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Uh Thank you. Well, I want to express it. Welcome to Alastair Alastair Ewing Alistair work. You never know Alistair whether to say your NHS education or NHS inform. But, but maybe you can correct me in a moment. I think there's not a lot to do by way of introducing you because the platform already has been created by, by the discussion, both the chats and the discussion, the presentation from Karen and from Jack. But Alastair is working on the national Digital platform. Respect is the, is the number one prototype for that platform. But I think it's fair to say that we all realize that whether it's tape or respect heading in the direction of the digital, the digital to world so that there's cross talk between primary care and secondary care. And even within within primary care or within secondary care is going to be a key element in getting this to function in a satisfactory manner. So I'm going to hand over to Alison. He's going to give us a little bit of an insight into the technicalities of this where it's heading where it's reached. And so Alice over to you. Uh Thanks Robin Robin, can I just check, can you, can you see my slides? Just, uh that's great. Thank you. So, I work for NHS Education for Scotland. I'm a product manager. And you might ask why, why is someone from the board that does education for NHS Scotland? Why, why, why am I talking? Well, uh the reason why talking is within, within, there's within HHS Education Scotland. We have a, a technology directorate and we've been building technology for a while. We're building education and workforce systems for quite a number of years. And more recently, we've been commissioned by the Scottish government to build out the National Digital platform. So that's why, that's why I'm talking, I'm not a not clinical person, I'm a, I'm a digital person. I'm a product manager. Uh We are set up like a little software company to build software within the N H S. And so I was going to talk about today was a little bit about the platform, a little bit of one of the products we built. Uh you know, an example of a care plan and then talk a little bit about where we are going with that. So to, to kind of start that set the scene. The reason why our organization was set up and why, you know, what we've been commissioned to do is is all down to the Scottish government's digital health and care strategy. Uh And in that, it is very clear statement that you know, we will build a national digital platform. And the point of that platform is to provide clinical data at the point of care to. However, it's providing that care wherever they are providing as well. So this is not, this is not hospital dating uh digital health and care strategy. This is about, you know, whoever is providing that care wherever they are, it's about providing a common architecture for innovation and what that actually provides means we end up building cloud systems and I don't uh delusional with a cloud conversation. But for me, cloud is all about people, it's all about having the information for the, you know, the people of Scotland in a single place that can be accessed. It means that whoever's accessing the data doesn't need to be in one place that the data is not being stored in a single server somewhere. It's being shared across the country. But it's also potentially about being able to share that data with, with people themselves. So they can have access to their own clinical data directly from within a national digital platform. And then the third part is really to allow that information to be used for research and quality improvement perspectives. So um while I'm gonna mostly going to talk about care plans are our biggest product or the, the product that we're most well known for in Scotland is our vaccinations products. We we mentioned earlier on how there are some of the tet work have developed pace through COVID. And from a digital perspective, there's lots of work that also progressed a pace through COVID. And, and one, you know, our best example of that is the vaccination system. And so before COVID, uh we didn't have a National vaccination service, you know, but then that came along very quickly. Uh we managed to stand up digital system which would allow the vaccinators to be able to find everybody in Scotland and identify them and be able to record which vaccinations they had. And then behind the scenes, we built the system that kind of manages that National Vaccinations Database. And, you know, started off with COVID vaccinations, but now has been extended to flu vaccinations and pneumococcal vaccinations and a number of other vaccinations. So it's kind of grown in time from that those original kind of COVID roots. And I think that the vaccinations um so that we couldn't have done the vaccinations work without cloud technologies without modern computing technologies, it just wouldn't be feasible. We couldn't have done it's fast enough, we couldn't have rolled, rolled out across the whole of N H S Scotland in a matter of days that didn't happen. Otherwise, you know, in previous times, rolling out products or even examples of testing able to that standardized across Scotland really, really tricky. It takes a long time where it's a vaccination service because we're in the middle of a pandemic really happened overnight. Across the country. And that was amazing, you know, getting around to work together, but also had a really interesting the vaccinations really interesting from being able to share this datas a while this data was captured in a health setting. Uh It was shared, shared widely. So, you know, we we potentially we could have our vaccination records on our mobile phones so that it wouldn't allow us to go traveling. So the share ing of data was a really interesting aspect of, of what vaccinations helped us understand. So that's what I was going to do. What was going to do is talk a little bit next to be part of the conversation we're having today is to talk about one of the other products that we're, that's being built on top of the national product platform, excuse me. And that's uh respect. So that's matching up with what Karen had been talking about in Lanarkshire. So I've included a copy of respect form system, just a test system. And this is this is what the outputs of our, our product looked like a respect product. It looks like a respect plan. The top half of the printed form is about the person's own understanding of their condition and what matters to them and you know what they fear what they wish for. And then the bottom half captures those clinical recommendations that was talked about earlier as well as the, the CPR decision or recommendation at the bottom that's highlighted in red. And so because it's a, you know, because it's a digital planets formatted and we don't have to worry too much about doctors' handwriting. It's all nicely printed is already we have a bit more accessible. But the the things that we liked about respect, respect as Karen mentioned was chosen as the first, the first thing to build on top of the national digital platform we wanted to use, we want to use products to understand what, you know, what are the components of a platform that, that we need and we use products to exercise that or to kind of guide us. And so we liked respect because it was, it's quite simple, you know, it's, it's only, it's a two page form. So from a digital perspective, there wasn't, they're not lots of complicated, not lots of content or complication. It was, it was very well defined uh been well designed by the Resuscitation Council. So someone had taken the ownership of all the hard work of making sure it works and it's captured the right information and that's laid out correctly, sort of branding and the color and all that layout that was really helpful for us. It means we didn't have to figure that out. So it's nice to page, nice and simple. It was, it's been adopted, it's widely adopted. So within, with many trusts in England, it's being used. So it felt like it was, you know, had good, you know, good um good foundations and a good candidate to, to use in Scotland. We liked it because very patient centric. You know, the first half is about what the patient understands. We liked the aspects of supporting realistic medicine and supporting those conversations. We liked the fact that the purple form was there and it was distinctive and it could be captured the information and we really liked the way that it, it wasn't just about, you know, our organization has been set up to share data between health and care. We like that respect wasn't just about, you know, what happens in hospitals. It really was a much broader uh conversation in hospitals and secondary care and primary care and community settings and that people were involved themselves. So it's a number of aspects that made uh respect, uh you know, a good candidate for that first, that first prototype for that 1st 1st product to build. And so um my next slide, I'm going to go and talk about what we, what we built and what the, you know, what the key aspects to um to what we built for a digital care plan. And this could apply to any care plan and we chose to apply it to respect in the, in the, in the first instance. So from our, from our perspective, we were thinking about digital solutions, we want it to be uh a national system, we want to have, you know, a single, you know, a single product that could be used across the country. Um You know, today there's been, you know, lots of the health boards doing different things and that's really slowing innovation, uh having a single thing that works. Uh you know, allows, allows, you know, a digital approach or a national approach to, to take place. We have a single system that everybody in Scotland fits into a single system. Um You can, that information can be accessed from anywhere. We put controls around it to make sure that access is safe and secure, but it is, it is a national systems. We don't have, we don't have one copy for tasing another copy for uh for Lanarkshire, it's just a single system. So as as people move, you know, as we move homes or they move locations for care, uh the data doesn't move, the data stays in this cloud system that's access by whoever needs to access it. So we, we want to make it accessible. So we, we, we built a webpage, there's no installation, you just connect to a web page and that will give you access to it. We make sure that you're allowed to do it. So the permission side of things are done through NHS Scotland's office. 365 logins, everybody has one of those who works for uh NHS Scotland and uh partners and in primary care and in the community. So if you have that identity that's what, that's what lets you in. So that made things simple. You don't have to remember another password means the health boards are in control of who can have access to it or not. And one of the things that was mentioned earlier on in the talk was just important for the this this information is about person. So we need to make sure we've got up to date information about that person. So having the demographics linked is another part. So we, we made use of the national digital platforms, Demographic Service. So that allowed us to make sure that we had that more subsidies, eight patient information. And we presented that as part of the a part of the user interface to make sure that the clinic, the clinical teams who are filling in, know who's being able filled in for make sure that patient safety is considered. Um And then the final three things that we've, we've, we've learned from building. So I've been really pleased to join this conversation and hear about how much learning has going, been going on, about trying things and working out. And so one of the things that we've learned when, when we, we put this live about three years ago in Forth Valley. And quite quickly, uh we realized that we were missing a future. So what we realized was when the clinical teams were using it, it was was it wasn't very frequent that the clinical teams could fill in the whole form in a single shot that the clinicians were being uh you know, disrupted or taken away or, you know, it needed. And I actually needed a bit of a conversation with a number of different people. And so what that led us to build was uh to support more about teams collaborating and being able to collaborate through the through a draft feature. So the idea in a in a hospital setting might be that the whereas the, you know, there may be a senior clinician has the conversation, maybe a junior, junior partners would write up the conversation and need the, you know, the senior clinician sign off or maybe outside a hospital setting. It might be that the the conversation and the initial right up of the plan was written by um you know, maybe by some of the care home team, a care home team and then their clinical partner, their GP who works with the care home was the one that could provide a clinical sign up. So we kind of discovered through working with clinical teams that in fact, helping collaboration was a kind of a key feature. So that's what we've added that. And I think that helps that, you know, previous um things like the emergency care. So, I mean, it's only GPS that limited wears respect is a much broader um church with more people being able to contribute that. And so the digital system allows that to kind of support that collaboration. And as was also mentioned, it also supports when, when things change, you know, person clinician and condition changes and they want to change your mind about how they care happened. Said it's much, much easier to update a digital system. We don't have to, you know, start from a blank page again. We don't have to be scoring things out. We can, we've got the information and we can take that forward. So the last two points were really about, I think what's the real key bits of a digital system? And it's all about share ing so our first bit was quite a straightforward way of sharing. So while we're building a digital system, being able to give the person themselves and their family a printed copy of their respect plan is a, is a really important part that they, the person still feels it. They've got something tangible, they can put it in the fridge, other hand bag or, you know, wherever they want to take it. So being able to give that formatted respect plan is an important part. So we made sure that was there from day one, but also being able to share the information and respect across the system, being able to share it so that anyone in the case of emergency has access to that. And so that's what we've really been working on most. And I was going to show you what that, what that looks like for most people. So um I was going to start by showing you. So most um in the acute setting, most health boards in Scotland have a clinical portal and a number of different clinical portals uh in use. And so this is an example is again as a test system, it's not real patient information. And Karen, I think this is one of your um clinical portals. This is what, how it looks a little bit in um in Lanarkshire. And so if a person in Lanarkshire has respect for, there'll be a little alert that pops up to kind of highlight that this person has a respect plan and then there'll be a link to the respect plan itself. You can see there's a little hover over that view document so that all of the clinical teams who are in the acute sector can have access to that, see that that relevant information, this respect information is available and then go and see the formatted purple document itself so they can get access to that. So imagine if you know person's arrived in A and E and the first thing to do is any checked and kind of report to what do we know about this person? So that's, that's what this is, that's how it looks for uh acute teams in our colleagues in primary care. Uh As Karin mentioned, we we automatically send respect plans to GPS and we make that appear within the document system. So again, it's part of the clinical workflow within primary care. As new versions are generated, we automatically send those through and then those can be filed against the patient records of the G P is keeping up today about what's going on without them having to necessarily be, be part of that confirmation. They've, they've been have that information shared with them. So what I was going to do to, to finish with my last slide was ready to talk a little bit about what we are, what we're doing now and where we're going with the digital Respect System. So, uh, today we have, we've got five live boards using digital respects. We've got forth Valley Tayside, Western Isles to freeze and Galloway very soon, Karen very soon. Uh Planet Shirt, uh, we've got trials planned in Fife and we're working with Orkney and Shetland and also Russia and Iran have started their implementation. So the, the, the growth of respect is really, um, really starting to take up across the country. We don't have all the boards making use of the system, but we're seeing more and more that the, the existence of a digital system has tipped the balance. So, um, respect is just one of many takes a care plan, but it's, it's, it's good enough. And if you have a different digital system, then that can tip the balance and the decision making with, you know, with clinical teams that there's not enough in it. And in fact, we're seeing the respect being used quite, quite widely, not, not necessarily just in the, you know, the palliative care, the bariatric medicine, but actually quite widely across, uh, seen as it gets bedded in because more and more people recognize that, you know, having something which is common enough is actually an advantage in itself. So beyond the regional boards, our work is really focused on the national Boards and really the unscheduled care services of the Scottish ambulance service, the G P service and NHS 20 for the or the 111 telephone service. So these are the places where that this respect information could be used and it's probably his most benefit. And when we survey our users, the use of respect, this is their number one uh request for the system to be able to get that respect information into the systems. And so we've, we've got our first uh toll in that water. So we're gonna one of the systems that the Scottish ambulance service use the clinical advisers within their uh commanding control centers. They have access to a system called CCS CCS, the web application. And so we're gonna, we're doing some work just now to make the respect information available in that, in that other web application in a similar way to, we made it available to the Lanarkshire Clinical Ports. That's our first step to get it to the Scottish ambulance service. But there's, there's more we can do to extend the information that they have just now to make sure that information is available within the cabs so that the drivers themselves have access to it. And there's, there's more and, and similarly, you know, how do we do the same thing for the, out of our GPS? And how do we work with the systems that NHS 20 for you? So these are all National board and so us having a national, one National board, one national system to another national system makes we do the integration once and it's the integrations that are really the 10 consuming thing. So we do it once and all the boards get a benefit from it. So that's, that's one of the ways that we're working on our next avenue of growth is to, to share more widely so other care settings. So community care settings, we've, we've learning that many of our community colleagues make use of systems like more. So how do we acts get providing respect information to them but also more widely how within directly within care homes, you know, how does, how does, how do we make that share ing and again, because we're set up as an organization to encourage chairing, you know, between health and care, then that allows us to um do a little bit more of that. I think there's a, there's a really an interesting angle with respect about how we share this information with people themselves. I've kind of talked initially about giving a paper copy to people as their, you know, after you've had the conversation. But the Scottish government has a another program called the Digital Front Door currently. And that's about giving people access to their own health and care information and potentially respect fits quite nicely into that as a potential data source and the information and at the top of the initial part of respect has been provided by people themselves as their conversation. It's their words that are being included in that. So that feels relatively safe bit of information to include back in a patient. I think we would start with, with read only information I think would be a while before we get having people to be able to change their records themselves. But it's just, it's a start. And then I think like beyond that, we can see that the work that the respect information we have is is only the first little slice of information that could be useful. We see there's a growing need to have something like an international patient, somebody which has everything about a person that can be, you know, provided to any of the unscheduled care services could be provided back to the person themselves. Maybe it's the kind of thing that I'll have on my phone that I I will carry with me. And so that has everything, all the my medications and my allergies and my problems and the you know, my wishes and plans have that with me. So that you know, if I do keel over, you know, that information is with me and is accessible to people who might, who might care for me. And then potentially there's there's additional growth, you know, to other types of careful. And so for example, things like potentially treatment escalation plans, I say this with great caution, this is the treatment escalation plans are not on, are not on our road map just yet. I think we we need the clinical leadership, the clinical guidance guidance to, you know, help that work happen just now, you know, our focuses on spreading what we have to unscheduled care. But it's almost like that's that's uh laying the rails to share information and then as more information comes available, then those rails will continue to be used. So I think uh we, you know, we will let we will be led by the clinical teams about what's important to, to digitize and and have that uh you know, have that be part of our platform. So the final side I have is is really an invitation. So we one of the things I I really enjoy most about working with respect is that it's a collaborative as a group of people that we work with. So there's a collaborative meeting which meets a quarterly basis to kind of keep people up to date with respect. So you'd be Welcome to come and join us. Please email my colleague for an invite and you know, come and listen and you have to be using respect or have an interest or be having planning to use respect. But if you're interested in, you know, what's going on in Scotland, you'll be more than welcome to join us. So I think I'll stop there. Uh Robin and that's okay. I have to take some questions. Thank you. Yes. Uh I'm not sure, but I've noticed on the chats that there are specific questions that I can just immobilize. Um Stephen, are you able to help out here? Just no, there's no questions just yet. Uh I was gonna kick off with one in that, you know, it really looks like you um the national digital platform as a prototype with respect in many ways that will streamline this process. And I suppose we've been chatting about the interface between tepes and respect as an A C P and, and the ability to maybe have a common tepe across Scotland and then work that all together. You know, I suppose I'm wondering what the utopia is here. I always think that Utopia is like, what, what, what, what are we after? Is it a it's a, it's a digital wallet for many ways for the patient to have all their documentation together and, and everything would run into each other. And so you would have your respect in the community bringing into TEP and maybe they would talk to each other and then back out again, back to respect and we can use the same sort of platform to do all of that. Yeah, I think that's, you know, we could have talked a little bit already about those bits of information which are helpful to reflect between the different systems that there's different, different information that's captured. I mean, so from, you know, my digital perspective, they're just data points. Uh you know, we, we need, we do, we still need the clinical agreement about what, what data points you want, what is your national tip? So I think that that's a clinical conversation as well. And I think there's, there's, I really like the work that can an alliance, the team have kind of talked about the, the use case about how these two systems kind of work together. And it's almost like the next level of analysis would be, how would they actually work together? What, what data points would you share between? Or, or maybe maybe there is no overlap at all. And so that, that's the kind of thing. So I don't have those answers, but it's the kind of thing that we would want to work with the clinical teams to understand, you know, how, how, how those to work together. But this gives the, it's, it's very much um the uh it's very much is realistic medicine, isn't it? Because it puts it all back to the patient, they own their own data, they own their own information. And then that information is accessible by the ambulance crew, as you said. And you know, if you want to print it out, you can print it out. You could, you know, have it on your phone if you wanted to have it on your phone. And you know, it's probably the way forward, isn't it? Um We have um Sarah's made a comment. Um uh It's maybe just the ins and outs of actually filling in the form. Um Theresa says, sounds like great digital system. Um making it easy to um access information, especially for, for care homes where we're sometimes you can get lost. Um It uh it sounds like an amazing process. Um uh Yeah, I think um uh it's about following that sort of steer from clinicians. And so if the steer is that the two things do different things, then, you know, maybe this is the next thing. Uh uh I, I think Alistair just to sort of give you a whiff. I think the steer from clinicians uh is going to grow in terms of human escalation plans. And the, the Lanarkshire model makes them embedded in a complementary fashion and it would be wonderful if in the fullness of time. Um The Lanarkshire, the Lanarkshire Lanarkshire itself, I'm speaking behalf of Jack and Karen without knowing what they're thinking. But, but, but piloting or, or pioneering the sort of cross talk between tips and respect that. I think they're doing in a non digital fashion would be, would be somewhere we would, we would all want to go and, and then, and also with a view to making a national phenomenon just to, for people who are um worried a little bit worried are tips. Uh Can we get agreement about, about what should go on a tip? You'll see there, Jack presented a tip that's been iterated probably about 17, 19 or 21 times. And there is, I think, just to say, uh growing awareness of what constitutes the core basics of a tip. And I don't think moving, I think because all that work's been done, moving to a national program or a digital program which is common to all will not be a difficult task. Um It would have been a difficult task five years ago but, but things have changed remarkably since then. So, but you seem and so um we have a break now just that everybody can go to the kettle on or pop to the toilet. Um For um we are, we're running over because as usual, these discussions are very interesting and there's lots of beer, lots of great questions and there's always lots of questions that come up more um going to give you 10 minutes. So it is 25 past. So we will get you back at um 25 to um there are breakout rooms um should be at the top left hand side of your screen. If you want to pop in there, you should be able to um speak to each other and have a chat. If there's somebody you've noticed that you thought you might want to have a chat to, it will be able to everybody and some of the speakers might pop in there um As well. So, um I'm going to turn off my camera to wrap my microphone. Anybody go put the catalog and I'll see you in about 10 minutes time. Alistair Robin Cara and Jack are going to hang about hopefully for the panel discussion, the end or pop back into the can discussion at the very end just in case there's more questions. So keep your questions coming and uh we'll see you in 10 minutes. All right. Bye.