By Dr. Shehan Hettiaratchy - Consultant Plastic and Reconstructive Surgeon
As begin to emerge from COVID, though there will be a few more twists and turns along the way, how will health systems recover?
There is no doubt that COVID has been one of the most testing challenges of all healthcare systems this century. That test is far from over but there are some immediate recovery challenges that need to be addressed. This will allow healthcare to get back to business as usual, or at least to the new normal of a post COVID world.
One of the most significant challenges all health systems are facing is the restarting of the non-emergency “elective” services that were put on hold during COVID. Some of these are very visible, such as non-emergency surgery (eg hip replacements). Other areas, such as cancer care, were maintained so you would think would be ok. However that may not be the case. Screening services, where early or pre-cancer conditions are picked up, were disrupted during COVID. This means that even cancer services, that were kept going during COVID, will be facing a backlog of patients, some of whom may have delayed diagnoses and therefore may be more difficult to treat.
So what’s the solution?
Unfortunately, is not as simple as just turning the tap back on. In the UK, health services pre-COVID were fine tuned to deliver just enough of this elective activity to meet demand. This was true in both private and public systems and was straight demand-capacity relationship. This meant the number of hospitals, staff, equipment were provisioned to deliver a certain level of output. It’s really hard to change that output significantly without spending more money to increase some if not all of the constraints. It might not even not be possible to change these limits.
You can’t create overnight an additional 100 trained surgeons or another 50 hospitals to do more operations even if we could afford it. In addition COVID, with all the implications it has for infection control in hospital, means that the processes for getting elective patients through hospitals is not as slick as it was, so even sweating the existing assets may not give the increase activity needed to meet the backlog of cases.
Finally, any increase in elective activity assumes no significant COVID levels. If COVID or variants rise, then all thoughts of trying to deal with the elective backlog will go out the window as the hospitals and staff are pulled back onto the COVID frontline.
So what does this mean? It means that the waiting lists that have soared during COVID are unlikely to disappear overnight. It means for every new variant that penetrates the population, the solution to elective backlog will get pushed down the road a bit more. It means that some patients may turn away from public funded health systems and chose to use their own money to sort out their health problems, if the private sector has the capacity.
It means that unless the healthcare burden of COVID can be nullified, any meaningful recovery of elective care is unlikely. Given what is happening globally with COVID this may mean that its effects are felt for years to come.
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Published by Dr. Shehan Hettiaratchy - Consultant Plastic and Reconstructive Surgeon
MA(Oxon) BM BCh DM FRCS(Plast)