Looking to the future and how we will deliver health care going forward

Dr Peter Lachman
Dr Peter Lachman

The second anniversary of the first lockdown is in a few weeks’ time. In many countries, especially in the lower and middle income categories, vaccination rates are low which means that the pandemic is not over and we cannot be certain that there won’t be another wave, writes D. Peter Lachman.

Nonetheless we are better prepared than before. I recently came across a paper called The History of Pandemics which makes interesting reading. The COVID pandemic should not have been a surprise as we have had three this century already i.e., SARS in 2002-3, Swine flu in 2009-10 and MERS in 2015, which is ongoing. As they did not affect Europe and were predominant in Asia, we in the West did not learn from them as we should have.

The response to pandemics over the centuries has not changed much. The authors of the paper state that “during centuries, implementation of public health measures such as isolation, quarantine and border control helped to contain the spread of infectious diseases and maintain the structure of the society.” Add vaccination and medications and we have the standard response to a pandemic. When the next one arrives, we should know what is required, with an early focus on preventing human to human transmission. But the question remains – will we as a society learn? As healthcare managers we need to adapt so that the response to the next pandemic will be agile and less disruptive to our health service.

As healthcare managers we need to adapt so that the response to the next pandemic will be agile and less disruptive to our health service.

Our learning should extend beyond the response to the pandemic and needs to include a reflection on how we will deliver health care going forward. Do we return to the pre-pandemic model of care, with lack of integration, long waiting lists, trolley waits and at times unsafe care that was not person centred? Or can we build a new way of delivering healthcare in partnership with the people receiving care? 

Over the past two years I wrote several blogs that highlighted some of the actions that  can assist in transforming to the health service that we require.

We cannot return to the pre-pandemic model of care broken down into component parts based on disease and not focused on health. Slaintecare aims for an integrated approach which in turn means a ceding of power to the people receiving care. Integrated care focussed on health and not disease is the foundation and the pandemic has made its implementation more important than ever. But will it happen? We can take a few steps in how we manage care to assist in ensuring the changes that are required.   

To deal with the surgical backlog built up over the past two years will require reinvention in the way we manage surgery, with smoothing the flow so that there are no peaks and troughs in demand and supply. This will assist in resolving the backlog and ensure future proofing of surgery. It will also have knock on effects in the ED and decrease trolley waits for in-patient beds. However, it requires a new way of thinking and a culture change with ceding of power, 7 day-week working and a more rational use of resources.

We need to embrace digital healthcare and ensure that we design systems that include telehealth, use of wearables and electronic healthcare records to allow seamless movement across systems. This means moving from disease management to health management. Hospitals and primary care will need to change to ensure universal health and funding should follow the patient and not the service. Equity  must be the foundation of any service redesign.

I covered eco-friendly healthcare the last blog and I think that a carbon neutral service is essential. Explore more ideas on how to achieve carbon neutral healthcare at Irish Doctors for the Environment. Finally, patient and healthcare worker safety must be at the core and the WHO Global Action Plan provides us a roadmap of what is possible.

All these changes will require changes in the way we think and work and a major shift in culture. We must embrace coproduction as the core value and modus operandi, working with the people receiving care. Listen to the podcasts that are hosted by Paul Batalden on The Power of Coproduction about “redesigning health care services to achieve better health through mutual respect, collaboration, and science-informed practices. More on coproduction can be found in the recently published IJQHC supplement which shows the growing evidence base for coproduction.

In the next few blogs, I will discuss these challenges so that we can enter the future with hope and enthusiasm, together.