In response to the COVID-19 pandemic, the NHS began scaling up the use of virtual consultations. Whilst rolling out the use of this technology has provided many benefits – removing the inconvenience of travel and the need to rearrange other commitments – its fast-paced introduction has led to many trusts encountering deployment challenges, particularly in ensuring equal access for all patients.
On 30th July the London AHSNs (UCLPartners, Imperial College Health Partners, and the Health Innovation Network) hosted a webinar on Virtual Consultations (VCs) and Equity Of Access, to provide trusts with an opportunity to share their experiences of tailoring support to those for whom virtual consultations may seem unattractive/challenging.
The webinar was kicked off by John Craig, Chief Executive of Care City who shared the startling finding from a recent analysis of race and health outcomes that black people in Barking & Dagenham develop long-term conditions 9 years earlier than their non-black neighbours; demonstrating that inequality makes a huge difference to health outcomes and that it’s not just complex but also multifaceted. Although social and economic inequalities can be tough to change, John is confident there is a huge amount that we can do together to make a real difference to inequality through the use of digital technology; not just by mitigating unequal access but by providing people with a range of options for accessing health services.
We had seven speakers at the webinar, from both clinical and operational roles. Here, we share some of key reflections and learnings.
Ask patients and use feedback to make changes
At Oxleas NHS Foundation Trust, when rolling out Webex and Attend Anywhere virtual consultation platforms, Debbie Stanton and Marilyn Hodge told us that they utilised patient feedback to make changes to their processes. This allowed the them to identify the groups who welcomed virtual consultations and those who had hesitations – survey data showed 35% of physical health patients (which tend to consist of older adults) didn’t want to use a video call again, this was less, at 25% in other areas.
Others too, such as The Royal Brompton and Harefield NHS Foundation Trust, have engaged with patient support groups and used patient feedback tools to inform their practice.
Consider the physical and mental needs of different groups
Laura Cook, Quality Improvement Manager for Dementia Clinical Network explained that some of the challenges faced by patients with dementia related to virtual consultation were as a result of other long-term conditions and sensory impairments.
Pre-COVID ONS data shows that in the previous three months only 47% of people over 75 years accessed the internet, but it’s important not to assume that people with dementia can’t access the internet. The Zoomettes are a UK wide virtual group for women living with dementia that have produced excellent guidance for people with dementia who want to access Zoom.
It’s important to consider various perspectives and adaptations that might be required. When asking families about virtual consultations for dementia patients, the feedback was that it was important for the software to accommodate multiple family members in various locations for a patient consultation.
Use text message reminders
The Respiratory and Transplant Medicine Team at The Royal Brompton and Harefield NHS Foundation Trust rolled out Attend Anywhere. The patient cohort for this service is varied in terms of age, geographical spread across and experience of technological engagement. Many patients supported by the service have multiple clinical appointments on different platforms which can cause confusion. To overcome this, they have simplified the process with reminder text messages to patients.
Conduct staff surveys and interviews to inform your approach
At the Royal Free they had taken a collaborative approach using patient and staff surveys, staff interviews and group workshops to create a learning system to influence the way that they build their virtual consultation processes.
Claire Kennedy explained that as a result of this, their psychology team highlighted a cohort of patients who were not engaging with virtual consultations, who fed back that having a consultation at home equated to a lack of safe space, metaphorical contamination of home space, psychological stress, and loss of recovery time. These factors had a subsequent impact on the quality of any healthcare intervention. This will inform the offer to this patient cohort going forward.
During this webinar it was highlighted that there is a clear need for shared learning and access to central resources to enable both clinicians and operational teams to learn from each other and develop solutions as a collaborative, rather than duplication of work in silos. At the start of our journey to organise this webinar we were acutely aware that we didn’t have all the answers or solutions but that we could add value by starting a meaningful conversation about equity of access and the measures we need to put in place to prevent expansion of the digital divide. As Harry Evans, our introductory speaker said, ‘digital exclusion is its own inequality’. Facing this together means that we can implement the best adaptations and solutions driven by patient need, focused on equity and targeting division.
You can watch the whole webinar and access all of the resources shared by our speakers on the FutureNHS platform here.