- Technology and resource planning adopted by the healthcare sector during the pandemic will continue to be used going forward;
- Datasets need to be made widely and publicly available to support a better understanding of the coronavirus and why some people are affected more than others;
- Charities who play an essential role in healthcare provision in lieu of public service and supporting patients as well as healthcare staff need to be funded whilst charity fundraising is temporarily impacted.
More than 90 business leaders joined our nineteenth Enterprise & Market Resilience During COVID-19 virtual roundtable at 8.00 am on Thursday 23 July. The aim is to have an hour-long meeting each week on Thursdays and build a community of people from different industries who can share relevant materials and experiences of operating in ‘the new normal’.
This week’s discussion focused on how the healthcare sector has responded to the pandemic and whether changes implemented during lockdown will remain in place moving forward.
The speaker panel included Rajesh Nair, Consultant Urological Surgeon, Guy's and St Thomas' NHS Foundation Trust; Trish Morgan, Centre Head, Maggie's Oldham; Jessica Ruth, Centre Fundraiser, Maggie’s; Neil Murray, Chief Executive Officer, Impact Data Metrics; and Bob Andrews, Chief Executive Officer, Benenden Health.
Raj Nair said that day-to-day everything changed within a very short period of time, from a regular timetable of operations and clinics to a 100% focus on dealing with the virus. Anaesthetists were diverted to intensive care units (ICUs), extra ICU beds were placed in every nook and cranny of the hospital and ventilators removed from operating theatres, which were reduced from 54 to 10.
Guy’s and St Thomas’ Trust normally sees patients from beyond its own regions of Southwark and Lambeth, from across the UK and overseas, but needed to take a step back from providing elective surgery during the pandemic.
With resources in short supply, the Trust also needed to prioritise treatment for those who were suffering from life-threatening conditions. One of the challenges today is that patients who were anxious about coming into hospital are now frustrated by waiting times as lockdown unwinds.
Despite everything, the Trust has managed its way through the crisis well and has learned a lot about the virus and mortality rates. However, there will be knock-on effects as people continue to struggle emotionally and psychologically as well as physically.
Technology adoption is here to stay
One of the useful outcomes is that the Trust cut a lot of red tape governing the purchase and adoption of new technology, especially video conferencing systems that enable remote consultations and virtual follow-up sessions. Video has also been used to allow family members to communicate with patients in ICUs, or for dispersed families to participate in calls when cancer treatments or diagnoses are discussed.
It’s likely that video will continue to be used going forward at the Trust, especially when managing the flow of patients through the hospital. It will make sense to reduce the amount of time patients spend having consultations, scans and follow-ups, for example, by carrying out such processes on the same day, or with video appointments. The Trust will also look at how to manage expensive operating theatres more effectively, perhaps by asking staff to work different shifts instead of on a 9-5 basis.
Rising waiting lists
Bob Andrews said that COVID-19 had a similarly striking impact on the private healthcare sector, as their hospital capacity was acquired by the NHS and all elective operations halted overnight. Some members of the general public also ceased to manage their own health normally, with many ignoring symptoms and staying away from GP surgeries and hospitals. Others could not seek treatment because procedures such as endoscopies could not be carried out. As a result, the usual waiting list for operations and treatments of four million has risen to 10 million.
This will be exacerbated by the need to abide by new rules on how long air needs to be cleaned in operating theatres, meaning that throughput is impacted. While the original contract with NHS England is unwinding, a new agreement for the private sector to provide 75% of capacity between 9.00 am and 5.00 pm to the Trusts trying to clear the backlog of necessary patient care.
Lack of access to support and advice
Trish Morgan said that the pandemic has had a massive impact on the organisation, not least because its centres, based on NHS hospital sites, had to close. Maggie’s exists to provide support and advice for cancer sufferers, their families and friends so has had to find new and different ways to deliver its services, again by using video conferencing and phone calls.
People are angry that COVID-19 has effectively robbed them of the chance to spend time with their families because of shielding or self-isolation, said Morgan. There are also huge levels of anxiety because of uncertainty about future treatments, as well as cases that may well turn out to be untreatable because they have been caught too late.
Jessica Ruth added that Maggie’s is underfunded for this financial year by £7 million, due to the cancellation of fund-raising activities and economic uncertainty that makes donors cautious with their cash. Now that centres are safe to open again the charity is encouraging people to come back, and for businesses to consider how they could donate cash and use its services going forward.
The value of data
Neil Murray said that there is a great opportunity to use data to prioritise COVID-19 patients and understand how they should be treated through the virus. This starts by understanding how patient groups are exposed to different infection risks, according to whether they have existing conditions (and how these are managed) as well as their gender, ethnic background or age.
Understanding the ‘molecular switch’ that turns an individual from someone who may get ill to one who will definitely become extremely ill is vital to drawing up well-managed pathways for effective treatments. Tests are underway on blood samples taken from healthcare workers and the findings will be overlaid with other data to gain more understanding of prognostic actions that can be overtaken in future.
Plotting a future path
Panellists were then asked what they would change in the healthcare industry in the near future. Bob Andrews replied that better funding and co-ordination were needed to ensure that the public and private sectors could work more closely together - and match patients with the right resources, rather than operate with a fragmented, regional model.
A lot more could be achieved with data, responded Neil Murray. It is difficult to source healthcare data for privacy reasons, especially in England where there is an opt-in arrangement to share data, unlike in Scotland where the agreement is to opt-out.
There are three things Raj Nair would change: the first is for Trusts to understand in more detail what resources they actually have, and what they need to deal with any future crises, such as extra high dependency beds.
The second is staffing levels, especially nurses, who shouldered a huge burden during the crisis. Healthcare professionals need the right levels of rest and recovery, and need to be remunerated properly for their work. Otherwise more will become disheartened and leave the NHS.
The third is to learn from the disease and make resources freely and publicly available, so it’s clear what has worked and what hasn’t. It has been necessary to throw everything at the virus rather than take a targeted approach, which could be more effective.