Health Policy May 7, 2020
Rethinking our healthcare service for a world with Covid

By Richard Gold - Accountable Care Journal


“In one sense, what the pandemic has done is to accelerate the slow overwhelm of the health system by long-term chronic conditions”

The latest in Public Policy Project’s breakfast webinar series on Covid-19 was a fascinating tour given by Charles Alessi (Chief Clinical Officer of HIMSS, Senior Adviser to Public Health England and a member of the original Steering Group in the development of Beyond the Fog) of other countries’ approaches to dealing with the virus and some clues as to why some had been more or less successful in dealing with it so far that might inform the UK’s planning for the future.

Interestingly, the discussion which was prompted by participants’ questions included a focus on a longer-term cause of fatalities — namely the underlying long-term chronic conditions which seem to be the most important determinant of survival (or otherwise) rates in Covid-19 sufferers (more so than simply the age of the patient).

The suggestion was that dealing with long-term conditions — moving towards a focus on lifestyle rather than just treatment — might be an appropriate way to prevent the system from being overwhelmed by future outbreaks. And the challenge was whether the healthcare system was up for this.

This is very much in line with the thinking behind Beyond the Fog, a report commissioned by the Royal Free Charity in which we rolled forward 10–15 years six key ‘megatrends’ affecting healthcare and applied system-level thinking to re-imagine the possibilities for technology-enabled, person-centred healthcare that spans all the areas of health and wellbeing.

A key underlying hypothesis in our work is that the current healthcare system, built to deal with acute illness is increasingly unsustainable for the chronic healthcare challenges of the twenty-first century.

In one sense, what the pandemic has done is to accelerate the slow overwhelm of the health system by long-term chronic conditions.

What we are experiencing now is acute in so many terrible ways, but the stress and exhaustion of frontline staff could be seen as an acceleration of what many were experiencing prior to the outbreak in a system that was pretty much in a permanent state of ‘winter crisis’. We already had a system that was having difficulty finding enough staff, losing too many trained professionals and struggling to come up with a viable workforce strategy.

And the lack of beds with ventilators is surely an acute version of the well-documented lack of beds in hospitals that had to deal with a fragmented health and social care system. The problem was known, yet progress in solving it glacial.

The positive side of this is that we are also seeing a huge acceleration towards some of the elements of a modern, sustainable system — such as virtual appointments so that patients need only make a trip to the doctor when it’s necessary. Moves in this direction were happening pre-Covid, but at a chronically slow pace.

And in all of the above cases, as described in Beyond the Fog, the lack of long-term, system-level thinking has been a chronic problem in the sector, inhibiting the cross-silo transformational change that is needed.

As politicians, policymakers, system leaders, healthcare professionals and the wider health ecosystem start to think about how things need to change post-Covid, it’s vital that they don’t only look at the acute issue and that they have the foresight, ambition and courage to look to solve the chronic problem. Our healthcare system was designed for a different age and any sustainable system that can deal with this century’s challenges using the capabilities offered by advances in technology and medicine requires a rethink of the nature of healthcare.

The good news is that (although it may be hard to remember this right now) we are at the dawn of the most exciting period in the history of healthcare — and if we take a long term view we can create a system that offers transformational improvements in the nation’s levels of health and wellbeing, a pathway to building a sustainable, integrated 21st Century public health and care system and an engine for economic growth and social renewal.

This will require a high level of ambition, commitment and long-term thinking — pretty much on the scale of 1948 — across an enormous swathe of organisational siloes. And it will require a shared sense of where it’s heading and a shared language for addressing the massive issues that need to thought through. We believe that Beyond the Fog provides a unique system-level framework to enable the debates that need to happen.

Richard Gold is co-author of Beyond the Fog and co-founder of Vision4Health, a not-for-profit with a mission to drive longer-term thinking in healthcare.

The original publication of this feature can be found here.

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