Video consultations - public and clinician views: consultation report

Appendix 5 Issues raised in relation to IT, equipment, and infrastructure

Source: BMA

Theme: IT provision (or lack of it or poor quality)

Issues / Requirements raised: IT provision (or lack of it or poor quality) would make widespread use of video consultations to deliver unless there is major investment in both hardware and software but also improvements in the bandwidth of hardwired networks and WiFi.

Source: Hospice

Theme: Confidence

Issues / Requirements raised: Some staff have struggled with the IT and having the confidence in using new IT software. There is a built-in bias against these individuals.

Theme: General

Issues / Requirements raised: Introducing clients to new technology has been difficult at times. Explaining access over the phone and not being able to be there in person has made it very difficult for those patients whose previous knowledge of digital technology was scarce. Some clients have felt frustrated by this.

Theme: General

Issues / Requirements raised: Introducing new technology (e.g. Near Me clinics) in a rapidly changing external environment means it may not be as well established as it potentially could be.

Infrastructure / integrated IT

Issues / Requirements raised: Integrated IT systems, WIFI, access to appropriate kit, suitable office space etc; educational resources and digital platforms.

Source: Marie Curie

Issues / Requirements raised: Hospice teams reported spending a lot of time working out how to use video consultation and then spending an equally long amount of time helping patients access it e.g. if the patient did not have a level of technological knowledge to facilitate the video consultation (or preferred telephone), physical assessments of their condition were difficult to make.

Theme: Incompatibility

Issues / Requirements raised: Some staff noted incompatibility of Microsoft Edge with Near Me. Suggested feedback was to include a section on how to change a computer's default browser to Chrome in Near Me guidelines/manuals.

Theme: Information prior to call

Issues / Requirements raised: Requirement for everyone to give their date of birth and full name. We understand the need for this function for clinical consultations - but it may well concern individuals who are joining for a non-clinical group discussion.

Theme: Provider to provider communication

Issues / Requirements raised: Providers having the ability to chat before the call would be a welcome addition.

Source: NHS Clinician

Theme: App

Issues / Requirements raised: An app would make the whole process and patient access far more straightforward, particularly for those who are not so IT literate.

Theme: General overview

Issues / Requirements raised: "Several our patients do not have access to smart phones, laptops and computers of a level which would support the system. Health boards themselves are not always resourced with work phones laptops or I pad or Wifi connection to link with patients. Poor connection can lead to very challenging appointments where patients are being asked to discuss delicate and private matters with sound and picture out of sync, freezing, sound being lost and disconnections. This feels very unfair and untherapeutic and has resulted in appointments having to be discontinued and taken up by phone or ended."

Theme: Infrastructure

Issues / Requirements raised: NHS internet infrastructure cannot cope with the load generated by video calls.

Theme: Platform / compatibility

Issues / Requirements raised: Platform does not allow the caller to switch off and hide their camera view which can be a source of distraction and might make calls intolerable for some patients who have body image issue. Backwards compatibility with older browsers may limit access for some users, which could link with issues of equality.

Source: North Ayrshire HSCP

Theme: All devices

Issues / Requirements raised: Near Me considerably drained the battery life of all devices tested and if using a mobile or tablet, it is unlikely to be plugged in at the time of the call. This would make it difficult to successfully have long conversations unless everyone's device was fully charged in advance.

Theme: Compatibility

Issues / Requirements raised: Mobile devices, had more issues than laptop, PC, or tablet.

Theme: Internet

Issues / Requirements raised: Some general challenges included broadband speed connection issues.

Theme: Mobile device

Issues / Requirements raised: Mobile devices would be the preferred method for many patients.

Theme: Mobile device

Issues / Requirements raised: Presentations became too small on mobile.

Theme: Mobile device

Issues / Requirements raised: Some people on mobile were unable to access the link, which was sent, with no fix for this easily found.

Theme: Provider to provider communication

Issues / Requirements raised: The provider is currently unable to see or chat to any other providers until a participant has joined the call.

Source: Parkinson's

Theme: General

Issues / Requirements raised: Poor Wi-Fi, lack appropriate Webb browser and equipment have all caused issues.

Source: Renfrew

Theme: Access to equipment

Issues / Requirements raised: One practice noted if they had one per room would look to book regular appointment slots which would mean they could have reception staff sending links out and talking people through how to log on instead of currently moving to Near Me/Attend Anywhere during phone consultation. This quite frequently leads to a breakdown of technology at patient end and involves far more time to fix the problem or to cancel the video and make other arrangements.

Theme: Integrated

Issues / Requirements raised: Link it in with other things such as Home BP Monitors for more complete picture, however still useful.

Theme: Picture quality

Issues / Requirements raised: Problems can also arise as sometimes picture is very pixelated, possibly due to resolution of camera on patient's devices and noted no use for seeing skin lesions-photographs.