Safety in numbers
The COVID-19 pandemic saw the private and public health sectors coming together to increase the country’s capacity to treat patients and save lives. The pandemic put significant pressure on our National Health Service 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.
Yet, 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.
Without meaning to sound flippant – I’d compare clinical care for cancer versus some less-complex procedures as the difference between making a casserole and a cake. Casseroles aren’t as ‘precise’. Ingredients can be added or removed based on personal preference and still deliver a great outcome. Cakes are an exact art. Forget the baking powder and your light and fluffy delight is as flat as a pancake.
Cancer treatment is a precise art. Whether you’re talking about chemotherapy, surgery or diagnostics, everything must be lined up perfectly to enable the procedure to take place safely. There’s no room for error. Things need to be meticulously planned. Just one missing piece of the ‘recipe’ and patient safety could be severely compromised.
One of the key pillars of medical ethics is non-maleficence – do no harm. This ethos underpins all clinical decisions. The current pandemic adds increased complexity to any decision-making process. Although the data remain limited, patients with cancer appear to be more vulnerable to worse outcomes from the infection, including greater need for ventilator support and increased mortality rates.2 Furthermore, it’s not just patient safety that has to be considered. There’s the duty of care to the medical staff to consider too.
Throughout the pandemic, medical teams have been faced with challenges. First, there was the issue of PPE availability, then a question around whether it was fit for purpose. While COVID-19 testing kits were available, the volume of lab technicians needed to process the results weren’t. And, accessing some essential drugs also wasn’t without its challenges. Where these issues were overcome, medical teams have had to make extremely difficult decisions regarding which patients to prioritise, particularly when there have been limitations on resources, especially in certain regions.
There’s no getting away from the human impact of the COVID-19 pandemic. People have understandably been frustrated and concerned by the significant reduction in access to cancer care during the height of the pandemic. And, tragically, there will be those who will see their life cut short. One mathematical model estimates that the impact of COVID-19 on healthcare provision and people’s reluctance to seek medical support due to safety concerns, could result in an additional 35,000 deaths from cancer3. It’s an awful situation, brought about by devastating circumstances.
The medical sector has faced an unprecedented challenge which they’ve risen to. It therefore feels unfair to make judgements on the underutilisation of private capacity without looking at the bigger picture. Healthcare professionals, policy makers and healthcare managers continue having to make difficult decisions on resource allocation on limited and constantly changing information. Patient safety and healthcare infrastructure has been a significant contributor to delays in treatment. It’s not just a case of private hospitals choosing to close their doors.
COVID-19 posed a risk to the whole infrastructure of the National Health System. We were – and indeed still are, facing a national crisis. As we start to move into our new ‘normal’, the private, public and social health sectors need to continue work together to give people the reassurance and confidence that they can safely seek support and access quality, safe treatment. In this era where uncertainty feels like it is here to stay, the only certainty we can hold on to is that everyone is doing their best in the best interest of the vulnerable and of wider society.
1. Britain’s Cancer Crisis, BBC Panorama, first broadcast 6 July 2020. https://www.bbc.co.uk/programmes/m000kqzv
2. The impact of the COVID-19 pandemic on cancer care https://www.nature.com/articles/s43018-020-0074y
3. Worst case scenario estimate based on a study conducted by DATA-CAN, the Health Care Research Hub (HDR UK) for Cancer https://www.bbc.co.uk/news/health-53300784