Video and remote consultations: Digital exclusion and workforce impacts in South West England

The 2020 COVID-19 pandemic changed many things, not least of all within health and care settings. The onset of the pandemic became the catalyst for a major shift towards the use of virtual tools designed to facilitate effective interaction between health and care professionals and patients.  

Prior to the pandemic, discussions were ongoing around whether increased expectation of digital competence and connectedness in the population could be marginalising those who lacked the skills or tools to get online – further exacerbating health inequalities. Additionally, the implications of virtual consultations on the health and care workforce needs further examining – with consideration given to confidence of staff responsible for implementing virtual processes, training needs, any potential risks to patients, and more.   

As part of its role in supporting health and care systems to transform lives via the spread and adoption of innovation, and in building the capability of its partners, the South West Academic Health Science Network (South West AHSN) has been investigating these issues and has published three linked reports, each examining different areas of digital exclusion. Through the reports, our aim is to examine some localised data, which will raise questions, and allow for analysis and exploration of the subject on a larger scale.

The Reports  

Report 1:  Understanding the impact of the use of video consultations on digitally excluded groups – March 2022

The outbreak of COVID-19 in March 2020 significantly accelerated the adoption of remote consultations, which are set out as a key pillar in the 2019 NHS Long Term Plan.  

The South West AHSN undertook a literature review to examine the impact of remote consultations on digitally excluded persons, as well as to identify how to prevent this policy from widening health disparities, and to suggest options for engaging more effectively with affected groups.   

The literature review was specifically targeted to cover the period of time between 2020 and 2021, to study publications that captured experiences during the pandemic.  

You can read the full report here. 

Report 2: Delivering remote consultation in ophthalmology in the South West of England – March 2022   

When the first COVID-19 lockdown was imposed in the UK in March 2020, video consultations were rolled out at speed throughout the health service as an alternative to face-to-face appointments. 

In the South West, video consultations across all clinical areas increased from 200 to over 10,000 per week in the initial months of the pandemic. And, in the period up to February 2021, the region showed the greatest utilisation of video consultations relative to population size in the country. 

The South West AHSN, working with the NHS England and Improvement South West’s Outpatient Transformation Team, undertook a project designed to understand how video consultation can be used within secondary care in an ophthalmological setting. 

The project sought to: 

• Understand the barriers preventing clinicians in the South West (Cornwall, Devon and Somerset) from using remote consultations (in particular video) within ophthalmology pathways. 
• Understand and document the support, enablers, and ways of working that are needed to fully embed video consultations within ophthalmology pathways 
• Review how digital exclusion impacts on the use of remote consultations.  

Information was gathered from interviews with ten clinicians and six operational managers, and the resulting data analysed to set out recommendations. 

Read the full report online. 

Report 3: Digital Exclusion: Feedback Report – Engaging Communities South West, July 2022    

The South West AHSN were commissioned by the NHS England South West Health Inequalities team to undertake a piece of research designed to better understand what the experiences of digital exclusion are in Devon, for those patients specifically trying to access healthcare digitally via online video consultations.  

Working with Engaging Communities South West, the South West AHSN looked to build an in-depth, qualitative, understanding of the impact of digital exclusion on health outcomes and explore the ways in which digital exclusion affects health outcomes or changes in the health of a patient or group of people. 

Research and analysis focused on four specific patient areas: 

• Perinatal 
• Carers and the cared-for 
• Children and young people’s mental health 
• Chronic respiratory disease. 

In total, 59 people contributed to this consultation from across Devon, 21 via Focus Groups and guided conversations, 38 via the survey itself, leading to four key recommendations which are outlined within the report.  

Read the full report online. 

Key findings: 

Our three reports suggest that there are several important areas of focus to consider in relation to the impact of video and remote consultation on digital exclusion and the health and care workforce: 

• Rurality and demographics: The rurality and isolation of the South West can cause direct problems with connectivity, and an ageing population presents difficulties of its own. While, for some, instant connection to healthcare professionals is welcomed, there are barriers to overcome, and some means of tracking patients’ ability to participate digitally might be necessary, as part of their patient records.   
• Patient involvement: The importance of involving users in research is evident throughout these reports. Extensive involvement of diverse patient groups, particularly those who do not normally engage online, is essential to developing a robust strategy for increased digital involvement that considers the different experiences, needs and expectations of different groups of people.  These reports show that it is important not to make assumptions around technological skills, equipment and connectedness for certain areas and certain user-groups 
• Workforce implications: It is clear that the health and care workforce cannot be assumed to be primed and ready to leap into a digital future without significant preparation and support. An underprepared or unenthusiastic workforce will not be able to ‘sell’ digital involvement, or adequately support patients with new technology and ways of working. Ensuring that digital solutions are deployed appropriately, and fully supported with in the Trusts concerned, is key to successful optimisation of this technology.    
• Alternatives to digital: While the value of digital is clear, for some it is simply not possible to engage with medical professionals online. For these people, efforts must be made to ensure that alternative, analogue means of communication remain in place, while still encouraging those who can participate online to do so.   
• Further research: Many opportunities for further research exist, including around staff engagement, patient needs and engagement, and which aspects of healthcare can most usefully be taken online, in order to build on the insights revealed by these three pieces of research.    

These reports were developed as part of the South West AHSN’s Technology Enabled Workforce Programme. To find out more about our work in this area, please visit the Programme’s webpages, or contact info@swahsn.com for more details.