When the pandemic finally settles, healthcare is going to be different.
The pandemic crisis is catalysing deep and lasting changes for us all. At the centre of this are our healthcare services, which won’t go back to how they were when the pandemic does finally settle. Some of these changes are already clear, others less so, but all of us will be impacted. New ways of working and changing priorities will fundamentally alter the nature of health services and how we engage with them.
Every disruption provides an opportunity, and coronavirus is no exception – be that a timely focus on supporting our valuable healthcare workforce or harnessing rapidly adopted new ways of working digitally. The question is whether existing healthcare providers can successfully adopt, integrate and sustain these, or whether new groups will take advantage of the disruption to leapfrog ahead.
From speaking with colleagues around the world, both frontline doctors and healthcare leaders across a range of organisations, I’ve set out the five main ways healthcare is expected to change:
1. Analogue to digital
Healthcare has been painfully slow to embrace digital ways of working. In the UK, NHS data shows that approximately 0.6% of primary care appointments with GPs were undertaken via video link last year, with 80% in-person. That switched to 7% in-person, with the remainder shifting to telephone and online consultations. In the US, access to Medicare telehealth services have been broadened so that beneficiaries can receive a wider range of services from doctors, and reimbursement is now the same as in-person visits.
The combination of a highly contagious respiratory pathogen and global restrictions on movement has successfully delivered a decade-worth of digital change in the space of just over a year. The sticking-point will be whether these changes can be sustained. Despite appearances, the quick adoption of off-the-shelf communication tools not designed for this purpose, and the failure to properly integrate these into workflows and patient pathways may see some progress undone. Securing these efficient and productive new ways of working will need further support.
Although telehealth and remote consultations have been among the most visible changes, there are other areas where digital transformation will have even greater impact in the longer-term. From the digitisation of contact tracking and tracing, to the growing demand for provider- and system-based digital command centres, or ‘air traffic controls’ to marshal patient flow and resources, the longer-term changes will be far-reaching.
As with other industries, the move to online working and rapid adoption of group messaging and online collaboration tools will also be a turning point for how healthcare staff work together – the end of the bleeper and fax machine has finally arrived. Healthcare is witnessing a transformation in how both staff and patients can communicate and collaborate more efficiently. Long overdue, I expect coronavirus will ultimately leave a positive legacy of digital transformation in healthcare.
2. New disease, new care models
History can provide some helpful lessons on how healthcare will be delivered differently in the months and years until a vaccine is widely available. Near my family home in East London, the Homerton Fever Hospital opened in 1870, initially dealing with a rising smallpox epidemic. It was the result of an 1850 report into the management of infectious diseases in London, where many general hospitals excluded patients with fever.
Long-since closed or repurposed, these infectious disease hospitals were once considered an essential resource to bring together patients and the meagre treatment resources. Jump forward to today, and the raft of rapidly converted facilities to cope with the patient surge may result in a similar model developing again, separating out infected patients.
While this has all been happening, there are concerns that patients with many common conditions have stayed away. Global modelling estimates that over 28 million elective surgeries were cancelled during the peak of the pandemic last year alone. At some point these patients will return, potentially sicker, and healthcare will need to quickly resume ‘business as usual’ while still managing the ongoing pandemic.
The question is how to do this safely while still managing a highly infectious disease – how to concentrate the appropriate resources and staff, and segregate these from non-COVID-19 patients needing care, who are often those likely suffer most from becoming infected.
New approaches to triage and testing are already being developed and combined with new urgent care pathways and facilities dedicated to patients with coronavirus. I expect these to continue and become formalised, helping free others up for the ‘business as usual’ of healthcare.
3. Promoting caring careers
The universal celebration and appreciation of healthcare workers during this crisis is leading us toward a permanent shift in the value of this workforce. Their scarcity is already well documented, with the WHO estimating the world needs another 18 million health workers by 2030 to keep health systems functioning. The ongoing wall-to-wall media coverage of the crisis may yet prove to be the best recruitment campaign in years, and many will be drawn by an opportunity to help. With over 750,000 volunteers registering to support the NHS in the UK, and State Emergency Registries of Volunteers being established in numerous US states, we are already seeing an impact.
Given sudden unemployment for many and a lingering economic impact, healthcare work will look relatively stable and secure with many new opportunities opening up. Former healthcare staff who have answered calls to help may return on a permanent basis, and the general shift to new ways of remote and flexible working will make it easier for many to re-enter the workforce.
Speaking to clinical colleagues, anecdotally they report a paradoxically high morale currently. This is being driven by a shared focus pulling staff together, a camaraderie of support from colleagues and management, and a long-overdue recognition of their selfless work by the public and media. I expect all this to boost caring careers just when we need it the most.
4. Unifying universal healthcare
The current pandemic has exposed the weak points in many health systems globally, with at least half of the world’s population still lacking cover for essential health services. Limited access and high costs prove particularly challenging in a pandemic crisis, where everyone has a vested interest in treating the sick and universal health coverage can be a powerful unifying tool. Delays, difficulties or reluctance in seeking care can leave contagious patients in the community or workplace for longer. Even those with insurance may not seek care quickly due to high deductibles and out-of-pocket costs.
While the presence or absence of universal healthcare may not be a decisive factor in addressing the immediate pandemic, the benefits will reveal themselves as countries start to recover. The social safety net it provides will ensure greater national resilience and accelerate recovery by promoting social equity and economic security.
Given the rapid rise in unemployment and accompanying loss of health insurance for those in jurisdictions without universal health coverage, these countries risk prolonging the economic and social consequences through heightened risk of catastrophic health expenditure and ultimately a workforce in poorer health. While universal health coverage would not have prevented coronavirus, it would have helped protect the poor and vulnerable better in many countries.
The costs of coronavirus testing and treatment will still have to be met in countries without universal healthcare, potentially resulting in a significant additional economic burden. This together with reduced risk pools for those who do have medical cover threatens a vicious circle of rising healthcare premium costs in these jurisdictions, further placing healthcare cover out of reach.
In the world’s richest economy, hit hard by the pandemic, nearly 28 million Americans were uninsured in 2018 according to the most recent Census Bureau data. There is already some evidence in polling data that support for universal health coverage is increasing. Many will no doubt view the case as having been made, and at the very least there hasn’t been a better time to make it. I expect a greater public focus on health policies with an accelerating global shift towards universal health coverage.
5. Global health security
While many healthcare teams will have prepared for major incidents and accidents in recent years, pandemic risk reduction and management wasn’t a priority. While awareness may never have been higher now, the health system strengthening required to deliver this will be considerable. Adapting to the new reality of cyclical waves of coronavirus infection will see a prioritisation of public health, including surveillance, detection and reporting, and rapid outbreak responses.
The World Health Organization (WHO) defines global public health security as “the activities required to minimize the danger and impact of acute public health events that endanger the collective health of populations living across geographical regions and international boundaries”. The timely publication of the first Global Health Security Index by Johns Hopkins and partners just before the pandemic offered a snapshot of the gaps that need to be addressed. Perhaps unsurprisingly given where we now are, the key finding was that health security is fundamentally weak globally. There will be other future health emergencies and this current crisis has emphasised the need for better global cooperation and preparation. Expect a major pivot in international funding and resources to address this.
Healthcare has a better future
Healthcare has never been in greater focus and there has never been a more appropriate time to harness that for the greater good of our societies. Future generations will look back on this period as a point of major change around the world. Despite the immediate challenges we are facing in the short-term, there are opportunities to build better ways of accessing, delivering and funding healthcare in the future – perhaps the most significant opportunities we have seen in generations. Recognising and grasping this will be important in re-setting healthcare before that moment passes – and future generations will thank us for it.