The COVID-19 pandemic created a seismic shift in healthcare systems across the globe, with the United Kingdom experiencing some of the most significant disruptions. Health facilities across the country rapidly pivoted to address the surge in COVID-19 cases, often at the expense of other essential healthcare services. Non-emergency treatments and diagnostic tests were postponed or cancelled altogether, leaving many individuals without the care they needed.
Beyond the reallocation of resources, public behaviour also shifted dramatically. Fear of exposure to the SARS-CoV-2 virus kept many people from seeking medical attention, even for serious symptoms. This reluctance was compounded by widespread efforts to “protect the NHS” as part of a collective altruistic effort. At the same time, reduced availability of face-to-face consultations due to social distancing protocols added yet another barrier to accessing healthcare.
The result of these combined factors was a sharp decline in healthcare utilisation. General practitioner (GP) consultations fell significantly, as did diagnostic tests, cancer referrals, and treatments for cardiovascular and other conditions. Both elective and emergency hospital admissions saw declines, while waiting times for treatments soared. Tragically, there was also a noticeable increase in the number of deaths at home during the pandemic, suggesting that changes in care-seeking behaviour had far-reaching consequences.
While the impacts of healthcare disruption were seen worldwide, the UK was hit particularly hard compared to other similar countries. The extent of this disruption has been well-documented, but less attention has been paid to its long-term consequences. A recent study sought to bridge this gap by examining the link between healthcare disruption during the pandemic and avoidable hospital admissions, a key indicator of health system performance.
Avoidable Hospital Admissions
Avoidable hospital admissions, defined as unplanned admissions that could have been prevented through timely community care, are often used as a warning signal of failures within a health system. Recognising this, researchers sought to understand whether the widespread healthcare disruptions during the pandemic were associated with an increased risk of such admissions.
The study used a novel approach by linking data from longitudinal surveys with participants’ electronic health records. This allowed researchers to analyse individual-level experiences of healthcare disruption and their subsequent health outcomes. The findings were striking: an estimated 35% of people in England experienced some form of healthcare disruption during the pandemic. The most commonly reported disruptions were cancelled or delayed appointments, including GP visits and outpatient care.
Increased Risk of Hospital Admissions
The study exhibited a clear association between healthcare disruption and an increased risk of avoidable hospital admissions. Individuals who reported any form of disruption were found to have 80% higher odds of being admitted to the hospital for an avoidable condition. This included both acute and chronic ambulatory care-sensitive conditions, with acute conditions showing a twofold increase in risk.
Specific types of disruptions had varying impacts. For instance, individuals who experienced disruptions in accessing appointments or medications were more likely to be admitted to the hospital for ambulatory care-sensitive conditions. On the other hand, those who faced disruptions in procedures, such as surgeries or other treatments, were at higher risk of admission for both chronic conditions and urgent care-sensitive emergencies.
These findings highlight the critical role of timely healthcare access in preventing severe health outcomes. Missed appointments, delayed treatments, and postponed surgeries all contributed to worsening conditions that might otherwise have been managed effectively within the community.
Delayed Care and Disease Progression
One of the key explanations for these findings is the role of delayed care in allowing diseases to progress unchecked. Routine appointments with healthcare professionals often provide opportunities for early diagnosis, treatment adjustments, and referrals to specialist care. When these appointments are missed or delayed, individuals may not receive the care they need until their condition becomes significantly worse.
For example, sudden changes in health, such as the onset of symptoms for an acute condition, typically prompt people to seek medical attention. However, during the pandemic, fear of exposure and reduced availability of services meant that many individuals delayed seeking care, often until their symptoms were severe enough to require hospitalisation.
Similarly, disruptions in procedures such as surgeries and treatments had profound consequences. Conditions that might have been treated effectively at an earlier stage were left to progress, leading to exacerbations of chronic illnesses or the development of complications. These delays not only impacted individuals’ health outcomes but also placed additional strain on hospital resources.
Challenges for the NHS in Recovery
Despite these challenges, certain aspects of the healthcare system demonstrated resilience during the pandemic. For instance, the UK’s drug supply chain largely withstood the pressures of the crisis. Pharmacies remained operational as essential services, supported by innovations such as remote GP consultations and home delivery systems. Even during periods of peak disruption, pharmacies were able to adapt, ensuring that individuals could access their medications.
However, the broader healthcare system has struggled to recover from the pandemic’s impact. The NHS continues to face a significant backlog of treatments, diagnostic tests, and procedures. Activity levels remain below pre-2019 levels, and ongoing issues such as staff shortages, healthcare worker strikes, and chronic underfunding have compounded the problem.
Economic pressures, including high inflation and the lingering effects of Brexit, have further constrained the NHS’s ability to address these challenges. As a result, the health system is under immense strain, and the long-term consequences of the pandemic’s disruption are likely to be felt for years to come.
Strengths and Limitations
The study examining healthcare disruption and avoidable hospital admissions offers valuable insights, particularly due to its innovative methodology. By combining data from longitudinal surveys with electronic health records, researchers were able to capture both self-reported experiences of disruption and objective hospital admissions data. This approach provided a comprehensive view of the pandemic’s impact on individuals’ healthcare access and outcomes.
Importantly, the study’s findings contrast with population-level analyses that suggested a decline in avoidable hospital admissions during the pandemic. By focusing on individual-level data, the researchers were able to uncover the hidden toll of healthcare disruption, shedding light on the long-term consequences for patients.
However, the study also faced several limitations. The observational nature of the research limits the ability to draw definitive causal inferences. Additionally, self-reported data on healthcare disruption may be subject to bias, such as overreporting by individuals who were particularly dissatisfied with their healthcare experiences.
The study sample also underrepresented certain groups, including ethnic minorities and individuals from socioeconomically deprived areas. These groups are known to have experienced disproportionate levels of healthcare disruption, suggesting that the true scale of the problem may be even greater than the study indicates.
Policy Implications and Future Research
The findings of this study highlight the urgent need for increased investment in the NHS to address the long-term consequences of pandemic-related healthcare disruption. Efforts to clear backlogs, improve access to timely care, and support healthcare workers will be essential in ensuring that the system is better prepared for future crises.
Future research should focus on identifying specific pathways through which healthcare disruption leads to avoidable hospital admissions. Understanding these mechanisms will be critical in developing targeted interventions to mitigate the effects of service disruptions. Additionally, exploring the social inequalities that exacerbate the impact of healthcare disruption will be crucial in addressing health disparities across the UK.
Another important area for future research is the long-term impact of healthcare disruption. While this study focused on avoidable hospital admissions within a specific timeframe, it is likely that some consequences of delayed care will only become apparent over a longer period. Tracking the experiences of individuals over time will provide valuable insights into the full scope of the pandemic’s impact on health outcomes.
Conclusion
The COVID-19 pandemic exposed vulnerabilities within the UK healthcare system, highlighting the need for resilience in the face of future challenges. While the NHS demonstrated remarkable adaptability in some areas, such as the drug supply chain, the broader system was overwhelmed by the scale of the crisis.
Moving forward, it will be essential to invest in the health system’s capacity to withstand future shocks. This includes addressing chronic underfunding, improving workforce retention, and leveraging technology to enhance access to care. By learning from the experiences of the pandemic, the UK can build a more robust and equitable healthcare system, better equipped to serve the needs of its population in times of crisis and beyond.
References
Green, M. A., McKee, M., Hamilton, O. K., Shaw, R. J., Macleod, J., Boyd, A., Katikireddi, S. V., & LH&W NCS Collaborative. (2023). Associations between self-reported healthcare disruption due to covid-19 and avoidable hospital admission: evidence from seven linked longitudinal studies for England. BMJ (Clinical Research Ed.), 382, e075133. https://doi.org/10.1136/bmj-2023-075133