Researchers within the University’s Public Health Intervention Responsive Studies Teams (PHIRST) programme have recently evaluated the impact of transitioning two public health services to a hybrid delivery model that included one-to-one and group support via telephone, online, and face-to-face consultations. Evaluating the move to remote delivery for drug and alcohol care service, Forward Leeds (known as the DASE project), and the Welsh National Exercise Referral Scheme (NERS) – both in response to the COVID-19 pandemic – the research focused on the impact in terms both of the user benefits, and the cost of moving key services online. It was found that while the remote services provided considerable user value, implementing them often increased the cost of delivery, rather than reduced it.
PHIRST said: “This is due to the need to invest in additional digital technology, skills, and human resource to support online services. For example, where an in-person session can be led by a single staff member, an online session may require two – one to lead the content, and the other to manage digital set-up and technical support or, in the case of the NERS evaluation, to ensure that exercises are being performed safely – doubling staff costs.”
The research also highlighted ‘the risk of remote services widening inequalities due to digital exclusion’. Both healthcare services did, however, experience benefits from remote delivery. The DASE project, for example, identified increased service efficiency due to a rise in attendance and fewer cancellations. Both also found that remote delivery widened accessibility to those with barriers to in-person engagement due to factors such as disability, caring responsibilities, and cost of travel, highlighting the importance of maintaining flexibility to meet different users’ needs.
PHIRST added: “With public services facing significant financial cuts during an economically turbulent time, we are now advising against viewing digital delivery as the solution to reducing costs, and urge robust funding to be implemented to offer a hybrid of both in-person and remote health services. We also strongly recommend ongoing development of digital delivery options to make them more efficient, cost-effective, and universally accessible.”
Katherine Brown, Professor of Behaviour Change in Health at the University of Hertfordshire, and PHIRST Connect Chief Investigator (pictured), said: “While our research has clearly shown the digital option isn’t necessarily the cheaper choice for service-providers, it also demonstrates the importance of continuing to support this delivery model, and why healthy funding is needed for these services to thrive in a hybrid model. While in-person treatment can lead to more effective welfare checks and improved rapport, engaging remotely is helpful for those with mobility restrictions, caring responsibilities, or severe social anxiety. For some people, digital services are the only way they can access the required health support.”
Katie Newby, Associate Professor in Health Behaviour Change, and PHIRST co-investigator, commented: “It’s important that people who are engaging remotely don’t miss out due to lack of funding or support. We know staff do fantastic work in both formats, and this needs to be supported and bolstered by continued investment and development. Having the flexibility to offer both remote and in-person engagement adds a valuable new dimension to care that can widen access while still offering a high-level service.”
Mary-Ann McKibben, Consultant in Public Health at Public Health Wales, said: “Pivoting to virtual delivery during the COVID-19 pandemic was important so we could continue to support NERS clients to be physically active and stay healthy. The PHIRST research has highlighted the success of a virtual approach in increasing accessibility for many, but also identifies some of the limitations that need considering if we are to deliver a hybrid model in the future.”