In April Traverse undertook a rapid research study that involved interviews with 12 people who had their care interrupted as a consequence of changing patterns of care due to the coronavirus pandemic. It is evident from recent reporting and publications that there are on-going concerns about how people are accessing care. NHS England have reported a 56% reduction in A&E attendance compared to last year, and UCL have expressed concerns about the indirect impact on the lives of cancer patients; and reports from Public Health England’s national lead for mental Health and well-being Gregor Henderson reporting in the HSJ that ‘One in four adults have not received the mental healthcare they need during the pandemic’.
The aim of our rapid research was to understand the knock-on effects of COVID-19 on people with a wide range of conditions who had chosen not to seek care, as well as people whose appointments had been cancelled or postponed.
The findings of the report were presented by Traverse Director Lucy Farrow and discussed on a webinar hosted by National Voices Chief Executive Charlotte Augst, with panel members David McNally, Head of Experience of Care at NHS England and NHS Improvement, and Martin Marshall, Chair of the Royal College of GPs.
Attended by over 75 people the webinar generated important debate about the implications of interrupted care and the effects of this on health outcomes.
One of the strongest themes to emerge from the webinar discussion was the increased use of virtual and remote consultations and appointments. Participants explored whether video is always the right option with some outlining a preference for simple phone calls. People from the Healthwatch network said that from their experience some have found telephone appointments brilliant - particularly for outpatient follow ups because they don’t have to drive or find and pay for parking.
Other participants talked about the fact that video functionality and apps are often set up from the point of view of the professional and not the patients themselves. There are plenty of hints and tips for health professionals such as from the RCGP including pre-planning and getting set up but much less is available for people who are receiving care or indeed to help professionals to understand how to deliver person-centred remote health care.
Some of the webinar participants expressed their concerns about the rapid adoption of digital being seen by the system as a proxy that digital works better. With the rate of GP telephone and online consultations nearly doubling between February and March 2020 as reported by the Health Foundation, and the number through April and May likely to be much higher we need to ask ourselves: what might be the right balance going forward? The reality is that for many, remote and virtual consultations are the only options at the moment so it is important we continue to hear from people about whether it is actually working or not and what support is needed to ensure people feel confident to receive healthcare in this way.
Key questions need to be addressed such as, ‘What can I expect? Who will I see? How will I know what my choices are? What support will I get? We also need to consider what works for both participants, the person receiving care and the person providing it. Drawing on the Traverse research, feedback from National Voices Our Covid Voices platform and work to better understand the experiences of people waiting for care and a growing body of knowledge through the Healthwatch network we would like to co-produce this information with people with lived experience.
Beyond the practicalities of making sure remote and virtual consultations meet immediate health and care needs, discussions also explored how to get the balance right between virtual and face to face care at the risk of moving to a more transactional and less person-centred model of care. Also how virtual appointments can link to other forms of support such as social prescribing and digital information along with what information and support people need to feel confident to make good decisions about accessing the care they need.
Work done by the RSA to understand how to make real lasting change after COVID-19 helps us understand which changes should be maintained or stopped. A key message is that services need to do more than layer new innovation on top of a return to business as usual.
With all this in mind, Traverse, National Voices and Healthwatch are undertaking some further work to explore more specifically how people are experiencing remote and virtual consultations. The Dr Will Zoom You Now: getting the most out of the virtual health and care experience will hear from 60 – 80 people responding to a series of questions about their experiences. The group will then help to identify top tips for organising, planning, preparing for and holding virtual appointments.
If you would like more information about this work please do get in touch with Jessie Cunnett, Head of Health and Social Care at Traverse. Jessie.firstname.lastname@example.org or on twitter @jessiecunnett You can also join the conversation on Twitter with the hashtag #drzoom