Benefits, challenges and sustainability of digital healthcare for NHS Wales: a qualitative study.

INTRODUCTION: Digital healthcare in the UK was adopted out of necessity rather than choice during the COVID-19 pandemic. However, as we move forward, UK governments and healthcare services have acknowledged its evident benefits for patients, staff and the National Health Service (NHS), and are keen to sustain its improvements in the long term. OBJECTIVE: To understand the benefits, challenges and sustainability of a future-proof digital healthcare. DESIGN: A semi-structured interview study was conducted. SETTING: In NHS services in Wales, UK. PARTICIPANTS: With clinical and non-clinical staff across a mix of clinical specialties. OUTCOME MEASURES: Semi-structured interviews were conducted to address benefits, challenges and sustainability of a national video consulting (VC) service, and thematically coded using a quantification method of qualitative work. RESULTS: A total of 203 interviews were conducted and 3 dominant domains emerged, with 7 themes and 26 categories. LIMITATIONS: It is important to acknowledge that these findings were captured during a pandemic. CONCLUSIONS: NHS Wales has demonstrated that currently there are an equal measure of benefits and challenges to a national digital healthcare. However, with ongoing government and service support, improvement and evaluation, it has potential for a sustainable digital future, in which the benefits can outweigh the challenges.

Online survey and interview evaluation to explore the use of video consulting among Allied Health Professionals during the COVID-19 pandemic.

OBJECTIVES: Allied Health Professionals (AHP) consist of 13 different specialty roles in Wales, sharing the responsibility of promoting and supporting the health and well-being of the population. During the COVID-19 pandemic, there was a shift in care provision, with the increased use of online consultations, such as those using video consultation platforms. However, this shift was associated with uncertainty and hesitancy, and, thus, to understand the usage and reasons for using video consultations, this study aimed to capture the experiences of both AHP and their patients, while investigating each role individually. PARTICIPANTS: A survey was distributed to and completed by n=8928 patients and n=4974 clinicians, all AHP were included except for orthoptists and paramedics due to ambiguities in the data. A further 86 clinicians participated in phone interviews. RESULTS: All professions had a high prevention of face-to-face with the use of video consultations (68.6% overall and 81.4% of clinicians reported the prevention). However, this was lower for certain professions such as podiatrists, potentially due to the specific patient needs, such as physical assessments. Also, a range of different appointment types were being conducted, and there was a high acceptance of these alternative methods among participants. The interviews with clinicians revealed five important aspects of video consultations: the perceived benefits, the perceived challenges, technology issues and necessary improvements, clinician preference and the future of video consulting. Specifically, the future of video consulting evidenced clinicians' desire for a blended approach to working, selecting the appropriate modality depending on the situation and patient-specific needs. CONCLUSIONS: Integrating the traditional methods of service delivery (face-to-face), and novel, innovative ways, such as video consultations, can motivate positive transformations for the efficiency and efficacy of health and social care.

Remote mental health services: a mixed-methods survey and interview study on the use, value, benefits and challenges of a national video consulting service in NHS Wales, UK

Social distancing laws during the first year of the pandemic, and its unprecedented changes to the National Health Service (NHS) forced a large majority of services, especially mental health teams to deliver patient care remotely. For many, this approach was adopted out of necessity, rather than choice, thus presenting a true ‘testing ground’ for remote healthcare and a robust evaluation on a national and representative level.ObjectiveTo extract and analyse mental health specific data from a national dataset for 1 year (March 2020–March 2021).DesignA mixed-methods study using surveys and interviews.SettingIn NHS mental health services in Wales, UK.ParticipantsWith NHS patients and clinicians across child and adolescent, adult and older adult mental health services.Outcome measuresMixed methods data captured measures on use, value, benefits and challenges of video consulting (VC).ResultsA total of 3561 participants provided mental health specific data. These data and its findings demonstrate that remote mental health service delivery, via the method of VC is highly satisfactory, well-accepted and clinically suitable for many patients, and provides a range of benefits to NHS patients and clinicians. Interestingly, clinicians working from ‘home’ rated VC more positively compared with those at their ‘clinical base’.ConclusionsPost 1-year adoption, remote mental health services in Wales UK have demonstrated that VC is possible from both a technical and behavioural standpoint. Moving forward, we suggest clinical leaders and government support to sustain this approach ‘by default’ as an option for NHS appointments.

Early evidence and lessons learnt from an NHS Wales Video Consulting Service.

Background: The use of video consulting (VC) in Wales, United Kingdom (UK) has expanded rapidly during the COVID-19 pandemic. Traditionally, VC has been the subject of small-scale projects and evaluations. In response to the pandemic emergency, there was an opportunity to roll out and evaluate VC on a larger and more representative scale, across a wider range of National Health Service (NHS) specialities.Aims: This paper presents an overview of a dataset captured by the 'The NHS Wales VC Service'. The purpose of this study was to capture perspectives of healthcare professionals only (including clinicians, administration and management) on the use of VC and explore lessons learnt from the national implementation process.Methodology: Using an online, mixed methods retrospective survey capturing descriptive and narrative data.Results: A total of 1256 NHS healthcare professionals shared their VC experience. Overall, responses were positive, and healthcare professionals expressed optimistic views regarding the use, value and benefit of VC, even when faced with challenges on occasions.Conclusions: A lesson learnt, is that difference occurs in innovation, even in a small country like Wales, yet it is not necessarily a negative outcome, but rather, respecting and incorporating difference, can improve long-term sustainability.

National video consultation service- changing the way we deliver future care

Aims In March 2020, when the COVID-19 outbreak emerged, Technology Enabled Care (TEC) Cymru went into partnership with the Welsh Government and CWTCH Cymru to offer a safe solution to protect the NHS and the public by developing and rolling-out a National Video Consulting (VC) Service on an All-Wales basis. The aim was to quickly develop and roll-out an NHS-approved communication platform (Attend Anywhere) to all primary, secondary and community care services, and into care homes, prisons, dentistry, optometry and pharmacy to offer video consultations to patients. Method The NHS Wales Video Consulting (VC) Service used a robust mixed methodology of surveys and interviews with patients, families and professionals. The real-time quality improvement approach was invaluable to the team as findings continually informed the approach and direction. Result Based upon 10,000 survey responses from patients and professionals, and more than 300 interviews the results demonstrate that video consulting is consistently high in satisfaction, clinical suitability and acceptability across a wide range of patient demographics and clinical specialties in Wales. The key findings are Very high in patient and clinician satisfaction (slightly higher in patients). Clinically suitable across a wide range of specialties, care sectors and Health Boards. Very high in patient and clinician satisfaction (slightly higher in patients). High acceptability of VC, which is believed to be associated to the ‘Welsh Way’ of digital implementation processes. Consistent data patterns across patient demographics (age, gender, urban/rural location). Consistent data patterns across clinical settings and Health Boards. Conclusion There is large appetite for VC in Wales, with high potential of sustainability and long-term use beyond COVID-19. The service is now working with clinicians, patients, carers and policy makers to explore the long-term use and sustainability of video consultations in Wales

Taming the chaos: NHS professionals' perspective of using video consulting during COVID-19 in Wales.

The use of video consulting (VC) in the UK has expanded rapidly during the COVID-19 pandemic. Technology Enabled Care (TEC) Cymru, the Welsh Government and Local Health boards began implementing the National Health Service (NHS) Wales VC Service in March 2020. This has been robustly evaluated on a large-scale All-Wales basis, across a wide range of NHS Wales specialities. AIMS: To understand the early use of VC in Wales from the perspective of NHS professionals using it. NHS professionals were approached by TEC Cymru to provide early data. METHODS: Using an observational study design with descriptive methods including a cross-sectional survey, TEC Cymru captured data on the use, benefits and challenges of VC from NHS professionals in Wales during August and September 2020. This evidence is based on the rapid adoption of VC in Wales, which mirrors that of other nations. RESULTS: A total of 1256 NHS professionals shared their VC experience. Overall, responses were positive, and professionals expressed optimistic views regarding the use and benefit of VC, even when faced with challenges on occasions. CONCLUSIONS: This study provides evidence of general positivity, acceptance and the success of the VC service in Wales. Future research studies will now be able to explore and evaluate the implementation methods used within this study, and investigate their effectiveness in being able to achieve better outcomes through VC.

Connecting and connectivity: providing video consulting in care homes in Wales.

BACKGROUND: During the COVID-19 pandemic, care home residents and staff were identified as being at risk of infection. Their safety was important, but equally important was safe delivery of healthcare to those who needed it. The Welsh Government provided care homes with video consulting (VC) to deliver safe healthcare to the vulnerable, combat isolation and protect the residents and staff. METHODS: To understand the use, value, benefits and challenges of using VC in care homes across Wales, telephone interviews were conducted between September and November 2020. RESULTS: From 101 interviews, findings suggest that while care homes are responsive to VC, there is a need for further awareness, better training and support for care home staff. CONCLUSIONS: Interestingly, issues around connectivity, lack of equipment and technical literacy were highlighted as minimal barriers. VC should be encouraged as a long-term service to support the health and wellbeing of care home staff and residents.

A visual step-by-step guide for clinicians to use video consultations in mental health services: NHS examples of real-time practice in times of normal and pandemic healthcare delivery.

Despite the increasingly widespread use of video consultations, there are very few documented descriptions of how to set up and implement video consultations in real-time practice. This step-by-step guide will describe the set-up process based on the authors' experience of two real-time National Health Service (NHS) examples: a single health board use (delivered in normal time), and an All-Wales National Video Consultation Service roll-out (delivered during an emergency pandemic as part of the COVID-19 response). This paper provides a simple visual step-by-step guide for using telepsychiatry via the remote use of video consultations in mental health services, and outlines the mandatory steps to achieving a safe, successful and sustainable use of video consultations in the NHS by ensuring that video consultations fit into existing and new NHS workflow systems and adhere to legal and ethical guidelines.