We cannot deny that the past year has been a challenge for the whole world, whether you were infected with coronavirus, you lost loved ones, you lost your job, or your health suffered because of the virus, everyone has felt the impact of COVID-19. However, it is apparent that there are disproportionally impacted groups that have suffered more from COVID-19, these include the elderly, people from Black, Asian, and Minority Ethnic (BAME) backgrounds, people with long term health conditions and people living in more socioeconomically deprived areas.
ADI hosted a discussion on how we can help those who have suffered the most through COVID? We were joined by Mike Farrar, Independent Management Consultant (former Chief Executive of NHS Confederation, and North West and West Yorkshire Strategic Health Authorities) who highlighted that there is not just one group that has suffered during COVID, there are significant groups of patients as well as the general population and it is essential to target those with greatest need and put resources into those individuals and groups. We were also joined by Dr Liam Knox, Postdoctoral Research Associate at Sheffield Institute for Translational Neuroscience (SITraN), who gave practical illustration of how the digital healthcare platform, TiM on MyPathway, has supported patients with MND, who otherwise would have suffered during COVID-19.
Inequalities existed within healthcare before COVID-19, the pandemic has however made these disparities more visible and indeed exacerbated them. There is clear evidence that COVID-19 does not affect all population groups equally, it has had a clear disproportionate and detrimental impact on people from BAME communities. Many people now are questioning how health disparities in minorities could be addressed? There are several inherent factors as to why BAME communities have suffered more including, individual diet, pre-existing health conditions, such as diabetes and obesity, which are more common in people from BAME backgrounds. It has also been identified that a higher proportion of BAME groups are key workers and therefore have been regularly exposed to the virus. Research also shows that the stigma that was presented early in the pandemic, that BAME communities were more likely to get COVID-19, negatively impacted those groups getting tested or seeking medical help. We need more understanding about the disproportionate impact COVID-19 has had on specific groups. Dr Liam Knox stated, “gathering and using data cleverly enables a more responsive healthcare system.” We need to improve our data collection for all groups. We need to be clever with data and use it to form our decisions and help reduce barriers. Can data be used to deepen our understanding of the wide socio-economic contributing factors?
The economic impact lockdown has had on the general population is vast. However, those hit hardest by the financial impacts of COVID-19 tend to be those who were already economically vulnerable. As a result of COVID-19, nearly one-third of lower-paid employees have lost jobs or been furloughed, compared to less than one-in-ten top earners (1). The impact this financial crisis has had on people’s mental health, along with the anxiety of isolation and loneliness is an issue that will outlive this virus. There has been an enormous amount of focus on mental health within the NHS, especially the strain that its staff have endured. Across social media, many celebrities and influencers are encouraging people to talk about their mental health, and individual companies are focusing on employee’s mental health, particularly whilst working from home. We are currently managing a global pandemic however, as Mike Farrar suggested, as a direct effect of COVID-19 we are now approaching a mental health pandemic.
People with pre-existing health conditions have also suffered because of COVID-19, not only because they were considered a more vulnerable category and therefore were required to shield, but also because of the impact the virus had on their healthcare treatment. There has been a lot of focus recently on hospital waiting times. Patients’ appointments have been postponed and therefore their treatment has been delayed which is likely to impact their long-term outcomes. As a result of people wanting to avoid hospitals and GP practices, there is also a rising group of people who have no diagnosis. Tackling the backlog of waiting lists is not a quick fix, however by involving patients in their healthcare and assisting clinicians by validating their conditions, this can seriously help reduce waiting times. Mike Farrar touched upon Gait therapy which was used to support patients waiting for hip and knee replacement surgery. Whilst waiting, patients received training to help improve their ability to stand and walk, and as a result some patients no longer required the surgery. NHS staff are overwhelmed, they are exhausted, and we need to support them. We need to encourage patients to take on some of the responsibility for their healthcare, we need to empower self-management and engage patients in their own healthcare. MyPathway encourages change in power dynamics, it allows the professionals to have some rest bite as patients are being remotely monitored. MyPathway allows organisations to move from an institution focus to patient focused care.
The impact that COVID-19 has had on the older population is drastic, not only because if they catch the virus, they have a higher chance of dying, but they have the added anxiety of knowing that the risks are higher, they have had to shield and therefore have been isolated, often alone. This highlights again the impact COVID-19 will have on the population’s mental health. As the vaccine is rolled out and the older population can return to normal life, we discussed if technology serves up another inequality for the older population as digital natives are naturally more self-serve. If we are moving towards a more digital led approach, how do we support those who are not so digitally engaged? Dr Liam Knox emphasised that there should always be a choice with your healthcare. TiM on MyPathway is not a digital replacement for traditional care, it is an optional extra for the patients. In other areas, such as palliative care, research suggests that there is limited evidence that older people cannot use digital technology. It is important to keep the older generation as independent for as long as possible, and if technology can be used to do that, especially as evidence suggests there will be little resistance, the older generation can be engaged in their own healthcare and become empowered using technology.
This article clearly shows that certain groups have been impacted more by COVID-19. However, it is also important to highlight groups that could have suffered as a result of COVID-19 but due to the rapid response, they have received the care that they so desperately needed during the pandemic. Dr Liam Knox discussed, Telehealth in Motor Neuron Disease (TiM) on MyPathway, a digital platform that has been implemented within Sheffield, that enables healthcare professionals to remotely monitor and support patients with Motor Neuron Disease (MND). Prior to COVID-19, patients often were required to travel long distances to attend their appointments, and in between appointments received very little information. Therefore, when the pandemic hit, TiM on MyPathway was accelerated to enable remote monitoring of MND patients. Early findings suggest that patients find the platform easy to use, even with significant disabilities and it only requires 5-10 minutes per week of the patients’ time.
Carers are also invited to create an account, so their health and wellbeing can be monitored. TiM on MyPathway specifically reaches out to the carer, as they understand they are a significant part of the patient’s healthcare team. Research suggests that carers need more support, due to COVID-19 almost all carer social and support networks have been stopped. Many carers have been shielding, and therefore have felt isolated. It is important to recognise and understand that carer’s mental health has also been impacted because of the pandemic. Carers are such an important part of our Health and Social Care system and it is so encouraging to see that they are supported in such a personal way.
Dr Liam Knox talked about his desire to create a more personalised TiM system, to enable healthcare professionals to send individual resources and improve interaction, by targeting information leaflets to more specific patients to improve their engagement. By personalising information, we can improve interaction, which is a promising direction of travel. Dr Liam Knox admitted he may be biased on this topic as he has a continued interest in research regarding motivation in long term conditions and targeting specific personalised information. Even So, this personalised approach would engage patients in their healthcare journey and enable clinicians and patients to share the responsibility of care.
Our discussion with Mike Farrar and Dr Liam Knox certainly helped to highlight who has suffered most through COVID-19, however what is clear is that there is no simple solution to suggest how to help those that have suffered. We need to target those with the greatest need, we must put resources into these groups. There is no quick fix and there are so many issues that need to be addressed, from supporting mental health services which are evidently going to expand, to collecting and using data to support the healthcare system. This will take time and we fundamentally need to look at the way we deliver and design services. There is a need to change people’s mindsets of who is responsible for care. We need to put patients into a stronger shared care model to empower patients.
What has also been highlighted is that COVID-19 has brough with it a cultural change in using digital technology. Previously people were hesitant to rely on technology within healthcare, however they have suddenly realised the huge potential it could now have. As Dr Liam Knox stated, “the digital technology revolution is now.” That being said, we cannot ignore that many people in the UK remain digitally excluded. They may not have the ability to access the internet, they may not have the skills to use online services, or they may not have the confidence to use their computer, tablet or mobile and therefore digital is not a replacement for traditional care, it is simply a support tool.
At ADI we are incredibly proud to be part of something which makes such a difference to patients and being a part of this discussion highlights that MyPathway can offer a profound set of opportunities to support people who have suffered from the effects of COVID-19.