Video consultations - public and clinician views: consultation report

Appendix 2 Process to co-design the Equality and Impact Assessment

Introduction / context

The outbreak of Covid-19 in early March 2020 increased the use and reliance of Near Me to support physical distancing and reduce the spread of infection. While some local EQIAs were prepared there was no national EQIA in place. With a Vision to grow the Near Me video consultation service, it was timely and essential to co-produce a national EQIA for Near Me.

Based on the available evidence to date, the first National EQIA was published on the Scottish Government Technology Enabled Care Programme's website on 1^st September.

It assesses potential impacts for each of the protected characteristics, socio-economic factors, and remote and rural settings.

The co-production process, high level analysis and findings are briefly described below.

Aim

The EQIA process aimed to engage with diverse user groups to ensure that benefits and barriers to using Near Me video consultation are understood, allowing strategies to be developed to improve choice and access where desirable to do so.

Co-production process

During April, May and June, informal engagement took place with various organisations, individuals, and NHS boards to establish relationships as part of pre-work. This culminated in mid-July with a virtual workshop which was held with representatives of the nine protected characteristics groups.

• Age Scotland
• Alzheimer's Scotland
• BEMIS
• Children in Scotland
• CRER
• Deafscotland
• Disability Equality Scotland
• Inclusion Scotland
• LGBT Youth Scotland
• MECOPP
• Muslim Women's Resource Centre
• Poverty Alliance
• Scottish Commission for Learning Disabilities
• Scottish Trans Alliance
• Stonewall Scotland
• Terrence Higgins Trust

Following the event, a document was drafted and circulated for comment. A follow up virtual meeting was held on 6^th August 2020 to consider the draft content and format of the document. The document was substantially revised prior to publication.

High-level analysis and summary of findings

Potential benefits and barriers were identified across the protected characteristics reflecting their heterogeneity.

"There is varied response as expected around preferences because each citizen is an individual." - People First Scotland

While this may seem an obvious finding it is nevertheless as an important one. Since its inception, generalisations have been commonly made about who video consultations are and are not suitable for.

The EQIA explores in more detail and with evidence some of the benefits and barriers. In summary:

• Near Me reduces travel time, inconvenience, and risk of infection with potential benefits across all protected characteristics.
• In its current form, Near Me is not yet fully accessible for everyone to use from home. Digital exclusion and/or a lack of confidential or suitable space are barriers for some.
• Maintaining the option of face to face consultations and the use of local clinics/hubs or loaning of devices will help overcome many barriers.
• The need for inclusive communications was highlighted.

Issues of training were touched upon. It was noted that discussions around training had tended to focus on technical aspects. It was recognised service providers may benefit from wider training and development in how to conduct an on-line consultation. While this training is available through NHS Education Scotland's Turas platform, it highlights that some further work is required to raise awareness.

Some feedback from the professionals related to impacts on staff carrying out on-line consultation. These issues will need to be explored in further detail.

"For health practitioners to be confident in using the 'Near Me' system and have a positive attitude about the benefits of it. If health professionals are not keen on using the 'Near Me' platform, it can lead to a poorer experience for the patient/care."

More generally, it was often the case that issues raised were wider than Near Me video consultations and reflected other isssues. For example, linked to loneliness and isolation: that people want human contact because a health consultation might be one of only a few contacts they have, and that a move away from face to face consultations was sometimes perceived to be linked to 'cuts' or efficiencies.

National and localised mitigation strategies to address any barriers to accessing Near Me are considered. It was also clear that further work is required to raise awareness about Near Me services because some people were not aware of it. A link to the supporting evidence gathered and some of the engagement to date is included in the Full Report.