At TEC (Technology Enabled Care) Cymru, we have spent the last three years capturing data on all things digital health in Wales. However, due to the pandemic, collecting in-person data has proven challenging. It has predominantly been gathered through digital channels (e.g., online feedback forms) and often completed by individuals who are already familiar with and inclined towards digital platforms, introducing bias. Now, as the effects of the pandemic wear off, we are seeking to change this narrative through ‘The Welsh Public Opinion Study’, the aim of which is to investigate what the Welsh public knows, thinks, and wants in relation to TEC. 


As a final-year medical student working with TEC Cymru, this project has been especially interesting when considering my own experiences in practice with TEC, both before, during, and after the pandemic, as well as thinking forward to working as a doctor. Having completed placements within various specialties across Wales, I have experienced the demographic range of the Welsh population as well as a range of attitudes towards healthcare and the NHS infrastructure. I have no doubt that to formally investigate the public's perceptions of TEC will be of huge benefit not only to those developing digital health platforms, but also to all healthcare professionals and NHS staff.


Inclusivity has been central to our strategy to ensure this data is representative of the Welsh population. It is vital to allow everyone in Wales the chance to have their say, regardless of demographics, background, digital or previous TEC experience. A survey is being distributed through online and in-person methods across Wales, with the aim of receiving responses from 0.3% of the Welsh population (10,000 responses). All survey questions have been written in both English and Welsh, and participants can choose which language to respond in when answering free text questions, promoting inclusivity. So far we have distributed QR codes on flyers and posters via letter-box drop offs, shops, public toilets, universities, schools, GPs, pharmacies and more. We have also set up stands in public areas, such as events, conferences and hospitals, where members of the public have had the opportunity to fill in the survey in-person. This is allowing us to reach those who are not digitally comfortable or equipped to scan QR codes. Furthermore, the online link has been distributed via email, social media and staff intranets. Through these methods, we have now received nearly 4000 responses since we started data collection in April. Although there is a way to go to reach our target, we are seeing some really interesting data and great insights from the public so far.


When thinking about different types of TEC, the data is suggesting that the Welsh public have both more experience and a greater awareness of video consultation (VC) services compared to remote monitoring services. This did not surprise me since I have reasonable experience with VC on placement in the Welsh NHS, but very little with remote monitoring. When asked the open question of what health conditions either of these services could be used for, popular suggestions from participants so far include diabetes, blood pressure monitoring, chronic respiratory disease, sleep disorders, dermatology and mental health. While I have my own insights based on my own medical expertise, clinical experiences and digital literacy, the public’s suggestions offer an interesting perspective. Although some state they do not feel qualified to answer the question, others are drawing on their own health experiences as well as those of family and friends. They are coming up with some great suggestions which I hadn’t necessarily considered myself, demonstrating again the importance of such a project in allowing all backgrounds and non-medical professionals to have their say. It is very easy to think that, as the professional, you know best and to forget that you are ultimately serving the patient. In NHS wales, the patient is the Welsh population, so who better to hear the opinions of?


Although there is a mix of opinions on the use of TEC, it is evident that more respondents have a positive attitude than negative. For example, of those who had used VC before, 65% liked the experience. Of those who had no experience using TEC, approximately three quarters state wanting to use it in the future. A frequent expression used to describe TEC by participants was the idea of it being the “way forward” and the “future” of healthcare and the NHS. 


“I think it's a great idea! It's about time the NHS is brought into the 21st century!”


Although accepted as inevitable with changing digital times, this change is not viewed positively by all.


“The future that leaves some behind”


“It is our future, but it doesn’t mean I like it”


There appears to be particular concerns about TEC discriminating against the elderly and disabled, as well as posing confidentiality problems and domestic abuse and safeguarding issues going overlooked. Confidentiality is a massively important topic in medical ethics and something which is instilled in us in medical school. Additionally, we are often taught about the issue of domestic abuse, including how to look out for the signs and to deal with the situation if we suspect it. However these dilemmas are never taught with digital platforms in mind. How can one be sure there is not an abusive partner on the other side of the video camera listening to what is being said? How do you know if the patient is able to speak openly? There is no way of knowing if someone else is in the room or is listening on the other side of the door, unlike the control you have when seeing a patient in your own clinic room. These and all other issues mentioned are vitally important to consider going forward.


The public have also been able to suggest their perceived benefits of TEC, with the most popular points so far including the environmental benefits from reduced travel, less need for time off work and childcare arrangements. Another recurring theme is the alleviation of parking-related stress. As a student, I have to drive to various NHS sites for placements and, having received a couple of parking fines for not registering my car correctly as well as being late due to circling around hospital car parks in search of a space, I can certainly sympathise! The last thing an unwell patient or someone attending an anxiety-inducing appointment needs is additional parking stress, something which TEC is able to help reduce the need for. Other benefits of TEC raised by participants include reduced waiting lists, increased patient autonomy and compliance.


“A Digital NHS is about improving patient outcomes through technology and empowering people to manage their health better”


“An opportunity for change”


The idea of “empowering” individuals to manage their health is fundamental to TEC, and so it is very encouraging to see the public sharing this perception. It is important to note that even amongst those who feel positively about TEC, there still appears to be some apprehension.


“I'm cautiously optimistic”


“Positive, but daunting”


This is just a small snapshot of the many opinions, ideas and suggestions this survey is yielding. Although overall more positive than negative, the Welsh public is reporting varied opinions and experiences with the use of TEC. Some of these insights were as anticipated, while others took me by surprise, reiterating the importance of gaining the public’s opinion. The study is the first of its kind, committed to attain an unbiased sample representative of the entire Welsh population. The survey will stay open until October 2023, or until the target number of responses is reached, and I greatly look forward to seeing what else the Welsh public has to say. Knowing what the public wants will help shape the NHS and, on a more personal level, my own practice as a Doctor. Equally, as the NHS becomes more digital, this also must be incorporated into medical education. As student healthcare professionals, we are the future of the NHS. I therefore hope the results of this study can also inform training curricula.