Health and care systems around the world are facing their greatest emergency in living memory.
This was the type of statement many commentators were writing before Covid-19. Then they were referring to the ability of systems to deal with the triple effect of an aging population, a steady rise in (generally) manageable long term health conditions and an expectation that modern medicine can fix everything.
These issues have not changed in the Covid-19 crisis. For some people risk of death through stroke or cardiac arrest is higher than risk of death through Covid-19. Currently the former is potentially preventable and treatable and the latter is not.
The Covid19 situation raises huge ethical issues around treatment intervention and palliative care when resources are in short supply and the population is ill prepared for conversations around such issues. This makes concepts such as health literacy, individual and community empowerment and self-management as important today as ever.
To enable a population to engage in discussions around treatment choices, when to intervene or not intervene, requires a population with a reasonable level of health literacy, an acceptable level of ability by professionals to communicate issues such as risk and probability and a population who feel that ultimately choices about health and wellbeing and how they are manged are down to them, with support from the relevant professional.
Whilst people are being urged to have end of life conversations with loved ones many do not have the skills or support to tackle this.
During the Covid-19 crisis we are seeing government deciding what is deemed essential and what is not – very much based on a population level interpretation of needs and wants.
This raises a whole range of ethical issues around what matters on the individual level versus what matters at population level.
Some could argue this is at odds with the shift towards person centred care- choices that are based on what’s important to the individual, on their values, culture and ability to participate or “what matters to me” rather than “what’s the matter with me”
This manifests in different ways: whilst cycling (an approved form of exercise) may be suitable for one person, for another person with mild dementia and arthritis then being able to keep busy in the garden may be the most beneficial. Currently in England you can buy a new bike but not buy plants for the garden.
There is a significant part of the population whose physical and mental health will have been negatively impacted upon during the coming months – from the timely detection of cancer to the much needed early rehabilitation support for people recovering from stroke, people struggling to manage their mental health and the strain on personal relationships and children who are at risk.
With the lack of access to routine health care, its more important now that ever that people are supported to manage their long term health conditions through the resources such as ours: https://cempac.org
As we move from the acute phase to a recovery phase it will be time to reflect on the resilience of communities and individuals and what we can do to ensure that going forward, people are empowered at the individual and the community level to make choices about their health and care and how they want to be cared for.
Perhaps in the coming months there will be time to have a honest and open debate on how health and social services will look in the future, their sustainability and the responsibilities of the individual, community and institutions in shaping and sustaining this. The emerging crisis in health and social care that was there before COVID-19 will still be there after the ‘crisis’ has passed.
Jim Phillips