The response to the COVID-19 pandemic has brought about significant transformations in healthcare and care services, prompting a reevaluation of established norms and assumptions regarding healthcare delivery. This article examines the global impact of the pandemic on health services and the resulting changes in care delivery, with a focus on the UK National Health Service (NHS) as a prominent example of rapid and large-scale adaptations.

Impact on Health Services

Moynihan et al. (2021) described the global pandemic as an unprecedented natural experiment in reduced healthcare utilization. During the peak of the pandemic in May 2020, many countries redirected resources towards essential services to mitigate mortality rates in crisis situations.

Across the world, there was a noticeable decline in non-emergency visits to Emergency Departments (ED) or Accident and Emergency (A&E) departments. In Northern Italy, pediatric EDs observed a decrease in non-urgent cases, allowing resources to be reallocated to prioritize emergency cases effectively.

This shift presented an opportunity to reconsider strategies and implement care models to optimize future ED visits. While beneficial for managing urgent cases, this change inevitably affected non-urgent and routine care, with the overall impact on patients in these categories requiring careful examination.

Coronavirus (COVID-19) in healthcare. Image Credit: Olena Yakobchuk/Shutterstock.com

Global Impact Assessment

A comprehensive global survey conducted by Moynihan et al. (2021) synthesized pandemic-related changes in healthcare service utilization across various categories. The survey, comprising 81 studies from 20 countries involving over 17.9 million services, consistently revealed a significant reduction in healthcare services up to May 2020, coinciding with the peak of the pandemic in many regions.

The survey indicated a 37% decrease in overall services, with a 42% reduction in visits, 28% in admissions, 31% in diagnostics, and 30% in therapeutics. Factors contributing to this decline included the suspension of routine care and patient concerns about COVID-19 transmission in healthcare settings, emphasizing the urgent need for infection control measures.

Changes in Care Delivery

While some services experienced reductions, others saw increases, notably telemedicine. In the UK, significant changes were implemented in primary and community care, including digital triage, expanded remote consultations, and infection control measures like ‘hot tubs’ in GP practices.

The NHS witnessed a surge in demand for critical care alongside decreased demand for non-COVID-19-related services, leading to a decline in non-urgent elective admissions and GP referrals. Outpatient services swiftly transitioned to digital platforms, minimizing face-to-face interactions.

Crisis services for mental health emerged, reflecting heightened public awareness of mental and physical health during the pandemic peak. Furthermore, large-scale organizational changes were enacted, such as sharing waiting lists across healthcare sectors to manage elective care efficiently.

Opportunities for Future Change

The post-pandemic recovery phase presents an unprecedented opportunity to implement systematic changes aimed at reducing low-value care, including overdiagnosis and overtreatment. Studies like that by Moynihan et al. (2021) underscore the importance of monitoring the long-term impact of missed care and launching public awareness campaigns to encourage seeking medical assistance promptly.

In conclusion, the COVID-19 pandemic has necessitated swift adaptations in healthcare delivery worldwide, with significant shifts towards digital and remote care models. As we navigate the recovery phase, it is crucial to leverage these experiences to build more resilient and responsive healthcare systems for future challenges.

References

• Lewis, R. et al., (2020) Understanding and sustaining the health care service shifts accelerated by COVID-19. The Health Foundation. Online: https://www.health.org.uk/publications/long-reads/understanding-and-sustaining-the-health-care-service-shifts-accelerated-by-COVID-19.
• Moynihan et al., (2021) Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review BMJ Open. Doi: 10.1136/bmjopen-2020-045343.