The health & environmental benefits of NHS Near Me –

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If the year 2019 is to be remembered for anything, other than it being the year before Covid-19 struck, I guess it might well be because it was when, at long last, it felt like the climate change emergency truly entered the public consciousness. I for one was delighted that campaigner Greta Thunberg and our other young people through mass school strikes over climate change were rarely out of the headlines.

And then came the coronavirus. Suddenly the world faced a public health emergency, and the environmental catastrophe we are careering towards worryingly became yesterday’s news.

However, there must always surely be hope. I can see a future, post-Covid-19, when it will re-enter the public consciousness again as the No. 1 crisis facing humanity. And when that happens I like to think that many of the lessons the pandemic is teaching us will help steer a course towards creating a planet that is far healthier and a society that is much fairer than it is now.

To illustrate, I would like to consider one very small example of collective efforts making a positive contribution: video consulting for health and care – an aspect of public health policy and engagement on which I have been again working on.

In early February I tweeted: “I would have thought #coronavirus should prompt as many appointments as possible to be provided by @NHSNearMe. Reduce risks of people coming into health care facilities and support strategic management #commonsense”, and this is indeed is what has happened.           

As I wrote in my blog published by the Melting Pot in May 2020 the pandemic had prompted a sudden acceleration in the use of video consulting by health and care professionals. NHS Scotland’s video consulting platform of choice, Near Me, quickly became established. Originally seen as being particularly useful in the north of Scotland where the distance between patients and clinicians can be problematic, Near Me has since enabled services to continue to be provided without potential exposure to Covid-19.  In doing so it has significantly reduced the number of people going into health and social care premises. And, in doing so has made an important contribution to reducing the risk of the infection spreading, alongside all the other benefits.

Just a few weeks ago I read this quote by a senior manager in one of Scotland’s health and social care partnerships: “Near Me video consulting has been life changing and life enhancing for many people.”

But more than that, the manager went on to give a striking example of a key benefit of Near Me. Using video consultations for obstetric appointments meant that some patients no longer had to make 200-mile round trips to see an expert. No fewer than 1,000 such journeys had been saved because of Near Me.

Prior to March 2020, when the coronavirus lockdown began in Scotland, there were around 300 appointments each week using the Near Me system; by June, there were over 17,000 every week, with now more than 200,000 in total. Quite remarkable.         

Given the huge increase in use the Scottish Government produced a vision that, where appropriate, all health and care consultations are offered by Near Me. The  Scottish Government’s Technology Enabled Care team launched a public engagement exercise to seek views on the vision (see www.nearme.scot/views). One aspect is an on-line survey for the public and that includes inviting views on the environmental aspects; another is seeking views from the professionals and partner organisations. It is set to gain a high number of responses which will help to shape the future and better understand the benefits and any barriers.

Alongside this at the end of every Near Me appointment patients are invited to take a survey. When I last checked, 68 per cent of people said that if they had not had a video consultation, they would have travelled by private car or motorbike to an appointment. The average one-way distance would have been 13 miles. Incidentally, 0.7 per cent would have travelled by aeroplane and a similar percentage by ferry. This was based on a sample of 15,000 people who responded to the question on travel.

In more in-depth studies a recently published academic paper also considered the economic and environmental impact of video consulting for new colorectal referrals in part of the country. It found that in the period studied video consultation appointments saved 50 patients no fewer than 6,685 miles travelled, 148 hours travelling time and £1,767 cost. Carbon emissions saved equated to 4,659 C02e lbs (carbon dioxide equivalent pounds). Another study looked at the use of video consulting for gastroenterology patients in another Scottish health board area. It calculated that these patients travelled more than 826,000 miles per annum for around 21,700 appointments. Doing so resulted in a significant carbon footprint: 242 metric tonnes of carbon dioxide. By using remote consulting more than 12,700 patient miles were saved. 

When you scale it up the various gains through use of Near Me are considerable including around 15 million miles travelled per year saved, let alone the reduction in travelling time, missed appointments, greater choice, and convenience.

Covid-19 has caused strange things to happen throughout the world. Lockdowns have resulted in some significant and, I hope, permanent changes to our travel habits. More than 150 cities throughout the world are providing additional dedicated walking and cycling infrastructure in anticipation of continuing demand for them post-pandemic.

These measures might make it easier for some of the positive behaviours brought about by the pandemic to become permanent. And they are positive not only from an environmental point of view. It has been reckoned that if every person in London walked or cycled for 20 minutes a day, an astonishing £1.7 billion could be saved in health treatment costs over 25 years. It has also been claimed that if every car driver switched to cycling for a daily 5km commute, the health benefit from physical activity would be worth over £1,000 every year.

Coronavirus has impacted on most aspects of our lives and some of the measures we are taking to control its spread can have positive untended consequences. Preventing carbon dioxide from entering the atmosphere might not mean very much to some people but it does impact on polar bears. Directly or indirectly that should matter to us all. Some experts suggest that by the end of the century these magnificent animals could become nearly extinct because of shrinking sea ice if climate change continues at its present pace.

Let’s not lose sight of the fact that and remind our NHS Scotland chief executives, who made a commitment, that NHS Scotland would by 2045 be what is termed a “net-zero” service, meaning that its reported carbon emissions would be either zero or offset by an appropriate mechanism. The two are connected. As things stand, patient, staff and visitor travel are not measured in determining emissions, largely because it is difficult to do so accurately and consistently. However, it is accepted that they do carry a significant environmental impact that would undoubtedly be lessened by greater use of video consulting. If we are to take this seriously perhaps the matter of measurement needs to be remedied.

As one consultant psychologist who responded to the public and staff engagement put it “I don’t understand why any treatment modality which will save the health service thousands of pounds, and will be better for the environment is even a point of debate.”

The planet is going through a major public health crisis. Perhaps in learning to deal with it we will also address some of the environmental concerns that caused our children to miss school for a few hours last year. We surely owe it to them to try our very best to make wise use of our resources, change our habits and save our polar bears.

Maimie Thompson is a former Head of PR and Engagement for NHS Highland