South West Academic Health Science Network

In 2022 we were commissioned alongside our partners Engaging Communities South West by the South West Academic Health Science Network in 2022 (now known as Health Innovation South West) to investigate the impact of digital exclusion on health outcomes for patients who have been offered video consultations. The research was to show the factors and barriers to access, motivation, capability, confidence, and experience of digital services and the influencing factors of digital exclusion.

To gain an in-depth, qualitative understanding of the impact of digital exclusion on health outcomes, a survey, focus groups and guided conversations were conducted. The latter two focused on the four patient cohorts selected by the South West AHSN: children and young people’s mental health, chronic respiratory disease, perinatal, and carers and the cared-for. In total, 59 people contributed to this consultation from across Devon, 21 via Focus Groups and guided conversations, 38 via the survey itself.

Key Findings

• Of the survey respondents, the majority (55.17%) were aged over 55, female (68.97%), and White British (86.21%). 36.67% of respondents identified as having a disability and 20% said they were carers.
• Barriers to accessing virtual appointments did not appear to be related to confidence, capability, or motivation to use the internet. Unreliable internet connection, poor digital infrastructure and incorrect links caused problems for some people. Lack of privacy in the home was a particular concern for young people, carers, and the cared-for.
• Focus group participants who experienced difficulties using video consultations said it negatively affected not only their physical health, but also their mental wellbeing, as difficulties and delays accessing virtual appointments caused stress and anxiety.
• Among focus group participants, the most common suggestions to make virtual consultations more accessible was to provide better guidance on how to use video call software and for more consistency in the software used across different services (e.g. hospitals, surgeries, etc).
• The findings of the online survey showed that less than a third of respondents (28%) described themselves as “not very” or “not at all” confident, capable, or motivated to use technological devices or internet services.
• 55% of respondents who were offered a video consultation said they were “unhappy” or “very unhappy” about the offer. 20% said they were “happy” or “very happy” about it.
• 48% of respondents said they were “satisfied” or “very satisfied” with their video consultation, while 38% said they were “extremely” or “slightly” dissatisfied.
• 60% of respondents who experienced difficulties using video consultations said it negatively affected their confidence or willingness to use digital services in the future, 53% said it negatively affected their confidence in the healthcare service they were using, and 50% said it affected their mental health.
• There was also no significant difference in the feedback collated related to either primary or secondary care. The general consensus from participants was that a video consultation is good for certain reasons (e.g. discussing test results) but anything that would benefit more from a physical examination (e.g. checking a rash) should be done face-to-face.

Summary

Overall, the patients taking part in this consultation understand the benefits of using virtual appointments and there is some willingness to use them in the right context for certain conditions or types of consultation.

However, experiencing barriers such as technical issues, a lack of skills, knowledge or support, and concerns over privacy means that some patients are having a poor first experience using video consultations, which is leading to a reluctance in patients to use them in future. Much of people’s experiences may be related to personal preference or the effect experiencing these barriers has on their ability to use a video consultation.

Patients taking part in this consultation indicated that their experiences are having a negative effect on both their mental and physical health, and also their confidence or willingness to use digital services in the future.

Recommendations

Due to the relatively small sample size, analysing trends, patterns and issues has been challenging and great care needs to be taken when drawing conclusions from this data. The trends or issues raised in this report may not represent the entire population. However, based on the patient feedback gathered in this report, 8 recommendations were made:

1. Support digital infrastructure – poor digital infrastructure or unstable internet connection in rural areas needs to be addressed by NHS England.
2. Engage with patients and staff to improve functionality – ICS and Health Trusts, supported by NHSE and working with technology providers should engage with patients and staff to improve functionality of the platforms and resolve users’ issues.
3. Review current information available – a complete audit by NHSE programme leads of the current information, advice and guidance on video consultations available to both patients and NHS clinical and operational staff is needed.
4. Improve skills, knowledge and support for patients and staff – Health Trusts, with support of the ICS should develop improved staff training and patient guidance.
5. Ensure Alternative Communication Mechanisms – alternative communication arrangements should be provided by Health Trusts, with support of the ICS for when a patient experiences difficulty in setting up appointments.
6. Privacy Concerns need to be monitored – patients should be assessed thoroughly beforehand by the individual healthcare provider to ensure that there are no privacy concerns or safeguarding implications, and effective staff guidance on how to deal with these issues produced.
7. Further consultation work is required by NHSE – there is scope for further work and more understanding about the impact of digital exclusion on health outcomes for patients who have been offered video consultations.
8. This report should be shared with all relevant stakeholders – We recommend NHSE SW sharing this report, so healthcare providers can gain a valuable public insight into impact of digital exclusion on health outcomes.

Using our report and two others, Health Innovation South West produced an extensive blog online via: Video and remote consultations: Digital exclusion and workforce impacts in South West England – The South West Academic Health Science Network (SWAHSN)