Near Me video consulting programme: equality impact assessment

Executive Summary

Policy vision and aim

Near Me is a video consulting service that enables some people to have health and social care appointments from home or ideally, wherever is convenient and practical. This is a free and confidential web-based platform. To have a video consultation a device for making video calls like a smartphone and an internet connection is required, as well as space to attend an appointment.

The aim is for all health and care consultations are provided by Near Me whenever it is appropriate.

Background / context

Near Me is transforming the way people are accessing health and care appointments. Following an initial pilot phase in 2017, and early scale up programmes in the North of Scotland, a national rollout programme was established in 2018. A key driver, particularly in rural areas has been to reduce inequalities in accessing services, in part, due to lengthy travel times.

As part of the response to Covid-19 in March 2020 Near Me is now being used in every NHS Board area in Scotland (hospitals, GP practices) and is being expanded to other services and settings.

Prior to March, there were around 300 Near Me consultations a week and by May it was around 14,000 a week. Recognising the transformational change, a Vision for Near Me was produced in May 2020, endorsed by the Cabinet Secretary for Health and Sport.

Introduction

Based on the available evidence to date this document represents the first National EQIA for the Near Me on-line video consultation service. It assesses some potential impacts for each of the protected characteristics, socio-economic factors, and remote and rural settings.

National and localised mitigation strategies to address any barriers to accessing Near Me are considered. This will be reviewed later this year, but several mitigating actions have already been highlighted.

The EQIA has been prepared on behalf of the Scottish Government under the leadership of Dr Margaret Whoriskey, Head of Technology Enabled Care and Digital Healthcare Innovation. There is no evidence to date that the policy is directly or indirectly discriminatory under the Equality Act 2010.

Engagement and evidence gathering

Since publishing the Vision in May 2020, a range of engagement and evidence gathering approaches have taken place to further understand the potential benefits and barriers of using Near Me. A public engagement exercise was launched on 29^th June to seek views and initially ran until 31^st July^[1]. In mid- July, a virtual workshop was held with organisations representing the nine protected characteristics. This was followed up by a further virtual meeting on 6^th August 2020.

The work to co-produce the EQIA sits within the wider context of the public engagement exercise which took place in July and August 2020. The findings will be reported in September including feed-back to groups who participated, health boards and through the media. Following on from this national plan will be prepared setting out ongoing engagement and process to revise EQIA towards the end of the year.

"Video consulting should continue to be offered after physical distancing is over, but it is not universally appropriate. It should therefore be an option rather than mandatory."

One of the issues to be further explored is how to ensure that people are able to make informed choices about options for appointments which will best serve their needs and circumstances, recognising that the options on offer may vary.

Overview high-level summary analysis

A strong theme which emerged during the engagement was concern that moving to a system where video consultation is the default would be detrimental to certain protected characteristic groups, and in indeed other groups. Connected to this was a worry that for various groups including women and LGBT people who are in difficult domestic situation it would not be appropriate to have a consultation from home. It is therefore important to ensure that face to face appointments (in person) continue to be an option. A further mitigation of this potential inequality could be to ensure that there are options of local places outside the home where people can have privacy to have their appointments.

Another theme of note was the need to consider the intersectionality between each of the characteristic groups. For example:

• Older people from ethnic minority backgrounds may have a different experience than older people in general.
• Young LGBT community also have higher rates of mental health problems.
• People with protected characteristics are associated with higher rates of relative poverty, e.g. disabled people.

Common to all / many

Feed-back from public engagement highlighted potential benefits and barriers. This was also the case within each protected characteristic reflecting their heterogeneity. This is an important finding since assumptions or generalisations were being made about the appropriateness (or otherwise) of the use of Near me.

• Near Me reduces travel time, inconvenience, and risk of infection with benefits for all protected characteristics.
• In its current form Near Me is not yet fully accessible for everyone to use from home. This is due to digital exclusion and/or a lack of confidential or suitable space being barriers for some.
• Some of the barriers highlighted the importance of face to face (in person) being continued to be offered.
• The use of local clinics/hubs and loaning of devices may further help to overcome many barriers.
• The need for inclusive communications was highlighted.

Potential benefits, barriers, and mitigation

Potential benefits and barriers and associated national and local mitigations are summarised in boxes one to four, respectively.

Box 1 | Potential benefits in accessing Near me, including:

• Enables people to attend appointments in a safe manner, reducing the risk of infection, particularly for older people, individuals shielding and pregnant women.
• Improved access to health and care services through removing travel barriers. This is particularly relevant for people with disabilities, elderly/frail people, people suffering chronic pain, people with carer responsibilities and people living in rural and remote communities.
• Reduced time off work or education to attend appointments, especially relevant for carers, young people, and low socio-economic backgrounds.
• Supports carers, family members and translators to be involved in an appointment, particularly for ethnic minorities, those with disabilities and older people.

Box 2 | Potential barriers to accessing this service, including:

• Attitudinal barriers resulting in limited use of Near Me for certain groups where clinicians or organisations may make assumptions about video appointments not being appropriate for these cohorts.
• Lack of a safe and confidential space to conduct a video appointment, particularly for younger people in a house with others, carers or those with disabilities and situations where domestic violence is occurring.
• Lack of inclusive communication of Near Me information and patient resources limits use, especially for people where English is not their first language, have a learning disability or low literacy skills.
• People who are digitally excluded for whatever reason. Particularly for younger and older people, minority ethnic populations including gypsy travellers, homeless people, rural and remote communities, and those from low socio-economic backgrounds.

Box 3 | National mitigation

• Build links with Connecting Scotland, Public Health Scotland, and Scottish Council of Voluntary Organisations to understand the scope and impact of digital exclusion on use of Near Me and provide advice to ensure compatibility.
• Develop inclusive communication and guidance materials for using Near Me, including easy read, languages other than English and bespoke to groups as required (e.g. young carers).
• Share best practice inclusive guides/resources with health boards across Scotland.

Box 4 | Local mitigation:

• Continue to maintain choice and appropriate deployment of consultation type including face to face appointments
• Consider the need for local hubs/clinics to access Near Me
• Establish processes to enable interpreters to join Near Me appointments where appropriate. This would include both service-provided interpreters and informal interpreters/support for appointments, such as from family members.
• Establish and communicate processes to enable patients to do a test call.
• Raise awareness about consultation options including the appointments by video.

Next steps

• As all health boards are now using Near Me, they will be expected to review the national EQIA and adopt it following any relevant modifications and mitigation as per local circumstances.
• The national team will develop a plan to support ongoing engagement and to address any mitigation required.
• Work with each Health Board and other stakeholders to communicate the findings from the public engagement.
• Continue to explore the use of Near Me in prison and custody services including preparation of EQIA or suitable provision of Version 2.0.
• Any potential technical modifications will be described and progressed in partnership with Attend Anywhere who have recently appointed a User Experience Design Lead.
• As part of preparing version 2.0 of the EQIA the vision for Near Me will be reviewed to ensure it is consistent with feedback and evidence. Mitigation strategies and plans will be further developed and implemented.