are expected to do and if they don't do it then questions are asked at the moment that doesn't really happen I'll come back to that point in a minute Patricia I just wanted to maybe echo about what Zahid was saying and talk about the people or the users I mean if you look at a lot of the adoption of technology for self monitoring then when you actually put it in the hands it is very well received and I go back to something we said in our own submission NHS Florence all you need to do to be monitored by Florence is to be able to text, answer some questions or take a fairly simple measurement on an instrument and the patients overwhelmingly really like this system whether it's for diabetes, blood pressure, heart failure we've tested it a little bit for wound care however it's becoming very difficult to disseminate yet again because it pushes the clinician into a different way of working who's going to look at the Florence results who's going to talk to the patient if they need to talk to a clinician so I think there is a barrier for patients and one of them is that we're not actually providing them access to these technologies to see how they can improve and how their mental well-being improves as well once they feel that they're being monitored anyway if they've got a chronic condition Marie I wanted to pick up on some of the cultural barriers that there are within the NHS to this so I was looking particularly at this attend anywhere pilot which I'm a Highlands and Islands representative it's absolutely key that we cut down on journeys to hospitals for routine outpatient appointments we need to be doing that in a systematic way that will save us huge sums of money, save us flights I mean as a busy working mum it will make the people who are using the healthcare system able to be a lot more productive while they interact with the healthcare system I'm so disappointed to see that only one patient was enrolled in six months and that's not a new technology at all it's not a difficult technology to use those must be cultural barriers those must be barriers amongst the patient group who expect to be able to go face to face and see a doctor and barriers amongst the doctors who'd like to have a patient in front of them and I just wonder how on earth the savings and the improvement in service is so obvious so we can't do it for that and the technology is not even new if we can't do it for that how are we going to do it for anything? The attend anywhere I'm familiar with that from within the NHS and it hasn't been that bad I think maybe the example you've got from one of the submissions was A was it a particular surgery that had only one uptake but that has proved quite popular with clinicians and I think it's very helpful if you can identify technologies that become popular with the clinicians who then have to amend their back end way of working it's this business change element that we were talking to before and I think that they see that as being helpful to them especially in remote and rural locations where that kind of contact becomes quite critical in fact we've taken that technology and put it into secondary care now and GPs are using that to contact the secondary care clinicians and to be able to help them with the assessment of patient results so it's that kind of that's an inevitable march of technologies when you put that type of in admittedly it's not advanced technology for a GP who's trying to manage a broad base of a broad base of patients but some patients like that some patients like going to their GP if that's the point in terms of culture in that side of things but I think we need to stick with these things and make sure that they're available and we give choice to patients as the technology kind of adoption flows through the country it'd be wrong to give up on these things and put them on the back burner You raise an interesting point here I mean we don't just dump technology in NHS and amongst clinicians and with people there needs to be a lot of investment change management and actually the softer stuff the cultural change that's required the training, the time to actually understand this technology and how to use it properly and the processes and change thinking that investment isn't taking place and that needs to happen across the spectrum we're just putting money into the hardware and the software, we're not putting it into those softer elements and that's with the success lies we've got lots of innovation, we've got lots of technology but it's not being rolled out and it's not being used We've taken evidence on NHS governance it's told us that in the current climate where budgets are declining we're doing things like this so that ties in with that evidence in another area that we're looking at Anyone else? Christof did you want in on this? Exactly, just a word of warning the systems we're talking about telemedicine basically there's a problem medicine is not only see and speak and here medicine is touch and feel and smell and everything the physicians perspective or GPs perspective if you want if I can only see the patients I might miss out on a lot so I love to have them close by and also touch and feel and so on and basically make an assessment that clears out the whole process where I can really get a result but again there is technology there is progress on that front so we're talking now about things like the tactile internet where you can actually remotely touch people and I'm sure more of these things are to come and I'm making my point again without communication technology it's not going to work so there are reasons why these technologies don't experience an explosive uptake but I think they will come it just will take time but we also need to build on our digital infrastructure to enable them I was looking at dictionary definition of innovation that says a new method idea or product innovation's got a very positive connotation but some innovation might not be positive for example a few years ago you would have to physically walk to the doctors to make an appointment now you phone up but if you phone up and you have to phone 96 times as one person recently reported to me that they did to try and get an appointment then that is not an innovation that is necessarily a positive innovation so and I use that just as an example to make the point if innovation is coming in are we evaluating current practice adequately to assess whether we need innovation to improve services or whether innovation is coming in to try and you know patch over a hole in the system John if I could take innovation and bring it down to medical devices my information is that there are well over 40,000 different medical devices in use every day by NHS Scotland the Scottish health technology group which is the bit of the NHS that does the assessment much as the SMC does for drugs has probably over the last five years since it was set up assessed about 60 of these very rough but it's right as an order of magnitude now you've touched on assessment and I just wanted to point to the scale of that as an issue now SHTG have developed a fast assessment method called the innovative medical technologies overview process which has got a maximum 12 week programme and we like it very much because SMEs need it easy to use and it gives them a fast response and sometimes the most useful response is we will never buy that it's good that they know that quickly so that they don't waste money this is for devices and where does this fit in with the MHRA well one aspect of that assessment is that you have to have an e-marking an EU and that's taken as given for pharmaceutical products of the MHRA licences the devices and the Scottish TIG and then you make a decision whether that goes into the NHS is that how it works a company trying to sell the NHS that doesn't have a CE marking will not sell it everyone understands that John sorry SHTG doesn't say whether you can sell to NHS or not that was maybe the misunderstanding they don't allow the sale you can go in it is the case that the NHS will never buy anything that doesn't have a CE marking or other regulatory approval but the issue of assessing it in terms of will this innovation pay for itself and deliver what we are talking about around this table is a difficult one because of the scale these 40,000 odd devices most of them have just been sold to the NHS and are in use even some of the more innovative ones but the innovative medical technology's overview process is a step a huge step in the right direction and I don't know if they'll provide value for money or do what they say on the tin most of them that may be the case Patricia well maybe if I could say a bit more somebody also connected to an SME in working with SMEs and bigger companies most companies put an enormous amount of effort into gathering evidence for the benefits of the device and in doing calculations around the health costs so these are provided as papers by the companies to NHS and most devices will not move to sale unless you can show such benefits again the problem comes that whether you have these papers or not every group in NHS wants to pilot the device for themselves so again this exhausting process for staff and everybody else but it would be unfair to say that the medical device industry does not put great efforts into the efficacy and the costing of its devices seeing the cost in regards to how some devices impact on patients unfortunately it's a very high cost as well Elaine Working with the NHS we have created an innovative environment that lets clinicians and healthcare workers come to us with ideas for innovation we have a responsibility to make sure that this is actually something that can go on and be developed into something that will be useful I think we talked about very geographic ideas that will work specifically in one area but may not necessarily work in a wider area so part of what we do is a very full evaluation of the proposed technology before we even determine if this is something that we should develop further and that will bring in all aspects of whether this is a good idea whether there is already a solution whether perhaps they're trying to solve a problem that has already been solved in other areas whether there's an IP position whether the technology is currently available so that will all happen before we even start to develop IP and as it currently stands we probably only move forward with approximately 1 in 10 innovations that come to us from the NHS and there's always a good reason a good explanation as to why we wouldn't necessarily move forward with those and sometimes it's just about getting people in contact with areas where there's already development going on in that area so we don't want to start to reinvent the wheel and that comes back very firmly to the idea where if there's some kind of co-ordinated effort towards innovation we can actually identify pockets and we can put people together and help them to work together towards a solution rather than have many different solutions in place throughout the country could I just clarify something on the health board to then analyse so going through that whole process then they go through another 14 processes even if you have sxtg endorsement or you've had a big green tick from the innovative medical technology assessment you've still got to sell your product board by board for most I know there are big strategic procurements that are done centrally each board would review the papers so we've got another 14 rounds that's the spread issue is that very similar to the SMC process technically for pharmaceuticals is the same that you get a central approval this is for use in NHS Scotland and then each health board decides and assesses whether there is a role for that drug within their own health board is that a similar thing and that happens quite routinely with the central pronouncement there is a question is should it there is a similarity but as far as I know the NHS would not take on a drug in Scotland unless it's been through the SMC process unless it's a cheap generic so the fundamental difference with the technology assessment is that you can get through without the central assessment exactly and there are so many of them I'm sorry we're running very short of time and I want to give everybody an opportunity to make one final comment there's a number of points that have been raised and it's been very interesting to discuss this one and I suppose it's a very it's a very cliched way of doing it but that's me if you were want to get your tuppence worth into developing