Comment / More data needed to understand virtual benefits

Covid-19 has boosted the use of video consultations. Near Me, the Scottish video conferencing service was launched at the end of 2016, primarily to improve access to healthcare for those living and working in the remoter parts of Scotland. Prior to March 2020, 13 of the 14 health boards were already using the service to some extent. However, take up was slow. And, while some clinical staff objected to remote consultations, many simply did not see the benefit in changing the existing ways of working.

This all changed with the coronavirus, with virtual appointments really coming into their own. In the first four months of the pandemic, there was a 50-fold increase in video consultations. Work done by the University of Oxford to assess the service concluded that most patients and professionals perceived Near Me as beneficial in the long term, as well as during the pandemic. This comes with a caveat. They concluded that it works better for some specialities than others, and patients must always be offered it as a choice even where it is clinically appropriate.

The Near Me service is being rolled out beyond health and social care into prisons and social housing and new features such as group consultations are being developed. It is here to stay.

So, while it is clear that video consultations are changing the way that healthcare is provided, it is not at all clear what the financial impact of this is.

Indeed, one of the recommendations of the University of Oxford work was that there needed to be further analysis of the evidence that Near Me generates financial savings. HFMA’s Scotland Branch commissioned the association’s policy and technical team to start this analysis in relation to outpatient clinics. (See Near me: assessing the financial impact of Scotland’s video consultation service)

It soon became clear that there is not enough information at a clinic- or patient-level to be able to make this assessment. During the early days of the pandemic, too much had changed to be able to isolate the impact of video consultations. For example, travel costs fell to almost nothing because of the lockdowns. So, it was impossible to work out how much of that saving related to video consultations. After that, when clinics were held, the use of video was one option alongside face-to-face and telephone. In these circumstances, there was no clear saving as the clinic was held in the same place with the same staff on site.

It should be possible to make assessments of the savings in both direct financial terms and in carbon dioxide emissions as a result of reduced travel. We should also be able to calculate the working hours saved for patients who have not had to wait in a clinic for their appointment.

However, to assess whether video consultations can deliver a cash-releasing saving for NHS bodies, there needs to be a systematic approach to data collection. This would provide the ability to assess the cost of the clinic before and after the introduction of a remote option for patients.

The need for a better understanding of the financial impact of virtual consultations stretches much wider than Near Me and Scotland. But until we have a better grip on this, we will be operating in the dark and planning for future services will be difficult. Putting the necessary data collection in place has to be the first step.

The HFMA would like to thank all of those that contributed to the preparation of the briefing, in particular, Adrian Ennis, Chris Marshall, Debbie Sagar, George Batchelor, John Sturgeon, Maimie Thompson, Marc Beswick, Paul McKenna and Rosemary Cooper.

* Andrew Bone is director of finance at NHS Borders