Video consultations - public and clinician views: consultation report

Appendix 3 Communication and engagement plan

"Meaningful engagement involves engaging people affected by a particular policy, event or change and ensuring people of all backgrounds can take part and have their voice heard and acted upon."

Health Improvement Scotland Community Engagement Website (August 2020)

Introduction

There have been challenges for all organisations to carry out effective public engagement during Covid-19. Recognising this in her correspondence to boards on 25^th June 2020 the Cabinet Secretary for Health and Sport commented:

"I appreciate that the engagement will need to take account of the continually changing environment in which we are operating and may require different engagement approaches to be deployed."

This was a particular dilemma for the Scottish Government's Technology Enabled Care Team leading the public engagement as they were seeking views about an online service at a time when a vast majority of engagement and communications was only being facilitated via online methods. From an equalities point of view one of the objectives was to better understand why people do not use the service particularly why patients might be digitally excluded for whatever reason(s). This was a key theme of the Equalities Impact Assessment.

While traditional methods like telephone and postal are very effective to facilitate feedback, this too was problematic as all staff carrying out the public engagement were working from home. There was also no mechanism in place to promote a free-phone number or a free-post address that could be easily serviced.

Advice was sought from Health Improvement Scotland (HIS) Communications and Engagement adviser, the Consultation Institute, and others. These discussions focused on possible approaches when carrying out engagement during a time of physical distancing including building in flexibility to any plans being developed. The approach taken was also guided by HIS Communications and Engagement EQIA. This helped to identify engagement opportunities available to people who share protected characteristics, and those likely to face disadvantage.

Objectives of the public engagement exercise

• To understand the potential benefits and barriers of using video consulting for health and care appointments, from various perspectives both during Covid-19 and beyond
• To gain insights about those currently excluded from using the Near Me service
• To identify potential improvements to the Near Me service
• To review the Near Me Vision and governance arrangements as appropriate
• To raise awareness with service users and service providers about how Near Me can be used for health and care appointments

Developing and implementation of the engagement plan

Effective public engagement has always required a range of approaches to involve different audiences. The Covid-19 pandemic, however, has forced the need for even more creativity including tailored approaches. Preparatory activities were carried out in May and June 2020. This included co-production of feedback surveys, other materials, and fostering links with a wide range of organisations?

The first task was to raise awareness of the engagement exercise itself and to encourage people to feedback or get involved. From experience, if this phase is successful, then in turn it will generate ideas to further reach out including to those not on-line. The approach used a combination of planned activities but with capacity to respond to any ideas or requests to 'meet'. This should also reflect in the number, type and range of responses received.

As this was a national engagement exercise combined with some of the barriers to engagement it was agreed that this would form phase 1 and that gathering views especially for those excluded for whatever reasons would be ongoing but informed by current findings.

Raising awareness of the public engagement exercise

Near Me website and contact details

In advance of the launch on 29^th June information about the public engagement was prepared for the Near Me website including a public version of the Vision.

A named point of contact was agreed and details including a telephone number (though not a freephone line) were promoted on Near Me views. A dedicated email address was also set up nss.nearme@nhs.net.

Social, local, and national media

Social media

The public engagement exercise was launched on the week-beginning 29^th June via twitter. Twitter was used extensively throughout the period of engagement including various targeted campaigns. This was through the corporate accounts @NHSNearMe, @TecScotland, @DigiCare4Scot and members of the Technology Enabled Care Leadership Team:

Margaret Whoriskey: Head of technology enables care and digital health care innovation: @mgtwhoriskey

Hazel Archer: Digital Access Programme Lead: @hazelarcher

Clare Morrison: National Near Me Lead: @clareupnorth

The main hashtag used was #Nearmeviews which was decided through a poll on twitter. During the public engagement all boards, some health and care partnerships and many others were active on twitter including MSPs and senior Scottish Government officials.

The number of followers tripled during this pro-active engagement period.

Local and regional media

Tailored local media releases were prepared for all 14 territorial boards^[18] and issued to over 120 print, online and broadcast media across Scotland. This was a deliberate approach to try and reach more local audiences including those not online. The media releases included a telephone number and an email address for follow up contact. Local media covered the story in all board areas, such as NHS Lanarkshire:

"Patients consulted over views on video technology for appointments"

National media and online

A national media release was published on 2^nd July 2020 and issued to all national print and broadcast media Link. Promotion was also via BBC Scotland through the Dr Gregor Smith, acting Chief Medical Officer, as part of the First Minister's Daily Brief (6^th July) and mentioned through Professor Jason Leitch Clinical Director on various TV and radio programmes including BBC Radio Scotland football programme 'Off the Ball'.

Many organisations including VHS Scotland, Third Force News, ALLIANCE Scotland, Health and Social Care Scotland promoted the public engagement on their websites and cascaded information:

6 Jul - VHS Scotland Public consultation on NHS Near Me

3 Jul - Third Force News Video conferencing vital for those with hearing issues

1 Jul - ALLIANCE Chief Medical Officer discusses building Scotland's capacity against COVID-19

Stakeholder management (public)

Stakeholder analysis to reflect the objectives of Near Me was carried out during May and June 2020 and built on considerable work carried out by the team during 2019/20. Following on from this a data base of named points of contacts across a wide range of national and local organisations was developed including.

This was a time-consuming exercise because in many cases there were no named points of contact on organisation website (mostly generic email addresses or feedback forms) of which a majority when contacted did not reply. Moreover, on all but a few occasions office telephone numbers were not answered. This again presumably reflected the challenges of Covid-19, home working and wider disruption to many organisations.

Based on the contacts identified, organisations were emailed a letter on the week beginning 29^th June which included a link to the public survey and national media release. Issues with reaching out to people who were not online were highlighted with a request to use local contacts and communication channels where possible. Correspondence was tailored to the audience and one example is provided.

Using this approach over 300 organisations were contacted directly by the Scottish Government Near Me Team leading the engagement. Over and above this many organisations confirmed that they had cascaded the link to the Near Me website using social media and via email to local contacts (Box 4).

Box 4 Examples of information cascade as part of public engagement

"We can circulate material through our newsletters, face-book and twitter feeds, linked in and other local publications. In normal times we could offer meeting space. Anyway, please feel free to use me as the local contact and I will make sure material is circulated."

Dundee Volunteer and Voluntary (17^th June)

"Thanks for sending all of this information over. We've shared this with CCPS members and will post links to the survey on our social media too."

CCPS - Coalition of Care and Support Providers in Scotland (7^th July)

"Thanks very much for sharing this, we'll get the TEC team to look and share it! I'll forward onto our communications team too and see what they can do with putting it out further."

Young Scot (9^th July)

"Thank you for your email. I will share this with colleagues at SYP and will ask if it can be included in our next membership newsletter."

Events and Campaigns Officer, Scottish Youth Parliament (13^th July)

"I have included information about the consultation in our newsletter which went out on Friday and am offering support to our service users who would find it difficult to take part online."

Community Collective Advocacy Development (13^th July)

Stakeholder management (health care professionals)

Prior to the public engagement the Near Me leads worked with range of health care professionals through a series of webinars facilitated through NHS Education Scotland. A data base of contacts for professional bodies was prepared. Through the National Clinical lead for Near Me, contacts were also written to on the week beginning 13 July including a link to the online survey with a request to cascade to their members and invite general feedback.

During the public engagement various virtual meetings were held to raise awareness and facilitate feedback. Clinicians produced short film clips which were available online https://tec.scot/animations/ and promoted through twitter.

Calendar of activities to raise awareness and facilitate feedback

A range of activities were carried out directly by the Near Me Team to raise awareness and facilitate feedback from the public and health and care professionals. There was considerable interest from across the UK and further afield including around the public engagement. Key activities are summarised (Table 1).

Table 1 Summary of main activities to raise awareness

Date	Purpose / activity	Organisation (s)	Method
29 June	Soft launch of Public Engagement	N/A	Twitter
30 June	Local Media	All 14 health boards	Media releases
30 June	Raise awareness	Healthcare Improvement Scotland	Webinar
30 June	Raise awareness	GP Practice nurses	Educational webinar
1 July	National Launch	With Deaf Scotland	Media
1 July	Raise awareness / seek views	SCVO	Virtual
2 July	Raise awareness / seek views	SCLD	Virtual
2 July	Raise awareness	Carnegie Trust	Virtual
2 July	Raise awareness	GP Practice, RCGP	Webinar
3 July	Seek views on British Sign Language	Scottish Government	3-way Virtual
4 July	Raise awareness / seek views	Institute for Healthcare Improvement, US	Virtual
6 July	Raise Awareness with public	Scottish Government	BBC Scotland Daily Brief
w/b 6 July	Raise Awareness	See stakeholder list	Email
6 July	Update on plans	Health Improvement Scotland, Engagement	Virtual
9 July	Raise Awareness / Seek views	Disability Equality Scotland	Virtual
13 July	Raise Awareness / Seek views	BDA	Virtual Meeting
13 July	Preparation for Focus Groups	SCLD
13 July	Raise Awareness / Seek views	SLI/Contact Scotland
14 July	EQIA Workshop	X10 organisations participated	Facilitated Virtual
15 July	Scoping interest	Clacks HSCP	Virtual
15 July	National launch clinician survey	All health boards	Twitter and website
15 July	Sharing experiences	HSE, Ireland	Virtual
16 July	National launch clinician survey	Professional bodies	email
17 July	Discussion on non-digital engagement	HIS Community and Engagement	Virtual
21 July	Discussion	Royal College of Surgeons of Edinburgh	Virtual
21 July	Raise awareness	Perinatal Network NHS	Virtual
23 July	Independent Evaluation by Oxford University published	Scottish Government	Various
23 July	Care Inspectorate Report published	Care Inspectorate	Various
24 July	Extension to on-line survey	Technology Enabled Care Team	Twitter
27 July	Discussion leading to circulation of survey to multiple clinical groups	NHS Education for Scotland	Virtual
29 July	Raise awareness and update	All health boards	Letter
29 July	Exploratory meeting re shielding and communications	Scottish Government/Public Health Scotland	Virtual
30 July	Meeting with a consultant	NHS Forth Valley	Virtual
30 July	Raise awareness	National Carer Organisations	Virtual
31 July	Closing date for on-line survey	Public
6 August	EQIA Follow-up Workshop	X 2 organisations participated	Facilitated Virtual
6 August	Exploratory meeting re-testing use of Near Me	Frontline Fife	Virtual M
9 August	Closing date for on-line survey	Health care professionals
12 August	Exploratory meeting re facilitating feedback via non on-line means	ALLIANCE	Virtual
12 August	Incorporating information about Realistic Medicine	Scottish Government	Virtual
14 August	Exploratory meeting re facilitating feedback via non on-line means	Care Opinion	Virtual
18 August	Exploratory meeting re facilitating feedback via non on-line means	The Consultation Institute	Virtual
18 August	International Conference	Part of HIMSS panel	Virtual

Facilitating wider feedback

Following various communications with stakeholders (correspondence, phone calls, emails, twitter, and virtual meetings), 12 organisations undertook to facilitate feedback (or had internal processes in place) from their service user and professional perspectives. To support this, hard copies of the on-line survey were available, a shorter questionnaire and a template for facilitators were also prepared. The methodology adopted by each organisation is briefly described below.

1) National carers organisations

A virtual meeting was held on 30^th July 2020 with representatives of National Carer Organisations: Carers Scotland; Carers Trust; Coalition of Carers in Scotland (COCIS); MECOPP; Scottish Young Carers Services Alliance; and, Shared Care Scotland. Following on from this they submitted a response by letter in early August.

A facilitated session over Zoom was also held with five carers as part of their local (West Lothian) coffee morning which had moved on-line.

2) Genetic Alliance UK

This national charity aims to improve the lives of patients and families affected by all types of genetic conditions. On 23^rd July they shared their 'Covid19 Impact Report' published on 2^nd July 2020. This was based on gathering views including on the use of telehealth and digital appointments.

3) Hospices in Scotland

The Policy and Advocacy Manager for Scotland co-ordinated feedback across the hospice network in Scotland. Hospices are using a range of virtual services when working with patients and families - including Near Me, zoom, skype, WhatsApp, phone calls and texting. The feedback they submitted related to virtual services in general, as it was not always possible to separate out specific comments that related to Near Me.^[19]

4) Marie Curie Scotland

Between April and June 2020 Marie Curie conducted eight focus groups with 37 participants in Marie Curie Hospices in Glasgow and Edinburgh. This was facilitated by their Policy and Public Affairs Manager who aligned the feedback to the Near Me survey / facilitators template. Feedback related to service users.

5) NHS Grampian

NHS Grampian's Equality and Diversity team collated feedback from their interpreting services who support patients where English is not their first language including British Sign Language (BSL).

6) NHS Greater Glasgow and Clyde

Through the boards Equality and Human Rights Team (EHRT), eight individual telephone interviews were carried out to determine the views of people, whose first language is not English, on holding health and care appointments by video. Responses were documented on the facilitators sheet.

The team also identified non-English speakers who, based on their patent records, had used the Near Me. Service. These patients were all written to in their own language. This was followed up via interviews conducted by EHRT assisted by NHSGGC interpreters. From this process 22 people were interviewed involving 12 different languages excluding English.

Feedback was also collected from disabled people via interview - Promoting a more inclusive society (PAMIS),^[20] also responded as an organisation with views gathered from some of the carers they support.

7) North Ayrshire Health and Social Care Partnership

The Partnership took part in some testing of use of Near Me in June using a variety of devices and method. Various scenarios were tested including:

• One to one consultation
• One to two consultations
• Small group training

The thoughts of staff and patients were summarised in a short report prepared by the Partnership Engagement Officer.

8) Parkinson's UK Scotland

The Service Improvement Manager requested the short questionnaire to seek feedback. The survey ran in July and August and was facilitated through their local advisers as part of their routine phone calls with service users. They also facilitated feedback from their Nurses.

9) People First (Scotland)

This is the National Disabled People's Organisation of adults with a Learning Disability in Scotland. People First have a national membership of around 1,000 members. The Service Manager gathered information across Scotland. In addition, working with their Development Workers service users completed the short questionnaire. This was done both as 1:1 and in small groups. Seven people completed hard copies of the online survey.

10) Renfrewshire Health & Social Care Partnership

The Partnership collected data across 29 GP Practices to seek feedback from the perspective of both patients and health care professionals.

11) Scottish Commission for Learning Disability [SCLD]

The Scottish Commission for People with Learning Disabilities (SCLD) aims to be a knowledge hub, bringing together practical support for people with learning / intellectual disabilities as well as promoting good practice and policy work in the field.

Small group discussions were held with 'The keys to life Expert Group'. This is a group of people with learning disabilities drawn from across Scotland. Since lockdown they continued to keep in contact by phone and video. Three meetings were held on 16 July: two by video (N = 4 and N=3) and one by telephone (N=2). A member of the Near Me team participated, and the sessions were facilitated by SCLD Policy & Implementation Manager.

12) Waverly Care

Waverley Care is Scotland's HIV and Hepatitis C charity, working to make a positive difference in the lives of people affected by HIV or Hepatitis C in Scotland

Through their Senior Research and Communication's Manager it was agreed to facilitate some feedback from service users. The feedback was based on information shared by around 10 staff, all of whom were involved in delivery of frontline services to people living with or at risk of Bloodborne viruses (BBVs). The views of service users were summarised and submitted in a short report.

Awareness of the public engagement

Being able to validate the extent of the communications and engagement is important. It provides the context from which to assess whether the engagement was effective.

As highlighted above the feedback was facilitated across a wide range of groups and using a variety of methods. The large volume and range of responses suggests there was good awareness, however, it is recognised there was a bias towards people who were online including using social media.

Concerns and criticism

Some concerns around awareness and engagement were received via four phone calls, through emails and on twitter. The feedback related to how people who were not on-line would find out about the survey or be able to feedback:

Dundee Pensioners' Forum, 4^th July^[21]

"What is being proposed here is a virtual revolution in the provision of health and social care. Older people are probably the heaviest users of NHS services and it is disappointing, once again, that this is an on-line consultation. Apparently, there is an option to feedback by phone. Where is the information about this option being promoted? How will older and disabled people not on-line, know about this phone option? And, how will it work? Will there be hard copies of the survey available for people to refer to when they choose the phone feedback option? Where are these hard copies?

It worries us greatly that once again, a consultation is put out that will directly affect the lives of many, many older people - and they do not really have access to it. Older people's voices must be heard in this discussion and it behoves those in authority to make sure they are.

Individual, in Lothian area, 9^th July

"As your survey is apparently only available online and only promoted online, you are going to get a biased set of results because you are excluding the most digitally vulnerable people who have no access to the internet (poverty, mental health, age, disability and lack of digital capacity etc).

By producing biased data, the NHS will be able to justify the exclusion of the most vulnerable. I am appalled."

Individual in Forth Valley area, 30^th July

"I am disgusted about how this survey has been publicised or lack of. I only found out through Brian Pirie Falkirk Council Community Council Liaison officer which you had passed to him.

The questions can only be answered by those who have access to a computer or smartphone which then eliminate a huge chunk of the population. Particularly the older section. My friend is a manager in sheltered housing and not a day passes without one of the residents asking for help with their phone or computer. Surely this survey is meant to get information from all sectors, and it is not doing that."

Community Collective Advocacy Development Workers at AdvoCard, 13 July

I am concerned about the short period which has been given to this public engagement exercise. Even now, with the opportunity to publicise the consultation, it takes time to get the word out to those service users who are not currently online, and time to then support them to respond.

I am therefore asking for the time period of the public engagement exercise to be extended, ideally by an extra two months, to allow more people to respond and to allow organisations across Scotland to get the word out to their service users and support them to respond.

In all cases these concerns were followed up and the further actions being taken to reach out explained including extension to deadline.

2.5.2 Online survey

Respondents were asked about their awareness of the public engagement. Just under 4,000 people answered this question with the most common way of hearing about the engagement being 38% via social media, 21% website, 14% media, 11% word of mouth and just under 10% via an elected member or local group. Around one in five selected 'other' (Table 2). The free text comments have not yet been formally reviewed but it may help highlight what has worked best. For instance, a good number reported that they had heard about in First Minister daily briefing and various TV and radio programmes.

Table 2 Awareness about the public engagement

Methods	Number of respondents	Percent
Social Media (Facebook/Twitter)	1,513	38.1%
Website (e.g. Near Me, NHS board, third sector)	838	21.1%
Other	727	18.3%
Word of mouth	417	10.5%
Community Council or local group	326	8.2%
Local media (newspaper, radio, TV)	318	8.0%
National media (newspaper, radio, TV)	238	6.0%
I do not know	52	1.3%
Elected representative	48	1.2%

Base: All (3,972)

Responders could select more than one category and so the percentages do not equal 100%