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Impact of temporary changes to health services as a result of Covid-19 and plans for phase 2

2020 has been a year of unprecedented challenges for Sheffield, the UK and the world. The impact of Covid19 has been felt profoundly by individuals, families and communities and has exposed many inequalities.

Since the onset of Covid19 and the government enforced lockdown from 23 March 2020, NHS Sheffield CCG has been collecting and collating insight from communities across the city. This insight was helped to inform our decision making during the first phase of Covid and was later used to help us plan our future commissioning intentions.

As a response to the challenges faced by the local healthcare system, some temporary changes to services had to be made. It is important for the CCG to understand what impact these changes have had on population of Sheffield.

We undertook two pieces of involvement to understand the impact of these changes on our communities. A telephone survey of a representative sample of the Sheffield population, and semi structured interviews by local community groups with residents.

A total of 1270 residents of Sheffield responded across the two methods. 1107 through the telephone survey and 163 through the community organisation-led activities.

The aim of this piece of work is to inform our commissioning within individual teams and the CCG as a whole.

Key findings

  • Over a third (36%) of respondents stated that they were less likely to access services during the lockdown period, compared to less than a tenth (8%) who were more likely to access services.
  • Nearly 8 in every 10 respondents across Sheffield are confident that health services are now safe to use following the recent Covid19 pandemic. However, just less than a fifth (17%) did not feel confident that health services are now safe to use. Black, Asian and minority Ethnic respondents were significantly less confident overall compared to White respondents (67% vs 79%). People reported they would feel more confident if they knew what to expect from services, and what measures were being put in place to keep people safe. A quarter (25%) felt they would only feel safe once the pandemic was under control, a vaccine was found or that infection rates subsided.
  • Each of the organisations who received responses from people from minority ethnic communities stated that a need for culturally appropriate services, where someone’s background was respected and that this needed to be upheld at all times.
  • More than 8 in every 10 said they would be likely to engage with services using ‘at distance’ methods, but mainly through telephone consultation and triage, with a sizable proportion stating they already had experience of engaging via telephone. The move to online services was generally viewed as a barrier, particularly by older participants, who didn’t have access to appropriate technology and lacked the confidence or motivation to learn. Concern was expressed by people who had experienced domestic abuse that using either a phone or a video call in the house when their abuser was present meant that they couldn’t be honest and therefore the technology was of limited value to help with their circumstances.
  • The most frequent route of accessing healthcare since Covid remained through contact with a GP, although there has been a notable increase in telephone engagement, particularly via the NHS 111 number.
  • A quarter (25%) of respondents reported that they thought their GP surgery had closed during the Covid-19 outbreak. This does not correlate to the actual number of known closures of surgeries (15%). It was observed that respondents living in less affluent postcodes were more likely to be affected by GP surgery closures compared to more affluent areas (27% vs 19%). A tenth revealed they had been anxious about their health (11%) or had lived with pain (10%) as a result of the closure of their GP surgery.
  • There was acknowledgement from all communities that people were refraining from contacting their GP in the way they would in normal circumstances with a reduction in respondents contacting their GP for their most recent health issue (66% down to 55%). This reduction was put down to concerns about attending the surgery and the risk of catching Covid, and not wanting to overstretch health services. There was also concern expressed that people hadn’t attended for screening appointments.
  • The majority of attendees (85%) considered their experience of primary care to be no different or better than before Covid. Younger respondents, aged 16-34 tended to say they had a better experience of accessing primary care than before Covid-19. Respondents aged 45+ tended to feel their experience was worse. While those from a BAME background were also more likely to rate their experience as worse than White respondents (25% vs 15%). This tallies with concerns expressed about access to interpreters to enable accurate diagnosis and care.
  • The removal of evening and weekend appointments at Crookes Practice, Burncross Surgery and The Health Care Surgery, Palgrave has caused limited impact on respondents as more than four-fifths (84%) said they wouldn’t have used these sites anyway. However, 12% said they will have to travel further as a result of the restrictions.
  • Of those engaged in routine healthcare, a fifth (22%) stated that care had been postponed or delayed since lockdown restrictions began. While a third said they had managed (31%), a quarter reported that they had developed health anxieties (26%); lived with pain (26%) or experienced a decline in health (24%) while awaiting routine care. Disabled people were significantly more likely to have experienced delays or postponements to healthcare; nearly half of this cohort (48%) provided this response compared to non-disabled respondents (18%). Nearly half of patients experiencing delays (49%) or postponements said they are willing to travel beyond the city boundaries to seek swifter healthcare although a third (37%) were unwilling due to issues such as cost, inconvenience, ill health, anxiety on practicalities of organising, and a lack of transport. This correlates to more affluent areas being more willing to travel outside of Sheffield for healthcare than less affluent areas (61% vs 45%).
  • There was little impact felt amongst respondents due to the closure of the MIU at Royal Hallamshire Hospital with 95% of respondents unaffected by this decision.
  • A large amount of respondents expressed concern about their mental health and described a sense that mental health was not ‘as important’ as dealing with the virus. Many people felt that services weren’t open or available, or that the support they had in place from family and friends, or via websites, was sufficient to keep the symptoms in check, but that there was an inevitability about requiring greater levels of support in the future.
  • Respondents commented on the support they had received from within their community, with the regular, pro-active contact made from staff and volunteers being highly valued and that that had helped with feelings of loneliness, isolation and worry. When asked to confirm the course of action respondents took compared to before restrictions were in place, there was a decline in engagement with local GP services (45% down from 67% before restrictions). An increase was seen in the use of self-help techniques (18% up from 11%) and also an increase in respondents who did nothing to address issues with mental health (23% compared to 14% before restrictions).
  • A quarter of participants felt the NHS was doing all it could to support people affected by Covid-19. A further quarter thought that aftercare and support was needed to help people affected by the pandemic. Nearly a quarter (23%) felt that communication was vital in supporting people during the pandemic. It was acknowledged that messaging was often confusing and people therefore relied on local networks to inform them of national changes.

We would like to thank the staff and volunteers from the organisations who helped us for their enthusiasm, commitment and perseverance in undertaking this work during very challenging times. We would also like to thank everyone who took time to participate and share their experiences. It has been hugely appreciated and will inform future commissioning decisions in Sheffield.

  • Mencap
  • SADACCA
  • Together Women
  • Shipshape
  • Refugee Council
  • ZEST
  • Chinese Community Centre
  • SMSR

 

 

 

NHS Sheffield Clinical Commissioning Group

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722 Prince of Wales Road
Sheffield
S9 4EU

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