Remote medical services could ‘disenfranchise’ patients, councillors warn

Patients could be “disenfranchised” by the rise of remote medical services in recent years, local councillors have warned.

Their fears, aired at the Health in Hackney scrutiny committee, come after a report by the City & Hackney clinical commissioning group (CCG) found that digital care remains “difficult and undesirable” for some people, compared to face-to-face appointments.

The October 2020 report, introduced by CCG director of quality Jenny Singleton, warns about the issues facing older people, carers, disabled people, those without smart phones, not on social media or experiencing economic disadvantage.

Hackney has long struggled with the digital divide, with Learning Trust figures from last year showing 10 per cent of the borough’s children have no access to devices at all. 

Cllr Michelle Gregory said: “I’m very concerned about hidden groups of people who may be forgotten about. Will there be regular contact or letters? People who don’t necessarily have access to the internet or receive updates. I’m very concerned about people out of the system.

“Some elderly people I know cannot even use a touchtone because they are partly deaf, and can’t get through to a GP on the phone nowadays because you need a certain understanding of technology. It’s not just about the pandemic.”

According to scrutiny committee chair Cllr Ben Hayhurst, councillors hear “continual feedback” from residents finding it difficult to get appointments in the borough, with Cllr Peter Snell calling for a unified system across GP practices.

Snell added: “I am aware that primary healthcare has been overwhelmingly relying on the phone system because the post has been so useless.

“It worries me that the Holy Grail is people being prompted to ask a question about your living conditions, your housing, who you live with, are you under stress from the people you live with, which would then trigger involvement from council support services, is what we should be aiming towards. 

“We’re operating on four different systems, so the idea we could do a simple fix across the piece to say you’re going to be prompted to pick up on environmental issues affecting your health, it’s not possible about four different systems. It would surely be a hell of a lot better if we could move towards a single system.”

According to a paper survey led by the City & Hackney Older People’s Reference Group in May 2020 with 106 responses, older people “much prefer” face-to-face or telephone services, with a “general theme seeming to be a lack of any access or poor access to services”. 

According to the survey, disabled people also find digital services more difficult to access, with 56 per cent of adult internet non-users made up of disabled people, according to 2017 ONS figures.

Singleton’s report concluded: “Patient experience is mixed for remote services, but generally quite positive. There are considerable advantages for many groups and positive feedback.”

But it adds: “There are safeguarding implications for remote services that need to be considered.

“Whilst there is a lot of work going on in City and Hackney, it does not seem to be very joined up and gathering together information for this report was difficult.”

Singleton has now made a number of recommendations, including support for GP practices to review their websites, improved internet access for hostels or housing with care schemes, improved access to patient advice and liaison services, and a better understanding of language issues and solutions for people with low literacy or little English. 

However, Hayhurst questioned how these recommendations can be delivered without “one person holding the ring, driving this all forward in the best interests of the borough”.

Singleton said: “Remote services offer people an amazing opportunity to take more control and be more involved in their care. They are loved, liked and valued by a lot of people, but as with everything, there are unintended consequences, and issues we need to make sure we look at as a system when developing these services going forward.”