Video consultations - public and clinician views: consultation report

1 Introduction

1.1 Background and strategic context

Near Me^[1] is an online video consulting service enabling health and care appointments to take place at home or as close to home as possible. It is approved for use through the Scottish Government Technology Enabled Care Programme. Launched across Scotland in December 2016, a majority of its initial use in 2017-18 was in rural and island areas in NHS Highland and NHS Grampian, followed by some early use in other NHS boards in 2018-19. One of the main initial drivers was to reduce the need to travel long distances for hospital outpatient appointments.

To put this early use in context, in 2019, NHS Highland carried out 250 Near Me consultations per month and NHS Grampian 133 consultations per month. Moving on from the early implementation, the Technology Enabled Care Programme's Delivery Plan for 2019/20 "Supporting service transformation Delivery", published in April 2019, set out a target to deliver 3,000 video consultations per month across Scotland by March 2021.

Following on from this, to assess this early work, an independent evaluation was commissioned by the Scottish Government's Health and Social Care Analysis Department. This was carried out by the Department of Primary Care Health Sciences at Oxford University with field work taking place between August 2019 and March 2020 (i.e. pre Covid-19). The resulting report, "Evaluation of the Attend Anywhere / Near Me video consulting service in Scotland, 2019-20", published on 15 July 2020 provides further background on the development of Near Me in Scotland including the original policy context.^[2]

Prior to the global pandemic Covid-19 hitting use of Near Me had started to slowly expand to around 1,200 consultations per month with almost all NHS boards adopting its use albeit to a limited extent (Appendix 1). However, use of Near Me was significantly scaled up as part of NHS Scotland's plans to reduce the spread of Covid-19 infection. So much so that by mid-May the number of Near Me consultations had risen to over 13,000 per week (=54,000 in May), and at its peak, in June 2020, 17,000 per week (=72,000 in June) (Figure 1, Appendix 1).

Figure 1 Number of Near Me consultations by week, from 1^st March to 20^th June 2020

Figure description:

The number of consultations increased from 300 a week in March to 17,000 a week in June 2020,

1.1.1 Strategic vision for the delivery of Near Me appointments

Responding to the rapid scale up the Scottish Government's Technology Enabled Care team prepared a Vision with the aim of: 'delivering safe, person-centred and sustainable care through video consulting' which was endorsed by the Cabinet Secretary for Health and Sport in May. The Vision followed on from a strong policy context published during 2018 and 2019, including and most importantly, 'Personalising Realistic Medicine' positioning the delivery of the Vision firmly focussed on people not technology (Box 1).

Box 1 Strategic policy context for development and roll out of Near Me video appointments: 2017 and 2019

September 2019 - Protecting Scotland's Future: The Government's Programme for Scotland 2019-2020

"Attend Anywhere [which powers Near Me] …will now roll out to primary care and social care services so more services can be delivered closer to people's homes."

April 2019 - Personalising Realistic Medicine

"NHS Near Me enables us to provide appointments where patients want them, rather than expecting patients to fit their lives around the NHS. It reduces health inequalities related to access and limits the detrimental effects of having to travel for appointments - for frail patients and relatives, it is less exhausting; for others, less time needs to be taken off work or school."

April 2018 - Digital Health and Care Strategy

"Spread the use of video consultations direct from people's homes (including care homes)."

April 2017 - A digital strategy for Scotland

"Realising Scotland's full potential in a digital world"

1.1.2 Governance arrangements

During Covid-19 to support the accelerated rollout of Near Me a National structure was developed including a 'Near Me Covid-19 Response National Group' which is chaired by Dr Margaret Whoriskey (Head of Technology Enabled Care and Digital Healthcare Innovation) providing leadership and links into Scottish Government COVID-19 Gold, Silver and Bronze Command arrangements.

Prior to Covid-19 Near Me governance was through the Technology Enabled Care Programme Board which has recently transitioned into a new Digital Citizen Delivery Board.

The focused work on communications and public engagement (March through to August 2020) reported through Dr Whoriskey, with the National Group responsible for overseeing the work including approval of this outcome report.

The Scottish Government's Technology Enabled Care team's forward plan (June to December 2020), published on 1^st July 2020 included commitments to prepare a national Equality Impact Assessment and to carry out a public engagement exercise.

1.2 Timeframes

In May 2020, the Near Me leadership team confirmed that public engagement would take place including a public online survey (29^th June to 24^th July 2020).^[3]

An update on the preparation for public engagement was provided to the Near Me Covid-19 Response National Group on 24^th June. At the meeting it was proposed that a separate online survey for clinical staff should be carried out. Following this, a survey for health care professionals was produced in collaboration with clinicians, representatives from professional bodies, and with advice from Professor Trish Greenhalgh and colleagues at Oxford University.^[4] This survey and other activities went live on 15^th July and closed on 9th August 2020. Wider feed-back continued throughout August and early September.

1.3 Equality Impact Assessment (EQIA)

With a Vision to grow the use of a video consultation service, it was essential to co-produce a national EQIA for Near Me. Based on the available evidence, the first National EQIA was published by the Scottish Government Technology Enabled Care Team on 1^st September. It assesses some 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 described in the Full Report which can be found on the Technology Enabled Care website. For the purposes of this report summarised in Appendix 2.

1.4 Public engagement activities

Full details on how the public engagement exercise took place are described in Appendix 3. The objectives, approach to raising awareness and summary of the number and range of responses is briefly set out below. This is to provide some of the context as to how the exercise was conducted.

1.4.1 Objectives of public engagement

• 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 raise awareness with service users and service providers about how Near Me can be used for health and care appointments
• To review the Near Me Vision and governance arrangements as appropriate

1.4.2 Raising awareness

Stakeholders were contacted in June and July, and a range of activities were carried out to raise awareness and facilitate 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. The methodology adopted by each organisation is briefly described in Appendix 3.

Following a period of informal engagement (May and June) on 29^th June 2020, the public engagement was launched on social, local, and national media. Tailored local media releases were prepared for all 14 territorial boards 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 (Box 2).

Box 2 Example of local media coverage

Daily Record, 1 July 2020

Patients consulted over views on video technology for appointments

1.4.3 Summary of feedback

The number of responses received by audience and activity are summarised (Box 3).

Box 3 Number and range of responses received

Audience	Feedback method	No.[5]	Notes
Public (general)	On-line survey	4,025
Health care professionals	On-line survey	1,147
Individual	Survey completed over phone/hard copy	47
Organisations (public)	Written response	38	Refer to table 7
Marie Curie service users	Report on eight focus groups	37
People whose first language is not English	Telephone interviews	30
Learning disabilities	Notes from virtual focus groups	25
Individual (public/patient)	Written responses	16	Refer to table 6
Individual (Health care professionals)	Written responses	14
People with a disability	Various	12	Report available
Carers	Coffee morning, zoom	5
Professional bodies	Written response	4
Total number of responses		5,400

1.5 Scope of this report

This report includes preliminary findings from the national public and clinical engagement carried out between June and August 2020. For the purposes of this report only work undertaken or directed by the National team or submitted as part of the engagement is included (see out of scope below). Feedback, in various guises, continued to come in throughout August and as far as possible has been included.

1.5.1 Out of scope

This public engagement exercise represents only one of the approaches being taken to engage and facilitate feedback on the use of Near Me. There are a range of other activities which have taken place (and ongoing) around the use of video consultation both at national and local level in Scotland, as well as further afield, including:

• National pop up survey offering patient/service user to complete an online survey at the end of their Near Me consultation^[6]
• Work to co-produce the National Equality Impact Assessment and patient information resources^[7]
• Evaluation of staff experiences using Near Me carried out by Allied Health Professionals
• Case studies and feedback facilitated through Health Improvement Scotland and others^[8]
• Ongoing engagement carried out by local boards, for example Greater Glasgow and Clyde carried out their own online survey
• Work being progressed by Connecting Scotland on Digital Exclusion
• Independent Evaluation of Near Me service by Oxford University, published July 2020
• Other research findings in Scotland by clinicians providing Near Me Service^[9]
• Ongoing work across the UK as part of response to Covid-19 including the
• Health Foundation and other research and surveys^[10]
• Ongoing work by the Institute for Healthcare Improvement on telehealth (to which the Near Me National Lead contributed)
• Virtual visiting

1.6 Scope of the analysis and discussion

This is not an academic study and there is only very limited reference to other reports and studies. No statistical analysis of significance has been carried out. It was recognised, however, that the amount and range of feedback was considerable and worthy of further analysis. To support with this, the Oxford University team evaluating Near Me has agreed to look at the data and this report and, as they deem appropriate, carry out more detailed quantitative and qualitative analysis and some wider literature review. This will be included within their current contract with Scottish Government, as described earlier, with their findings due to be published later this year.

During the public engagement extensive use was made of Twitter to promote and engage around the use of Near Me including patients and staff experiences and views. It is not proposed to analyse this content though it might make for an interesting study.

Carrying out a national public engagement exercise during a pandemic and to get the number and range of responses is of interest. For the purposes of this report, however, discussing the process and approach in more detail is out of scope.

1.7 Structure of this report

This report describes the public engagement exercise (public, staff, and partners) and presents the preliminary findings based on a wide range of feedback including both qualitative and quantitative analysis. It explores the potential benefits and barriers around the use of Near Me video consultations across health and social care in Scotland from varying perspectives and under different circumstances.

The remainder of the report is structured around four main sections:

• Analysis of feedback from public and partner organisations
• Analysis of feedback from healthcare professionals and organisations
• Discussion, focusing on benefits, barriers, and improvements
• Recommendations