Technology Enabled Care Programme

Transcription

1 H&WB Executive Group Item 14 Purpose Technology Enabled Care Programme This report provides an update on proposals to develop technology enabled care across health and social care partnerships. Recommendations 2. Members of the Executive Group are asked to: i. Provide comment on the plans for the 10 million technology-enabled care programme; and ii. Note the progress that has been made in drawing investment from Europe and consider how we best support partnerships to access further investment opportunities (annex 1). Background 3. The shared ambitions of COSLA, the Scottish Government and NHSScotland for March 2015 were laid out in the National Telehealth and Telecare Delivery Plan: a. Telehealth and telecare will enable choice and control in health, care and wellbeing services for an additional 300,000 people; b. People who use our health and care services, and staff working within them, will proactively demand the use of telehealth and telecare as positive options; c. There is a flourishing Innovation Centre where an interacting community of academics, care professionals, service providers and industry innovate to meet future challenges and provide benefits for Scotland s health, wellbeing and wealth; and d. Scotland has an international reputation as a centre for the research, development, prototyping and delivering of innovative telehealth and telecare services and products at scale. 4. Ambition (C) was realised with the launch of the Digital Health Institute (DHI) in late 2013, which now has sixteen approved projects and 28 proposals nearing the end of the approval process. There is currently a pipeline of 141 opportunities on top of this and grant funding has been allocated to the value of 517,066 to date. 5. Meanwhile, Scotland s reputation continues to grow internationally with the awarding of 3-star accreditation under the European Innovation Partnership for Active & Healthy Ageing (EIP AHA) for the Telecare Development Programme which rates Scotland as one of the top regions in Europe for the use of telecare; and with the National Falls Programme also recognised, this put Scotland within the top three regions in Europe for the use of technology-enabled care in support of our older population in their own homes. 6. Scotland was also chosen to host the inaugural European Telemedicine Conference and inward investment continues to be attracted from Europe for programmes such 1

2 as SmartCare, United4Health, Unwired Health and Mastermind. Scotland is heavily involved in all of the action areas within EIP AHA, and leads the action group on Integrated Care. 7. Through Edinburgh University, Scotland is likewise leading a pan-european consortium seeking potential investment of hundreds of millions of Euros as part of the Knowledge Innovation Community on Active & Healthy Ageing (LifeKIC). 8. Ambitions (a) and (b), however, are progressing more slowly - hence the Cabinet Secretary s announcement of 10 million to support the spread and expansion of telehealthcare. 9. This paper develops further detail on the 10 million Technology-Enabled Care component of the Integrated Care Fund for 2015/16. This sets out five key areas for embedding and expanding the application of technology-enabled care across Scotland in order to fully realise the ambitions in the Delivery Plan. These aim to integrate and mainstream this approach within core partnership planning and delivery arrangements and provide an excellent opportunity to promote development at scale. Although the 10 million is for 2015/16, some of these actions will be prefaced with work in 2014/ A dedicated Programme Board has been created to oversee the Programme, with the National Telehealth & Telecare Advisory Board (NTTAB) continuing to have overall oversight of the National Telehealth & Telecare Delivery Plan. It will be administered and run by the Joint Improvement Team (JIT) with additional support and capacity provided by the Scottish Centre for Telehealth & Telecare (SCTT), the ehealth Division within the Scottish Government, the Quality & Efficiency Support Team (QuEST) and NHS National Services Scotland. Conclusion 11. Members are invited to comment on the plans for the 10 million technology-enabled care programme, and note the progress that has been made in drawing investment from Europe and consider how we best support partnerships to access further investment opportunities (annex 1). Alistair Hodgson Joint Improvement Team September

3 TECHNOLOGY-ENABLED CARE PROGRAMME Annex 1 CONTEXT 1. The 20:20 Vision for Health and Social Care provides the strategic context for telehealthcare developments in Scotland. Technology-enabled care 1 is vital to the successful delivery of this vision, and the importance of digital technology is both recognised in the Scottish Government s Routemap to 2020 and in the wider publicservice reform agenda. 2. Building on the Telecare Action Plan and the Telehealth Strategic Framework , and with an overall focus of at scale, the National Telehealth and Telecare Delivery Plan for Scotland to 2015 was launched by the Cabinet Secretary for Health & Wellbeing in the spring of It set out the Scottish Government s, COSLA s and NHSScotland s commitment to embed technology-enabled options in the redesign of our health, care and support services. There is also an SNP manifesto commitment to increase the number of people who are able to receive telecare services at home. 3. While the initial timeline set out in the Delivery Plan is to 2015, many of the objectives go beyond this timeframe to fit within our longer-term ambitions to Oversight and monitoring of the Delivery Plan is provided by the National Telehealth and Telecare Advisory Board (NTTAB chaired by Director of JIT), whose membership is drawn from a range of key stakeholders across primary care, secondary care, social care, third sector and user/carer organisations, and who require quarterly progress reports. 5. Since the launch of the Delivery Plan, significant progress has been made in a number of areas, evidenced by investment made nationally and locally, our collaboration with European programmes, and the number of people who are increasingly being supported at home. 6. However, whilst specific funded projects (such as United4Health, SmartCare & MasterMind see Annex 1) have recruitment targets (a combined 19,089 by end 2016,) taken together with the figures from Living it Up (currently over 9,000 with a target of 55,000 by 2015) and the number of telecare clients (circa 122,000 new since March 2012), NTTAB have projected we are unlikely to reach an additional 300,000 people by This paper outlines how this commitment can be met, by effectively targeting the Technology-Enabled Care Fund and extending the Delivery Plan by a further year. 7. Scotland is currently at the forefront of implementing technology within care settings, but there is still massive potential to reach more people, to offer more direct health/care support and to realise more benefits it is imperative we continue to invest energy, imagination and resources to maintain our leading position. We have achieved this success with modest investment from Scottish Government and used this to lever supplementary inward investment from Europe/UK Government agencies. 1 'Technology-enabled care' is the term used in this paper to cover the wide range of technology solutions developing in Scotland, including Telecare, Telehealth & mobile health & wellbeing services. 3

4 8. Through implementation of NHSScotland s ehealth strategy there has also been significant investment from Government in core ehealth electronic systems such as the national Patient Management System, the Key Information Summary, clinical portal technology and GP practice systems to provide more integrated services and make much more and richer information available to health and care staff when and where they need it. 9. However, there are also areas where Scotland is not so well placed: Although telecare is now well established across Scotland, considerable variation still exists across areas; We lack robust local Telehealth infrastructures or a national Telehealth infrastructure; While there has been progress made across Scotland over past five years, there continues to be patchy adoption of telecare as a routine response to facilitate early discharge from hospital, prevent admission and support people with conditions such as dementia to maximise their independence and provide support to carers; Telehealth is not sufficiently embedded or embraced by clinicians and NHS services across primary and secondary care, and there is limited interoperability with the core ehealth electronic systems; Telehealth and Telecare are not integrated in ways that would support better person centred care; Telecare is predominantly delivered through analogue systems which inhibit the flexible applications available through mobile/wireless devices and restrict integration of information/data necessary to offer integrated care; Services are insufficiently mainstreamed, with a lack of high level strategic focus at Board/Partnership level with a perpetuation of project/initiative approaches supported by short term funding; Sustainability is too often dependent on external funding with savings and efficiencies not resulting in enhanced core budgets. BACKGROUND 10. The Cabinet Secretary for Health & Wellbeing convened a high-level ehealth summit of digital health leaders from across Scotland on 04 March 2014 looking at how technology and innovation will support the delivery of the 2020 Vision for Health and Social Care. During the summit, Mr Neil identified the following priorities for Scotland: How technology can support improved outcomes for people; The rollout of home monitoring solutions; The rollout of telecare to support integrated working; Remote monitoring and consultation, especially via videoconferencing; Internal efficiencies within the NHS; A personalised electronic patient record for citizens by These were to be focused on 4 themes : Dementia; Diabetes; De-hospitalisation; and Medicines (HEPMA 2 ). 2 Hospital Electronic Prescribing and Medicines Administration 4

5 12. Work on HEPMA and the personalised electronic patient record is already being progressed by ehealth. During a debate in the Scottish Parliament on 05 March 2014 on how innovation and technology will support the delivery of the 2020 Vision for NHSScotland (Motion S4M ), the Cabinet Secretary announced 10 million to support expansion, service redesign and scaleability of telehealthcare as part of an integrated care package. 4 APPROACH 13. Five priority areas have been identified for development and expansion of Technology enabled Care. These have been built on developments and evidence to date. Detailed scoping and project planning will be progressed over the next six months to generate robust delivery plans for each of the five areas to ensure effective implementation during 2015/16, with some activities commencing during 2014/ Integration Boards and Lead Agencies will be required to articulate within their Strategic Plans how they will they will extend and deliver Technology-Enabled Care within their overall care delivery arrangements. It was agreed by the Health & Social Care Management Board (HSCMB) that the guidance currently being prepared to support the preparation of strategic plans will incorporate specific requirements regarding how Technology-Enabled Care will be, how it will contribute to a reduction in hospital admissions and timely discharge practice and the level of investment in the commissioning of this provision during the life of the Plan. 15. The National Delivery Plan sets out five key principles 5 to underpin the design, development and delivery of Technology-Enabled Care. The areas set out below complement and support these principles and are fully aligned with the delivery of the ehealth Strategy and underpin the ehealth vision of Scotland being an international leader in digitally enabled care to support people to live longer, healthier lives at home or in community settings. 16. In order to successfully deliver our ambitions in respect of the Integration legislation and the National Delivery Plan there are a number of essential requirements that must be met: Robust, sustainable and flexible technology platforms capable of supporting integrated and personalised care. These should use open standards for ease of connectivity and there should be coordination of provision to prevent unnecessary duplication; Information must flow seamlessly through these platforms between devices and the core ehealth systems used day-to-day by clinicians/staff; Broadband infrastructure that is reliable and available, acknowledging that Scotland-wide availability is still some way off; The technology should be unobtrusive/invisible and easy to use for both staff and clients/carers; The application of the technology must be integrated into the care support arrangements using the technology becomes part of daily routines in ways that support and enable self-care; 3 Official Report: 4 [to] help us deliver real results in telehealth and telecare over the next 2 years page 21. 5

6 The benefits of using the technology must be clear to users/carers and clinicians/staff and result in more efficient and more effective care; Second-line and back-office support services must be available to assist clients/carers and clinicians/staff to use technology to best effect. Wherever feasible these should be shared services; The deployment of Technology-Enabled Care should be set within partnership strategic service and commissioning plans; Technology-Enabled Care should be seen as good value to ensure sustainability beyond development funding. 17. None of the above has been fully achieved but all of the above have been partially achieved. Some of the above can only realistically be achieved if there is sufficient scale to justify infrastructure investment and to provide economies in application costs; these require to be driven through National Programmes. Some requirements will only be achieved through local partnership leadership and commitment. The success achieved to date in Scotland is in no small part due to a good balance between local and national leadership, collaboration between both parties and improvement and support to local partnerships. It is essential for this approach to be sustained going forward. PROPOSALS AND INDICATIVE BUDGET 18. The 10 million will be used to address deficits in the essential requirements set out above to drive widespread adoption. Some of these requirements can only be addressed by National actions those relating to ensuring there is an infrastructure available across all of Scotland, while others will require a local drive to design and deliver operational arrangements that fit within local circumstances. All of them will require collaboration between Local and National Partners. Support will be provided by JIT, SCTT and ehealth with a Programme Board to monitor and drive delivery. 19. The following five priority areas have been identified as the focus for the 10 million Technology-Enabled Care Programme and are drawn from operational experience in Scotland and beyond and considerable dialogue with stakeholders. It is important to note, however, that the funding will be flexible the ability to move money from one project to another as the need arises will be retained. Furthermore, these workstreams are very much interrelated. There will be significant overlapping and mutually supportive activities that will ensure overall cohesion: i. Expansion of Home Health monitoring as part of integrated care plans to move beyond the small/medium scale initiatives that have been introduced in a small number of areas to substantial programmes across Scotland, building on United4Health match funding will be required from participating Partnership areas. Local options include utilising the Integrated Care Fund; ii. iii. Innovation for Dementia to extend and develop the use of technology to support people with dementia and their carers, building on the positive evaluation by York Health Economics of work undertaken in Renfrewshire and the Dementia Demonstrator work in Lanarkshire; Expansion of National video conferencing infrastructure to build on and extend the successful national co-ordination and management of this facility within the NHS so it is available across all health and social care sectors and to 6

7 significantly expand its use for direct clinical and care consultations and multidisciplinary team working. This includes working across the other work streams to embed video conferencing technology into existing TEC systems, enabling citizen video conferencing across the public sector; iv. Build on emerging national digital platforms of Living it UP and ALISS and their back office services to expand supported self-management information, products and services for Scottish citizens this will include direct access to advice and assistance for the public through use of home and mobile technology as well as second line support for clinicians/staff who need to use complementary technology and who access and share information from telehealth and telecare devices; v. Expansion of telecare and move to Digital Telecare scoping a move for Telecare from analogue to digital to facilitate integration with Telehealth and the use of more user friendly, less obtrusive equipment alongside the continued growth, application and development of Telecare and Telehealth. 20. The above have been chosen for the following reasons: The importance of extending the number of people who directly benefit from Technology-Enabled Care with home health monitoring being identified as a service ready for wider application. This will lead to direct and tangible benefits and measureable outcomes that are absolutely in line with integrated care helping people to optimise their independence and wellbeing at home. The worldwide significance of dementia requires that we seek innovative ways of applying Technology-Enabled Care to support care for those with dementia. There is an opportunity to draw from a number of successful small scale initiatives to design and expand technology supported care in this area. The importance of ensuring there is an infrastructure (technology and organisation) that is reliable and available to all this can only being achieved through nationally led actions. The potential to improve patient care experience and optimise use of clinician time exists within the national video conferencing arrangements. The chart below indicates there is still a great degree of variability of telecare provision across Scotland (within the Reshaping Care for Older People Programme, the Local Improvement Measure B3 aims to increase the Proportion of people aged 75+ with a telecare package): 7

8 rate per 1000 aged Community alarms and other telecare rate per 1000 aged 75+: 2013 The contribution these areas will collectively make to improving the quality of care and helping achieve sustainability faced with constrained budgets and a reducing workforce pool. 21. These are mutually reinforcing thus in combination are greater than the sum of the specific themes. 22. A proportion of the total funding will be allocated towards central programme management, which will include expert advice and support to local partnerships; commissioning of feasibility/research work; monitoring and evaluation; shared learning and development opportunities and seeking further external funding. NHS National Services Scotland have indicated that they will be able to provide a degree of programme management, project office capacity and additional data analysis capabilities. ANTICIPATED OUTCOMES 23. The following outcomes are anticipated through this programme: i. 100% increase in the number of people receiving home health monitoring with a consequent reduction in emergency admissions to hospital from this cohort (e.g. early evidence from the Ayrshire and Arran pilots indicate reductions in emergency admissions in excess of 70% are being achieved, with 40% reductions from German pilots, and 20% from the DH s Whole System Demonstrators); ii. A scalable service model for home health monitoring that is efficient from both a clinical and financial perspective. This will include improved patient targeting, triaging and monitoring arrangements and the introduction of more cost effective technologies; iii. A significant increase in the number of people with dementia who are able to be effectively and safely supported at home in the community with technology enabled care services; iv. By March 2016 an additional 300,000 people will benefit from Telehealth and Telecare solutions over 2012 numbers, as asserted in the Telehealth and Telecare Delivery Plan; v. Video conferencing will be integrated across Health, local authority, third and independent care sectors in at least two geographic areas and the number of 8

9 vi. vii. viii. clinical consultations will have doubled by over current levels. (Currently clinical use of video conferencing is not measured, a base line position will be established through a survey of use over a one month period and separate recording of clinical use will be introduced.) This will also contribute to the Scottish Government s carbon reduction targets by reducing travel; A detailed feasibility report will be available that sets out the costs, benefits and methods of moving from analogue to digital for Telecare devices; Living it Up will be expanded to a further five geographical areas in Scotland, increasing usage to a total of 80,000 people by end of March 2016, and have identified a sustainable funding model to support expansion to cover all of Scotland; Technology-Enabled Care will be seen as a mainstream and integrated part of care planning at a strategic and operational level as evidenced through its inclusion in the Strategic Plans required during DELIVERY ARRANGEMENTS 24. Delivery will be overseen by a Programme Board comprising members from each of the Joint Improvement Partnership Board, the ehealth Programme Board and NTTAB, reporting to the HSCMB. The overall programme will be managed by the JIT with a dedicated Programme Manager. Additional support and capacity contributions will come from NHS National Services Scotland, SCTT and ehealth. 25. Currently under development, each of the five areas will have a project plan with a lead agency/official assigned to each, clear objectives and milestones set out and resource assumptions included. 26. The JIT, the ehealth Team and SCTT have collaborated to develop these proposals in consultation with NTTAB and ehealth Leads and will continue to collaborate to manage the implementation and provide advice and assistance to local partnerships to assist with delivery. 27. The HSCMB have approved this approach, and the Cabinet Secretary for Health & Wellbeing has endorsed it. The ehealth Strategy Board, Innovation Champions Network, NTTAB and the Joint Improvement Partnership Board have also all signalled their support. 28. A renewed focus is now required to accelerate the pace of deployment and application as an integral part of the Health and Social Care integration process. Technology-enabled care must move from being an adjunct to care (bolted on to some care packages as an additional feature), to being a core part of care delivery. 29. The Integrated Care Fund and the dedicated 10 million to support and promote Technology-enabled care can enable this over the next few years. 9

10 ANNEX 1 Annex 1: Involvement in Europe The rest of Europe is looking into Scotland with considerable interest as Scotland s reputation within Europe continues to go from strength to strength. Within the European Commission s flagship programme the European Innovation Partnership for Active & Health Ageing (EIP AHA) the JIT s Telecare Development Programme was recognised as one of the top ICT-enabled programmes in Europe. With SPARRA and the National Falls Programme also recognised, this put Scotland within the top three regions in Europe for the use of technology-enabled care in support of our older population in their own homes, with Scotland now one of the few formal Reference Sites within Europe. We are also recognised as one of the leading contributors within the EIP AHA, and lead on the action group specifically looking at integrated care. We have to date managed to attract over 4 million euros in funding since the launch of our Delivery Plan, along with match funding from local partnerships. Scotland is leading involvement in several forthcoming bids, including LifeKIC (potentially worth tens of millions of Euros over a ten-year period) and with further opportunities forthcoming under Horizon 2020 (such as HealthMatch worth over 1 million to Scotland over four years), there is potential for significant European funding to be invested in Scotland, along with further investment from the Technology Strategy Board, over the next few years. Not only do we need to maximise these opportunities, but we must be in a position to support local partnerships to fully benefit from any investment that we attract and, ultimately, support partnerships to start attracting their own funding. The JIT, working closely with SCTT, is well placed to do this. The Health & Wellbeing Executive Group is asked to consider how we collectively best support partnerships to access further investment/opportunities. What follows is a breakdown of current European activity, split into the four different themes operated by the European Commission. NHS24, through the Scottish Centre for Telehealth and Telecare, currently act on behalf of the Scottish Government when engaging with Europe. They have a dedicated European Programme Manager and support team for this purpose. I. European Innovation Partnership on Active and Healthy Ageing The EIP on AHA is an initiative launched by the European Commission in It recognises the major societal challenges being faced by all of Europe s regions and has a goal that, by 2020 we will have improved healthy life-years for European citizens by two years. The EIP on AHA incorporates six thematic Action Groups relating to active and healthy ageing. Scotland is active in all six Action Groups (having committed to share the learning with European partners gained from national initiatives outlined in italics below and likewise share our learning from Europe with local health and social care partnerships in Scotland through the Improvement Network). A1: Adherence & medication (Pharmaceutical Care for Long Term Conditions) A2: Falls prevention (National Falls Programme) A3: Frailty (Acute Focus on Frailty) 10

11 ANNEX 1 B3: Integrated Care (ICT-enabled integrated health and social care in Scotland Scotland has overall lead responsibility for this group) C2: Independent living (Living it Up) D4: Smart cities and communities (Dementia Enabled Communities) SCTT leads the B3 Action Group s Co-ordination Group and provides programme management support for the delivery of the B3 Action Plan. NHS 24 and JIT staff and partners also have co-ordinator or central roles in the other 5 Action Groups. Although part of the European Commission s Europe 2020 vision, the initiative is not a funded programme but it sets the strategic direction of the European Commission, and is influential in resultant funding calls that come from Horizon Scotland s continued involvement is therefore crucial in being able to shape the direction that the EC is taking in this important area and influence future funding opportunities to innovate and reshape care. II. Research & Innovation Research programme in health and/or ICT innovation. The focus is on research and innovation at development stage. Two mhealth projects have been accepted and commenced in the spring of Unwired Health (pre-commercial procurement and development of mobile apps for managing Heart Failure and another to support immunisation programmes); esmart (clinically testing across Europe an innovative mobile app for support to cancer patients while undergoing and after chemotherapy). III. Innovation and Development CIP Projects The Competitiveness and Innovation programme is designed to support the European Digital Agenda, including healthcare. The focus is on scaling existing services/pilots and building the evidence base for telehealth and telecare deployment in Europe. There are currently two Pilot A projects on-going in Scotland, supported by the JIT, across seven Health & Social Care Partnerships in the West of Scotland (East Ayrshire, North Ayrshire & South Ayrshire, North Lanarkshire & South Lanarkshire and East Renfrewshire & Renfrewshire). The projects are: United4Health and SmartCare. These two projects will see home health monitoring for older people with long term conditions (diabetes, COPD and/or Heart Failure) and supported falls management delivered in an integrated care model approach over the next three years. These services were conceived and designed to secure a phased implementation of the National Telehealth & Telecare Delivery Plan for Scotland and to make important contributions to RCOP and the Falls Management Programme. Another CIP Pilot A deployment project MasterMind started in March MasterMind will deploy computerised cognitive behavioural therapy (ccbt) and videoconferencing supported mental health services to multiple regions in Europe. The project will focus on service, organisational and economic impact of deployment of these services and the evaluation is targeted to especially capture experiences and results in these areas to demonstrate the services sustainability for mental health service providers and authorities. 11

12 ANNEX 1 IV. Exchange and Learning Thematic Networks Funded from a number of European budgets these network programmes focus on sharing results and knowledge across the EU on the use of digital technologies to improve local service delivery. CASA (Consortium for Assistive Solutions Adoption) The overall objective is to improve the effectiveness of regional policies and instruments by ensuring the exchange of experiences among partners. The CASA partners work under the umbrella of the CORAL Forum (Community of Regions for Ambient Assisted Living) with the aim of feeding back good practices from a series of study visits and exchange of experiences to influence future policies and funding at European level. The visit to Scotland (held in March 2014) has proven to be the most popular destination amongst European colleagues, with over 80 attending the two-days to learn more about our successes in ehealth and telehealthcare delivery. JIT have been heavily involved in CASA, attending several local dissemination events with European partners who had identified the JIT s telecare development programme, in particular, as of particular interest to their local settings/stakeholders. The JIT have also hosted several delegations from Europe who have been keen to find out how we support both the integration process in general and partnerships more regularly, with a view to replicating aspects of the JIT s work in their regions. MOMENTUM Despite a wide range of telehealth services having been implemented and tested around Europe for a number of years now; very few become integrated within routine care at large scale. MOMENTUM aims, through the creation of a thematic network of likeminded organisations, to identify and address the different barriers to deployment by collecting data through an online questionnaire on telehealth services that either have become routine care or which are no longer running for various reasons. This will help identify critical components for implementing services that are sustainable on a long-term basis in a given provider system. Advancing Care Coordination and Telehealthcare Programme With an overall objective similar to MOMENTUM (in relation to identifying key components for successful deployment and sustainability of services), ACT through the collection of data on organisations and their workflows, patient stratification, patient adherence (acceptability of digital solutions), staff engagement and effectiveness of personnel resources in five European regions will provide key indicators on how to predict sustainability of digital supported services. Future European Funding Currently JIT and NHS24 are working in partnership with the ehealth Directorate, Digital Scotland and our academic, voluntary and enterprise communities to explore further opportunities within the Horizon2020, structural and Interreg funding calls for 2014 and Investment could potentially run into the tens of millions of Euros over the next few years. For example, the JIT is the lead Scottish consortium partner within HealthMatch, which has reached the final stage in the approval process for funding. A decision on funding is due in the autumn, and if successful would bring in over 1 million over four years). 12

13 ANNEX 1 Benefits Investment of over 4 million from Europe. From a relatively standing start in 2012, Scotland has managed to secure noteworthy EIP on AHA reference site status; involvement in 4 thematic networks to support knowledge transfer; participation (and lead roles) in 2 large scale Innovation Projects; and more recent involvement in a further 2 mhealth Research and Innovation Projects and 1 large scale innovation project. This has brought the following opportunities and benefits: New European funding streams which are closely aligned with Scottish strategic priorities e.g. the integrated care agenda; Opportunities to attract additional investment from Europe to support innovative service redesign and delivery in Scotland, as well as the export of Scottish products, particularly for Scottish SMEs; Scotland is increasingly seen as a leader in digital health and care innovation in Europe and so is able to attract further inward investment as well as promote opportunities for the NHS in Scotland and Scotland s digital health and care focussed SMEs to actively engage externally across Europe; Effective collaborations and partnerships can be built with like-minded regions to inform planning and service design and speed deployment and reduce wasted effort; Knowledge transfer can be facilitated, allowing us to share learning from other health and care systems. 13