Accessing health and care services - Interviews with 104 respondents - full report 19Nov2020

Headlines

• Of those that delayed appointments, the majority said there was little or no negative effect on their health. 
• For those where there was a detrimental impact, there were instances of increased pain and wounds needing to be dressed and in one instance, the need for emergency medical attention.
• Seven out of the eight people who felt the delay was detrimental to their health condition, had a disability. In the case of three of these people, they had multiple disabling conditions e.g. physical and sensory disabilities or mental health and physical disabilities.
• Two-thirds of the people who had experienced a remote appointment found the experience to be a positive one. 
• Positive reactions included less travel, less time in the waiting room and being quicker to get an appointment.
• In more detail, some people also said they felt they had the opportunity to ask the right questions, being offered a thorough discussion about the condition, not being rushed and being involved in the decision about what to do. Some had sent photos or videos of the condition and this resulted in being prescribed medication which helped resolve the condition.
• Around one-third of people we spoke to who had experienced a remote appointment had some negative experience. These included not having a specific time for the appointment and generally not feeling able, or being too rushed, to fully explain their condition in a remote setting. Technological challenges and wasting time for an initial phone call when the need for a face-to-face appointment was obvious, were other concerns.
• There were mixed views about different types of appointment. Some people clearly preferred face-to-face while others were happy with remote. Video and phone were considered good options while email or online forms were generally considered time consuming and not met by instant feedback.
• Face-to-face appointments were seen to be important for physical examinations (e.g. tests, seeing how a patient moved, checking a skin condition) and matters of a personal, private or emotional nature. 
• Phone appointments were seen as favourable when a face-to-face was not necessary and generally more reliable than video appointments.
• Nonetheless, video was seen as an effective way for the patient and doctor to see one another, supported by the viewing of body language and facial expressions.
• However, of all the remote options, those by video were particularly susceptible to technological problems. Some computers were not compatible with the meeting platform used by the NHS, others had camera problems and some people were not comfortable or able to connect remotely.
• People with more complex physical needs and mental health issues were more likely to favour face-to-face appointments, as their conditions were considered more complicated and needed the sensitivity of an in-person appointment.
• People aged 60+ years old had mixed views about using remote appointments. Some people in this age group were comfortable with technology and found it important to “move with the times”.  Others found it harder to adapt.  Some Illnesses associated with this group made it difficult to access remote appointments.
• People accepted the inevitability of remote appointments becoming ‘normal’. However, the need to ensure that patients had a choice about using them as an alternative to face-to-face, was considered important.
• The choice of appointments was often dependent on the medical need. For example, therapy was seen as being better in person, while video worked well for showing the condition (e.g. a rash) to the doctor and phone calls were sufficient for minor ailments. Most people were not offered this choice.
• In contrast to the above, the preference for appointments was less likely to be related to the type of practitioner or service.  For example, people felt that GPs, hospital doctors, nurses, consultants could all be seen either in person or remotely, depending on the medical need.
• The pandemic and its reliance on technological communication has revealed a group who were excluded from having video and online appointments. These interviews demonstrate that this group while not exclusive to any demographic group, is more likely to include people over the age of 60 and/or people with disability(ies).  This report demonstrates the need to do more work about how to engage this group with access to services.
• There will always be people who need and want to access services in person.  People were concerned that these patients were unable to fully access the health services they needed. This preference for choice, often dictated by the medical need, supports the survey recommendation for a hybrid model of service delivery.