Accessing health and care services – findings during the Coronavirus pandemic: Executive summary and Full report

A combined sample of 2185, the engagement focused on establishing people’s experiences of digital or remote consultations during the COVID-19 period and crucially, their expectations and preferences for service redesign and delivery in the restore and recovery stages post COVID.

Headline Results

• 37.4% of people chose not to make an appointment during the pandemic despite having a need to access health, social or emotional care, confirming the very substantial backlog of clinical and social care need that will need to be addressed.
• For those that had phone, video and online appointments during the pandemic, satisfaction levels were high. For example, 80.4% were satisfied or very satisfied with phone appointments. This may show that if those people who were putting off appointments were encouraged to use this alternative provision, they may be more satisfied than they would initially expect to be.
• For triage (being guided to the right service), GP, outpatients, getting medication, test results and emotional and mental health NHS wellbeing support (including counselling and therapy), people were mostly keen for phone appointments (between 53% and 87% were happy) relative to video (between 46% and 54%) and online (between 27% and 71%).
• A relatively high proportion of people were not happy to receive any form of remote appointment for their mental health (29.7% not happy for remote emotional and mental health NHS wellbeing support, including counselling and therapy; 43.6% for NHS mental health support for longstanding and serious mental health conditions).
• Most differences in preference towards future appointments were shown in terms of disability and age. For the GP appointments, people with disabilities were less happy to have any form of remote appointment compared to people with disabilities. This difference is shown irrespective of people’s ethnicity, gender, age or sexual orientation. Likewise, when controlling for the effects of other factors, younger people were generally happier to receive an outpatient appointment by video compared to older people.
• Older people showed strong agreement to preferring face-to-face appointments with their GP. Younger people were happier to have a phone or video appointment with their GP.

The report presents 13 recommendations as follows:

1. To further and strengthen the message that the NHS is ‘open for business’ and the ‘Help Us Help You’ campaign. There is a particular need to share these campaign messages among people with disabilities and women who are more likely to delay appointments when in need.
2. There is a need to ensure that communication is in appropriate formats, is received and understood.
3. Engage people with disabilities and women to better understand why they are more likely to delay remote appointments.
4. Make the public aware of the positive satisfaction ratings for phone, video, and online appointments, to encourage people not to delay appointments when in need.
5. Engage people with disabilities and Lesbian, Gay and Bisexual people to better understand why they are the least satisfied with appointments during the pandemic.
6. Offer a range of remote appointments, by phone, video and online (email, text and other online) given the public preference for a choice of remote appointments. Allow the patient to choose their preferred remote option.
7. Although the majority of people were generally happy to receive remote appointments, from a range of different services, they are not suitable for everyone and face-to-face options must continue. This is necessary for:

• Certain health conditions where a face-to-face examination is required, or a where a health need is described by survey participants as ‘serious’.
• Outpatient appointments and mental health support areas where there is a strong preference for face-to-face support.
• People with disabilities and especially so for those affected ‘a lot’. Understand that people with disabilities are the least satisfied with remote appointments and are less happy to have remote appointments in the future.
• Older and digitally excluded people who lack either the access, skills, confidence, or motivation to use remote technology with beliefs that such appointments are less effective than face-to-face.
• Where individuals, such as young people, are unable to secure a private space to hold confidential conversations with health and care professionals.
• The polarised opinions towards preferences for face-to-face appointments and remote appointments with a GP show a need for both options in future service delivery. Amongst older people, those with disabilities and for Lesbian, Gay and Bisexual people, there is a stronger preference for face-to-face GP appointments.

8. Allow patients the opportunity to choose a remote appointment with their regular GP if this is preferred.
9. Reduce the proportion of people who are digitally excluded and who will not use remote options, on the grounds of insufficient technology, internet connection or inability to communicate by such means.
10. Familiarise some older people, in particular, in how to use video and online services. Promote videos or other media to show the processes involved in having phone, video or online appointments to encourage their future use as well as ‘tips’ for effective engagement.
11. Health and care services to arrange remote appointments for specific times, rather than patients having to wait all day for a call-back.
12. Raise the skills of some health professionals in using the technology that is required for remote appointments.
13. Encourage men to seek mental health support when needed, to break down the perceived stigma and reluctance to open-up about mental health.