It’s well known that the COVID pandemic created unprecedented disruption in how healthcare was provided and delivered globally. With the emergency phase of the pandemic now behind us, it’s important to understand if and how these disruptions affected people’s health.
In a new study published in the BMJ, my colleagues and I have shown that people who were disrupted in accessing healthcare in England were more likely to be hospitalised for preventable conditions.
In England, non-emergency treatment, surgeries and diagnostic tests were postponed or cancelled. Appointments were moved online. Some treatment options were changed to allow for their safe delivery (for example, monitoring blood oxygen levels at home allowed people to be discharged earlier). Many of these changes were necessary to build capacity for treating COVID patients.
Patients were also deterred from seeking healthcare, either for fear of being exposed to the virus or altruistic behaviour in not wanting to be a burden at a time of crisis.
While much of this was described at the time, there has been no empirical evidence that we know of to demonstrate the health effects of this disruption. We simply did not know how bad, if at all, this disruption would be.
Reviewing the data
To investigate this, we used data on 29,276 people from seven large studies in England between March 1 2020 and August 25 2022. Each study sent several surveys to their participants during the pandemic to hear about their experiences, including in accessing healthcare.
People who participated in these surveys were then linked to their medical records by something called the UK Longitudinal Linkage Collaboration. This provided us with a powerful way to see whether people who reported any disrupted healthcare were more or less likely to be hospitalised.
We focused on so-called “avoidable hospitalisations”. These are conditions that could have potentially been prevented with adequate access to healthcare (for example, gastric ulcers, angina and asthma).
We found that 35% of people had experienced some form of disruption in accessing healthcare during the first year of the pandemic. Some 26% of people had trouble accessing appointments (for example, visiting their GP or an outpatient department). And 18% were disrupted in receiving procedures (for example, postponed or cancelled surgery, changes to treatments offered or delays in accessing cancer treatment).
People who had faced any level of disruption were 80% more likely to be admitted to hospital for a potentially preventable condition up to the end of the study period. The effects were consistent when looking at short-term issues (such as gastric ulcers, dental problems and cellulitis) and chronic conditions (such as asthma, angina and high blood pressure).
When we looked at which type of disruptions mattered most, our analyses suggested disruption to procedures was particularly significant. Disruptions in accessing appointments were also important.
Not everything was bad. Disrupted access to medications was uncommon (occurring for 6% of people) and we didn’t find meaningful associations between these experiences and hospital admissions.
Our study did have some limitations. Measuring the effects of healthcare disruption is hard. Linking specific moments of disruption to hospital admissions is impossible. Not all hospital admissions will have been due to disruptions in accessing care – some will have occurred anyway.
It’s also plausible that the full effects of disruption may not have occurred yet – it could take years to understand the total impact. For example, delays in cancer diagnosis due to postponed screening programmes might lead to poorer survival rates five years later if cancers are caught at later stages where they’re harder to treat.
What can we learn?
What we need to be doing now is learning about what worked and what didn’t in managing the COVID pandemic to help us prepare for the next pandemic. Our study suggests the importance of maintaining continued care, particularly in delivering treatments and procedures.
It’s of course easier to move GP appointments online than surgeries or treatments that need to be delivered in person. But focusing on preventing disruptions in delivering treatments is important in preparing for future pandemics.
Our study also raises important questions about the need to clear backlogs of treatments, diagnostic tests, procedures and appointments. The NHS waiting lists are at record levels and we cannot continue to let them grow.
A challenging economy coupled with chronic under-investment in staff and infrastructure is going to make tackling these waiting lists and the longer-term effects of COVID disruption difficult. Ultimately, we need to increase investment in the NHS to counter the legacy of COVID disruptions to healthcare.
This work was funded by the Medical Research Council, NHS Research Scotland, the Scottish Government Chief Scientist Office, Health Data Research UK and the National Institute for Health and Care Research.