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Intro:\ud This report adds qualitative understanding to an earlier report of health and social data for Maryport (Maryport – A left behind community? Health and Social Data Dive).\ud Methods:\ud Qualitative interviews with residents (n=8) and stakeholders (n=7) undertaken from November 2020 to May 2021\ud Findings:\ud This report has focussed on access to resources and services for people living in Maryport; it has shown Maryport to be an underserved community and revealed a range of interconnected challenges relating to education, employment, and connectivity. Many of the points raised by informants resonate with the findings in the CMO’s annual report (DHSC, 2021 ) and the OCSI’s work on ‘Left behind communities’ (2019). \ud Conclusions:\ud Maryport can be seen as a typical, left behind, coastal town. Furthermore, the difficulties faced by Maryport residents can be conceptualised as the wider determinants of their health.

Intro:\ud The Centre for Research in Health and Society (CRiHS) at University of Cumbria wanted to understand the most pressing health inequalities in Cumbria and the factors driving in order to target our research agenda. \ud Methods:\ud Short, online consultation with variety of Cumbrian stakeholders (49 responses).\ud Findings:\ud Inequity in healthcare is apparent in Cumbria; respondents reported uneven access to mental health services, secondary care, ambulance and emergency services as well as differences in commissioning practices across the county. Inequity in health was also reported which was caused by the synergetic effects of multiple (upstream and downstream) factors upon individuals.\ud Conclusions:\ud The provision of healthcare in Cumbria is challenging, as is tackling the wider determinants of health. There is a need for health and wellbeing eco-systems to combine actions at all levels and across sectors, for example, health services (front line, managerial, commissioning), local authorities, local business and VCFSE, together with the development of participation structures for community engagement.

Intro:\ud The purpose of this report is to present a ‘Deep Dive’ of publicly available health and social data for the town of Maryport. The OCSI (2019) report on left behind communities was used to guide the analysis.\ud Methods:\ud Presentation of health and social data for the town of Maryport accessed via a range of public data sources.\ud Findings:\ud The data examined suggests that Maryport faces numerous socio-economic challenges. Such challenges relate to Income, employment, health, education and training as well as connectedness to key services and civic, educational and cultural assets – ‘facilities that provide things to do often, at no or little cost’ (OCSI, 2019). Moreover, the Index of Multiple Deprivation (table 56 above) places six of the seven Maryport LSOAs within the 40% most deprived in England; this indicates that Maryport residents are generally lacking access to the resources required to meet their needs; resources that are perceived as customary to the rest of society. These challenges are most pressing for the neighbourhoods covered by the adjacent LSOAs Allerdale 005A (Ellenborough: South) and Allerdale 005B (Ewanrigg: North), and the MSOA Allerdale 005.\ud Conclusions:\ud Despite there being no Maryport wards identified as ‘left behind’ by OCSI (2019) this is largely due to the configuration of ward boundaries there wherein the two most deprived LSOAs are allocated to different wards. Had this not been the case, and had a ward been constituted that included both Allerdale 005A and 005B, then that ward would certainly have been identified as Left Behind.

Intro:\ud A presentation of data from the Indices of Deprivation for the North Cumbria Area\ud Methods:\ud Secondary analysis of the Indices of Deprivation\ud Findings:\ud Examination of higher-level data (i.e. county and district) illustrated how analyses across larger areas can obscure the existence of deprivation at the local level. As such, data for Cumbria County Council suggests it to be a relatively comfortable area with only moderate levels of deprivation. Analysis of lower-level (LSOA) data revealed a range of deprivation levels in North Cumbria and suggested some polarisation between and within LSOAs. This was apparent on the main domains for income and employment. Two domains stood out from the others due to the distribution of rankings being skewed towards most deprived; these are the domains for education, training and skills, and health deprivation and disability.\ud Conclusions:\ud The Indices of Deprivation reveal concentrations of deprivation in North Cumbria. However, more localised, pocket deprivation is remains hidden due geographically large and polarised LSOAs.

Background The complexity of fetal medicine (FM) referrals that can be managed within obstetric units is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video‐conferencing. We report the successful introduction of a fetal ultrasound telemedicine service linking a specialist fetal medicine (FM) centre and a remote obstetric unit. Methods All women referred for FM consultation from the obstetric unit were seen via telemedicine, excluding cases where invasive testing or cardiac anomalies were anticipated. The image quality was rated following each consultation. Women's experiences and family costs were evaluated by a questionnaire completed following the first telemedicine appointment during the first phase of the project. Results Overall, 297 women had a telemedicine consultation during Phase 1 (pilot and evaluation) and Phase 2 (embedding and adoption) of the project, which covered a four year period. There were 154 new and 143 follow-up consultations. Thirty-four women completed questionnaires during the Phase 1 of the study. Travel to the telemedicine consultation took a median time of 20 minutes (4,150), in comparison to an estimated journey of 229.8 minutes (120,450) to the FM centre. Women were generally satisfied with the service and valued the opportunity to have a FM consultation locally. Conclusions We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced to provide FM ultrasound of sufficient quality to allow fetal diagnosis and specialist consultation with parents. Furthermore, the service is acceptable to parents, has shown a reduction in family costs and journey times.

Supplemental material, sj-pdf-1-dhj-10.1177_2055207620925929 for Service user and staff acceptance of fetal ultrasound telemedicine by Elaine Bidmead, Mabel Lie, Alison Marshall, Stephen Robson and Vikki J. Smith in Digital Health

Introduction: The complexity of fetal medicine (FM) referrals that can be managed in a district general hospital (DGH) is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service.\ud \ud Methods: All women referred for FM consultation from the linked DGH were seen via a weekly telemedicine service, excluding cases where invasive testing was anticipated. Image and audio quality were rated (using a 5 point scale) following each consultation. Women referred for their first appointment were asked to complete a questionnaire following the consultation. Figures presented are median [range].\ud \ud Results: 80 women had a telemedicine consultation between October 2015 and September 2016. 37 cases were new referrals because of fetal anomaly (n = 17), exclusion of abnormal placental invasion (n = 11), small-for-gestational-age (n = 7) and prior history of fetal anomaly (n = 2) and 43 cases were follow-up consultations. Median gestation was 29 [13–36] weeks. Image quality was of sufficient quality to achieve the aims of the consultation in 79 cases with an image score of 4 [3–5] and audio score of 5 [3–5]. Journey to the telemedicine consultation was 20 [4–150] minutes in comparison to an estimated journey time of 238 [120–450] minutes to the FM centre. Estimated family costs for attendance at the FM centre were £95 [20–555].\ud \ud Conclusion: We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced and used to provide high quality consultations.

Introduction: The pilot explored delivery of complex obstetric ultrasound services via videoconferencing. A video link enabled a fetal medicine specialist to synchronously examine ultrasound images captured by sonographers at the DGH and to conduct remote consultations with parents. The study was undertaken to understand the barriers and enablers of technology adoption from the perspectives of clinical stakeholders. \ud \ud Methods: Adopted from the Stakeholder Empowered Adoption Model developed by the University of Cumbria, commissioners and managers were involved in determining the evidence needed to assist decision making; semi-structured qualitative interviews were then undertaken with six key clinical stakeholders.\ud \ud Results: The study identified a range of tangible benefits to DGH staff. Sonographers were upskilled; more involved in women’s pregnancies; and had better access to specialist support. Consultants felt better supported and less isolated professionally, resulting in improved management of high risk pregnancies. All clinicians recognised benefits for women of convenience and continuity of care. Potential barriers included: engagement of DGH executive/management; establishing the video-link; interruption of routine practise. Most challenges were overcome within the pilot.\ud \ud Conclusion: Fetal ultrasound via telemedicine has enhanced maternity provision at the DGH. Whilst staff acceptance is an identified barrier to adoption of telehealth, tangible benefits are known enablers. In this instance the identification of tangible early benefits for patients and staff influenced staff acceptance.

Introduction: The aim of this study was to evaluate from the patient’s perspective, a new fetal ultrasound telemedicine service to improve prenatal diagnosis and management at a rural district general hospital.\ud \ud Methods: Eligible patients requiring a specialist fetal medicine consultation were referred to a tertiary care centre for inclusion in the study. Women who underwent a telemedicine examination with a consultant guiding an ultra-sonographer and providing specialist counselling via video-conferencing link were approached to complete a structured questionnaire with the option of participating in a semi-structured telephone interview. The questionnaire included a 5-point scale to evaluate patient satisfaction with the consultation. The mixed methods analysis employed SPSS and Atlas.ti software packages.\ud \ud Results: Of the 80 consultations undertaken during the study, 38 new referrals having their first telemedicine consultation were approached; 31 returned survey questionnaires, and 16 interviewed. Survey and interview participants expressed very high satisfaction with the timely service (93.5 percent highly satisfied with quality of care overall), particularly as a result of the reduced travel times and costs. Analysis of the interviews revealed other advantages such as familiarity and continuity of care from staying local and increased confidence through the sharing of expertise, particularly during an anxious time in their pregnancies.\ud \ud Conclusion: A fetal ultrasound telemedicine service was highly acceptable to patients in this rural community, offering them a range of personal benefits as a result of easier access to specialist healthcare.

Antenatal care involves the screening, diagnosis and monitoring of the “at-risk” fetus using ultrasound. When a problem is detected by an ultra-sonographer (e.g. a fetal anomaly or small sized baby), the mother is referred to a local specialist or the regional FM centre in Newcastle for confirmation of the diagnosis, counselling and management. At present, three consultant-led maternity units in Cumbria refer FM cases to Newcastle. This means that patients travel for 6 hours at their own expense. Telemedicine could help in reducing travel and improving access to consultants. This new service is aimed at establishing a videoconferencing infrastructure between the obstetric ultrasound department at West Cumberland Hospital and the Fetal Medicine (FM) centre in Newcastle. It is currently in its implementation stage.

Teleswallowing:-\ud • Is an innovation designed by Blackpool Speech and Language Therapy Department to enable remote swallowing assessment of dysphagic patients resident in nursing homes\ud • It is a response to the growing demand on Speech and Language Therapy departments for swallowing assessments\ud • Was initially piloted in three nursing homes between August 2013 and March 2014, and was evaluated as successful in April 2014\ud • Was expanded to five further nursing homes in October 2014 to test findings on a larger scale and to enrich the clinical case for service transformation.