Listening to our citizens and patients during the coronavirus pandemic

It became clear in the spring of 2020 that the impact of the coronavirus pandemic on the way that health and care services would be delivered was going to be deep and far-reaching.

In order to protect patients, citizens and staff from the impact of the disease, a considerable number of changes were made to the way health and care services were accessed. This included making radical changes, not only to the way in which services were delivered but what was delivered where.

In addition, during this period many significant and detailed announcements were made by Government regarding the activities in wider society which included considerable restrictions on those with long-standing and serious health conditions.

Whilst many of these restrictions and some of these changes have subsequently been reverted, and to some degree society has returned to a sense of normality, there are many circumstances where the changes to health and care services might need to remain in place for many months, perhaps forever. In addition, the impact of the Government’s wider actions to control the pandemic has had an impact on our population’s health and wellbeing and the way they use NHS services.

When these changes are reviewed and evaluated it is important that alongside the expert clinical and managerial, as well as financial considerations, there is a clear set of feedback from patients and citizens to inform that evaluation. Therefore NHS Nottingham and Nottinghamshire Clinical Commissioning Group (CCG) and Nottingham and Nottinghamshire Integrated Care System (ICS) have collaboratively worked together to analyse and report on the impact of these changes throughout the pandemic period.

The overall ambition of this public insights project was to;

Understand people’s views of the changes made, even if they are not directly affected

Understand the tolerance of the population for keeping the changes made

Understand the impact of changes on the people directly affected

Understand the impact of keeping changes on the people directly affected

Understand the impact of changes on groups who are vulnerable and face barriers to accessing services as a result of the coronavirus pandemic.

Methodology

In order to present as rounded and robust set of insights as possible, four connected strands of activity were used to gather and analyse the data available. Firstly, a programme of quantitative research was conducted by talking to a representative sample of 2,500 citizens from Nottingham and Nottinghamshire both online and over the telephone. To supplement this, detailed focus groups and in-depth interviews were conducted to develop qualitative information to better inform the quantitative findings.

Thirdly, through pre-existing networks both within the CCG and through close working with the Community and Voluntary sector in Nottingham and Nottinghamshire, detailed discussions were undertaken to understand the particular barriers and challenges faced by different groups and communities as a result of coronavirus and the associated service changes. More than 100 groups were contacted during this phase of the work.

Finally, a desktop review of findings from national research and research and engagement in other areas was undertaken. A total of 30 sources were reviewed including national social research (e.g. Ipsos Mori); other Integrated Care Systems, Local Authorities and NHS bodies and national and local charities.

Key Findings

The main findings from across the programme are summarised below;

Many people have put off accessing healthcare during the pandemic, either because of concerns about overwhelming the NHS or through fear of contracting coronavirus.

The majority of our population are satisfied with how we have kept them informed and with the alternative access points that we have used in response to coronavirus.

In particular Local Authorities were identified as performing well in terms of keeping their populations up to date with changes

Some of our population have experienced the reverse and have struggled to access information about coronavirus and local service changes and have faced significant barriers to accessing services. These tend to be our most vulnerable communities and those who face the greatest barriers to accessing healthcare.

Some of the changes we have made in response to coronavirus have exacerbated existing inequalities in service access for our most marginalised and vulnerable communities.

Some of the barriers identified are shared across many communities, and some are very specific to particular communities.

Use of community pharmacy has been a success – satisfaction among our population with pharmacy services has remained high throughout the pandemic.

Remote consultations are broadly supported, although the level of support for increasing their use depends on the care setting and what is being discussed within the appointment.

There is little correlation between age of respondents and level of support for remote consultations.

For some communities there are significant barriers to accessing remote consultations. Some of these are shared across a number of communities and some are very specific.

Patients and their families who experienced the new, integrated discharge pathway when leaving hospital found it caring and efficient and would support its continuation.

What Happens Next?

This information and detailed analysis has been presented to the ICS Board and the CCG’s Governing Body in September and October. There was a commitment from both meetings to ensure that this important set of data will be incorporated into the future thinking for the provision of health and care services, both in terms of the response to coronavirus and more broadly.

The detailed reports can be read here.

Desktop research report
Final research report
Targeted engagement findings report
Recovery research and engagement – Interim integrated insights report