The COVID-19 pandemic has affected the lives of everyone in our society; for some its impact has been devastating.
Tragically, COVID-19 has resulted in the deaths of many people throughout the country. Every instance represents a life lost. And in many cases, the loss of a loved one has been made even harder for the relatives and friends of people in care homes and hospitals who were unable to be as near to them as they would have wished in their final days and weeks, due to COVID-19 restrictions. The emotional toll will also have been felt by the staff who have cared for and supported them, and who in many cases – particularly in adult social care – may have built up a relationship over years.
Both the people delivering care and the people needing and receiving care have had to grapple with the huge impact of the pandemic, and the restrictions needed to minimise the risk of COVID-19 infection. It has affected every aspect of health and care services.
Many people have had to wait longer to get the care they need, and for many these waits go on. The number of people in England waiting to start hospital treatment hit a new high in July 2021 – a total of 5.6 million. There were almost 300,000 people waiting more than 52 weeks to begin treatment.
Many of these people are waiting, often in pain, for hip and knee replacements and for other operations. Without the surgery they need, many people can be left unable to work or carry out everyday activities.
The number of people having long waits in ambulances at hospital emergency departments, due to pressures within the hospital, has been exceptionally high. In a survey of UK emergency departments in August 2021 by the Royal College of Emergency Medicine, half of respondents said they had been forced to hold patients outside in ambulances every day. We reported in March 2021 how hospitals were trying hard to avoid overcrowding and maintain social distancing within the hospital, but NHS England statistics show how this had had a knock-on effect on ambulance handover. An ambulance is not a suitable place for a patient to be waiting for treatment or waiting for a place on a ward to be found.
The pandemic has taken a toll on the health and wellbeing of older people. In July 2021, Age UK reported that 25% of all older people (around 4.0 million) were living with more physical pain since the start of the pandemic; 22% of older people (around 3.2 million) found it harder to remember things; 17% of the older people (around 2.7 million) agreed they were less steady on their feet; and 36% of older people (around 5.8 million) said that they feel more anxious.
In the same month, the Association of Directors of Adult Social Services released their Spring Survey 2021, reporting that almost 75,000 older and younger disabled people were waiting for assessments for care and support, with social care struggling to cope with people’s needs arising from the pandemic. Furthermore, they reported that just under 160,000 people were waiting for annual care reviews, which are vital for each person who is waiting for care, support or safeguards.
In feedback shared through our Give Feedback on Care service between April and December 2020, we have heard of people’s frustrations about trying to access their GP practices. People told us that new systems to triage requests have been cumbersome and phones lines have seemed blocked. Some have told us they felt they had to advocate for themselves to get access to the care they were seeking, for instance chasing up referral requests, prescription requests or discussing with a receptionist why they need an appointment. At times people have felt their concerns or symptoms were not being taken seriously. Among those people who did see a GP, some told us that they could not see their preferred professional or were not offered a face-to-face appointment.
Many care providers have turned to a more remote or digital model of care, often by telephone or sometimes using online/video, as a way of continuing to keep services running or available. This has undoubtedly been beneficial for many people, particularly for those who would otherwise struggle to visit a service in person, those for whom travelling to an in-person appointment creates extra health anxiety, and those who value the flexibility, for example if they just need a quick check-in or update with their care professional.
But remote care has not worked for everyone. In June 2021, Healthwatch published research exploring how and why certain groups are more likely to experience digital exclusion – including, older people, disabled people, families on low incomes, and those whose first language isn’t English. They found that there can be various reasons for digital exclusion, including digital skill level, affordability of technology, disabilities and language barriers. Not knowing how to seek alternatives to remote booking systems and appointments can also make people more reliant on families and carers, impact the quality of care they receive or impact their ability to access services altogether.
In their 2021 report on the importance of choice in remote mental health services, Mind highlighted that, for many, mental health services providing help and support by phone or online has been a lifeline – but also that for some it made their mental health worse.
An awful consequence of the pandemic, particularly during its height, has been the separation of families and carers from their loved ones. Whether this has been partners being restricted from regular visiting in care homes or family members being unable to sit with their relatives in hospital, the way it has affected people – through increased worry, stress and loneliness – has been deeply felt. Although the measures that have caused this separation were introduced to keep people safe, this does not reduce the impact on people’s wellbeing – both for those using health and care services as well as those who love and care for them.
The pandemic has also impacted how and when people may decide to access the care they need. There is some evidence that some people have not sought care and treatment due to fear of infection or out of a desire not to burden the health and social care system.
Findings from the 2021 GP patient survey (based on fieldwork conducted between January and March 2021) showed that, 52% of people who had responded to the survey had had an appointment in the previous six months – this was down from around 70% in 2020.
In adult social care, we have heard how feelings of uncertainty, anxiety and fear over safety, as well as restrictions on visiting, may have led to families choosing not to send relatives into care homes or takeup home-care services. This means that people need to rely more on family and friends. Carers UK have reported how unpaid carers have increased the amount of care they have given loved ones – by October 2020, 81% of unpaid carers said that they were providing more care since the start of the pandemic.
Some people were afraid to visit clinical settings for their cancer care because of COVID-19. Some people continued their care but without the various support groups they normally relied on for emotional wellbeing. Families were often unable to be with people who were having cancer treatments. We heard that families struggled when they were not able to support each other during these difficult times.
However, despite the widespread disruption and challenges caused by the pandemic, surveys have shown that, when people were able to access the care they needed, they were often positive about that care.
In the 2021 GP patient survey, a high proportion of people continued to say that they had a good experience of their GP practice: 83% in 2021, similar to the results across the previous three years. Satisfaction rates for appointment times were improved: 67% compared with 63% in 2020. Nearly nine in 10 respondents to the survey said their healthcare professional was good at listening to them (89%), giving them enough time (89%), and treating them with care and concern (88%).
Findings from the 2020 urgent and emergency care survey (based on feedback from people who attended a type 1 or type 3 service in September 2020) showed that a third of people (33%) who had attended a type 1 department (a major emergency department) and 44% of people who had visited a type 3 department (typically a minor injury unit or walk-in centre) said their overall experience was ‘very good’, rating it 10 out of 10 – an increase from 2018, when the survey was last carried out.
*This article has been written by the Quality Care Commission.
