Coronavirus response could create 'very serious unintended consequences'

NHS England analysts have been tasked with the challenging task of identifying patients who may not have the virus but may be at risk of significant harm or death because they are missing vital appointments or not attending emergency departments, with both the service and public so focused on covid-19. 

A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resource going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.

“What we don’t want to do is take our eye off the ball in terms of all the core business and all the other healthcare issues the NHS normally attends to. 

“People will be developing symptoms of serious but treatable diseases, babies will be born which need immunising, and people will be developing breast lumps and need mammograms.”

HSJ understands system leaders are hopeful that in the coming days they will be able to assess the scale of the problem, and the key patient groups, and then begin planning the right interventions and communications programme to tackle it.

“It could be about asking primary care to find them, or launching public information campaigns for certain patient groups, for example, or working with specific charities or groups,” the source explained. 

Data collections already suggest work will need to be done to contact patients from a wide range of groups, including heart disease and stroke patients.

Public Health England data published last week showed ED attendances had plummeted to around half of the normal level in the three weeks to Sunday 29 March – an unprecedented shift in demand.

This included a reduction by about half in attendances for heart complaints. 

There have also been multiple warnings about fewer people coming to hospital when they were having a stroke, prompting a warning from the national clinical director for stroke, Deb Lowe. On Twitter she highlighted “empty stroke beds” in hospitals and said: “Please don’t stay at home if you think you are having a stroke.”

Nuffield Trust deputy director of research Sarah Scobie said it was “a considerable worry that people are keeping away from routine and urgent health services, and also from emergency departments”.

She added: “The PHE data suggests there could be significant problems already developing for heart disease related conditions patients, for example. Attendances relating to myocardial infarction at emergency departments have dropped right down, whereas ambulance calls in relation to chest pain have gone right [up]. 

“It’s possible that people are therefore staying away from hospital then getting even sicker as a result, but there is not the data available yet to prove this hypothesis.”

She continued: “Public awareness campaigns could be a powerful means of getting patients to come in for their appointments. We have seen with recent campaigns about how to seek help, like earlier on to call 111 and then shifting to more online, that the public does listen to this messaging, and in the majority of cases acts on it.” 

NHSE declined to comment directly about the programme. A spokesman said: “The NHS is pulling out all the stops to respond to the biggest global health threat in a century, while also ensuring that people can still access the services they need in as safe a way as possible.

“There is capacity across the country to treat all those needing urgent, emergency and other essential care, and we want patients to continue to access services. While patients have rightly responded to the expert advice on staying at home, they should still seek medical help whenever they need it.”