It has been nine months since healthcare systems around the world had to implement their pandemic planning paper-exercise in real life against Covid-19. In the UK, the government introduced a series of measures to manage the pandemic, including private facilities agreeing to reallocate much of their national capacity to support the NHS and help to meet the anticipated demand for clinical care.
The pandemic put significant pressure on our NHS, but it coped the best it could. Non-urgent, non-Covid-19-related services were deprioritised to ensure that healthcare resources were pointed at the greatest public health challenge of this century. While initially this approach gave us comfort, concern grew when the public learned that many private beds remained empty during this time, with questions around why they couldn’t be used to support patients whose cancer diagnostics and treatments had been delayed. It is a perfectly reasonable question, and one which I can empathise with.
As a patient, we only see the care we get access to. A bed isn’t just a physical entity – it comes with a whole support team including HCAs, porters, doctors, nurses, laboratory technicians, drugs and critical care support. When it comes to conditions such as cancer, whether it is chemotherapy, surgery or diagnostics, everything must be lined up perfectly to enable the procedure to take place safely. Cancer treatment is a precise art requiring meticulous planning. There is no room for error. Just one missing piece of the “recipe” can severely compromise patient safety.
This is crucial, as one of the key pillars of medical ethics is non-maleficence – do no harm. This ethos underpins all clinical decisions and this pandemic has added complexity to this decision-making process. Duty of care in this situation is not limited to the patient but also to healthcare staff.
Throughout the initial peak of the pandemic, healthcare teams have faced challenges – from the availability of PPE to assessing whether it was fit for purpose, from the accuracy of Covid-19 testing kits to the availability of lab staff to process the results. At times, access to essential drugs and critical care staff was also limited. Where these issues were overcome, healthcare teams have had to make extremely difficult decisions regarding which patients to prioritise.
There is no getting away from the human impact of the Covid-19 pandemic. Tragically, there will be those who will see their life cut short. It is an awful situation, brought about by devastating circumstances. The scars of succumbing to or surviving the pandemic cannot be underestimated and plenty remains unknown.
Now that the initial peak of the pandemic has passed, the NHS has started to restore some of its other services on a localised basis, and the nationwide contract between the NHS and independent sector providers has also been scaled back. While a proportion of private sector resource is still available to support the NHS during this time, many facilities have introduced measures such as extending opening times (including at weekends) to enable them to see patients expediently.
Throughout the pandemic, private medical insurance providers took a united stance through the Association of British Insurers (ABI) to support the response to the national challenge. In conjunction with the Independent Healthcare Providers Network and ABI, new processes and practices were introduced to help private medical insurance customers during this uncertain period. Private hospitals share weekly situation reports which help insurers to identify the services that are available and which consultants can see our customers.
At Aviva, we feed this information directly into our front-line systems so that our claims teams can help support and guide customers to relevant treatment providers, booking appointments for them where the functionality is available.
Our number one priority is customer safety. Through our “Aviva Assurance” process, we capture each provider’s Covid-19 operational processes to assure ourselves that appropriate protocols are being followed to provide treatment in a safe environment.
We also fund a PCR test for customers who are about to undergo private medical treatment to test whether they have the virus, in order to protect them, other patients and healthcare workers Our claims data for the past few months saw suppliers successfully adapting to the situation. As expected, and in line with national guidelines, surgical treatments for non-urgent conditions such as orthopaedics dropped significantly during the peak of the pandemic.
However, claims for outpatient consultations and treatment remained buoyant as healthcare professionals adapted to providing care through video or telephone consultations. We also saw cancer services being reconfigured to offer care at home where appropriate and private hospitals repurposing areas within the hospital to help them to continue treating patients in a safe manner.
The pandemic has changed the face of both public and private healthcare forever. Covid-19 has brought with it new challenges. We are already hearing about increasing levels of mental health conditions – reflected by our experience of customer claims. Patients who have had Covid-19 are reporting a range of lingering post-viral fatigue, neurological, cardiac and respiratory symptoms.
As the health industry navigates its way through the situation, there will be opportunities to take stock and learn from the experience. We have seen digital healthcare adopted at a pace, triage processes introduced to ensure that valuable resource is focused on those most in need, and a more personalised approach to healthcare. We have also seen the UK’s obesity challenge move up the government’s public health agenda. By tackling obesity, the nation will see a positive impact on other conditions such as diabetes, heart disease and some cancers.
We are proud of the way that the whole healthcare industry has come together to face Covid-19 head on. All of us have adapted, pulled together and learnt valuable lessons from the experience, and my hope is that we put this knowledge to use to rebuild a more resilient, healthy and fair society.
Dr Subashini M is associate medical director at Aviva UK Health and Protection.