The Imperial College Health Partners and Ipsos MORI, on behalf of NHS England and NHS Improvement, convened six dialogue and deliberative workshops in London. The two-stage project gathered insights on Londoners’ concerns and explored their views on measures related to COVID-19.
Problems and Purpose
As public health officers were preparing for a new wave of COVID-19 infections, there was a need to understand how Londoners felt about the changes that have been put in place in the London health and care system as part of the emergency answer. Therefore, this deliberative engagement program aims to explore the concerns of the citizens and their views on the tensions and trade-offs related to measures that could be put in place in response to the pandemic. [1] This process seeks to assist and inform the NHS decision-making process as it manages a second wave of COVID-19 cases.
Background History and Context
The urgency of the COVID-19 pandemic has forced public health officials to implement changes in the London health and care system rapidly. The crisis required an institutional capacity to make quick decisions and shift priorities. While the measures implemented in the spring began to ease up, there was an opportunity to find new ways to engage Londoners in the mid and long-term planning of the NHS response. This engagement project was created to support the preparation of the NHS for a potential increase in cases over the winter. [2] The deliberative project was informed by an initial dialogue conducted in June by Ipsos MORI and the Imperial College Health Partners, as well as the work on the OneLondon Citizens’ Summit on uses of health and care data. [3]
Organizing, Supporting, and Funding Entities
The workshops were conducted by the Imperial College Health Partners and Ipsos MORI on behalf of the NHS England and Improvement (London Region).
Participant Recruitment and Selection
The participant selection process for this two-stage process proceeded as follow:
1. The dialogue stage of the project took place in June 2020. Participants were drawn from the 100 Londoners who took part in the OneLondon Citizens’ Summit. [4] Drawing from that pool ensured that the participants reflected the population, views on health and care data, and the local NHS geographic divisions. The first workshop was attended by 58 participants, while 61 attended the second one. [5]
2. The deliberative stage took place in July and August 2020. For this stage, 59 participants were selected to take part in the four workshops. The participants were recruited to reflect London’s diversity in terms of gender, age, socio-economic category, ethnicity, caring responsibility, and health and social care usage. They were also representatives of the local NHS geographic divisions. [6]
Methods and Tools Used
This two-stage process took place entirely online. For both the dialogue and deliberative stages, the workshops combined moderated discussions in small break-out groups of around six people and plenary sessions where information was shared by experts or by moderators who shared summaries of findings from the smaller groups. The composition of the small groups varied at every workshop. Also, stimuli (scenarios, expert presentations, handouts, and exercises with fictional cases) were used in both stages. However, the deliberation workshops focused on more specific topics than the dialogue stage. [7]
What Went On: Process, Interaction, and Participation
This two-stage approach was divided between a dialogue stage and a deliberation stage.
Stage 1: The first stage entailed two workshops (June 3rd and June 6th) to discuss the participants’ concerns more broadly. The first workshop entailed small-group discussions on the participants’ lived experiences of the pandemic and the changes that NHS had to make in response to the COVID-19 crisis. This process was supported by a presentation on the NHS’s immediate response, a roundtable of experts explaining the decisions that were made, and a presentation on access to health services in the current circumstances. The second workshop began with small-group discussions in which participants reflected on the previous workshop and discussed their views on the measures being considered by the NHS. Following this discussion, the participants discussed in greater detail four areas (consolidation of services, virtual consultations, access, and prioritizing planned care). Experts provided high-level information on these areas, and participants were presented with case studies on the potential impact of these measures on individuals. [8] The views of the participants were used to inform stage 2 of the project.
Stage 2: The deliberative stage took place over four workshops. The participants discussed a series of policy proposals and ideas: prioritization of elective care, deferring treatment, consolidation of elective care, self-isolation, virtual consultations, and access to urgent and emergency care). [9] The structure of the deliberative workshops was as follow
o Workshop 1 – Topic: Prioritization of elective care (July 23rd)
The deliberation centered on three questions: 1) How should we prioritize patients moving forward?, 2) Are there other criteria we should be considering when making decisions about who receives treatment first?, and 3) How should the NHS respond when patients say that they want to delay their treatment until COVID-19 is less of a risk? Experts took part in plenary sessions and provided information on the topic. In smaller groups, participants discussed the topic and were presented with exercises involving fictional patients that required them to indicate which one should get their treatments first and why. [10]
o Workshop 2 – Topic: Access to planned care (July 25th)
The second workshop discussed the consolidations of elective services, justifying the “virtual first” approach to consultations and the participants’ expectations regarding NHS management of self-isolation. The structure was the same as the other workshop, and participants were given handouts explaining the proposed changes and case studies to show how the changes might impact individuals. [11]
o Workshop 3 – Topic: Access to emergency and urgent care (July 29th)
The third workshop explored emergency and urgent care changes through questions about limiting walk-in access, redirecting people to other services, and initial trial service. Participants also discussed how these changes might affect people and how to mitigate these impacts. The workshop entailed discussions in plenary sessions as well as several breakout group discussions. Experts gave two presentations on the topic, and participants reacted to fictional scenarios and patient journeys. [12]
o Workshop 4 – Topic: Finalizing expectations and communications (August 3rd)
The final workshop had two goals: 1) reflect and refine emerging expectations about how proposed changes should be developed, and 2) reflect on and identify the key messages and how to keep people informed on these policies. This session was comprised predominately of breakout group discussions. Participants were given eight drafts based on the synthesis of discussions from the previous three workshops. [13] A final plenary session took place to present the final expectations to the whole group. [14]
The purpose of the deliberative workshops was to develop a set of expectations as guiding statements to assist the NHS in responding to the pandemic. The draft expectations given to the participants in the final workshop were written by the Ipsos MORI and the Imperial College Health Partners. In groups of five to six, participants were asked to review and discuss the draft expectations by focusing on three specific things: 1) if the expectations were reflective of the discussions; 2) if there was anything that should be reformulated; 3) if anything was missing. The expectations were reviewed based on the ten groups’ feedback before being presented to the participants and senior healthcare leaders. [15]
Influence, Outcomes, and Effects
The output sought by this whole process was intended to develop an informed and considered set of expectations to guide the NHS future planning in response to the pandemic. A summary of the results can be found here.
Analysis and Lessons Learned
See Also
References
[1] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 3, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf
[2] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 2-3, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf
[3] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 25, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[4] Following a purposive sampling approach, these participants were selected based on a series of quotas (e.g., age, ethnicity, socioeconomic grade, people having children and caring responsibilities, people with long-term conditions). OneLondon, Public deliberation in the use of health and care data: Appendices, p. 3, https://www.onelondon.online/wp-content/uploads/2020/06/Appendices.pdf
[5] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, Annex 7, p. 6, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[6] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, Annex 1, p. 109, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[7] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 28, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[8] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, Annex 7, p. 6, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[9] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 26-27, https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[10] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 29 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[11] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 29 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[12] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 30 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[13] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 13 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[14] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 30 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.
[15] Ipsos MORI and Imperial College Health Partners, London COVID-19 Deliberation: insights and expectations from a deliberation with Londoners, September 2020, p. 13 and 32 https://www.ipsos.com/sites/default/files/ct/publication/documents/2020-10/nhs-london-covid-19-deliberation.pdf.