A global crisis of trust that’s a symptom of global failure

Trust is hard to win in a crisis. With crises everywhere, trust is globally challenged. How many of us trust the arguments of energy companies that rake in vast profits as households choose whether to spend their money on food or heating? The climate crisis is deepening inequalities, and those same inequalities are a barrier to finding solutions. ¹ Is it possible to maintain trust in the NHS as the UK’s healthcare crisis deepens on a background of chronic overdemand? ² Even trusting the evidence is a complex notion, as the first in a new series of explanatory essays from the James Lind Library explores. ³

The COVID-19 pandemic has tested every aspect of the relationship between science, health, the political system and society – and most areas have been found wanting. The starkest lesson, and the one most easily overlooked as we lurch from crisis to crisis, is the danger in aiding and abetting a long-term erosion of public health that leads to inevitable damage to baseline population health. ⁴

Unfortunately, ‘building public health infrastructure’ and ‘improving baseline population health’, long-term and complex challenges, aren’t likely to engage voters or social media influencers. Deaths from cardiac surgery, on the other hand, resonate instantly. Acute care, like a crisis, is much more suited to winning public attention.

Two new research papers in JRSM examine cardiac surgery during the pandemic. Day et al. offer reassurance that outcomes from cardiac surgery itself are unaffected by the pandemic. ⁵ They do, however, urge caution about the impact of prolonged waiting times. And this second theme is developed by Yates et al. who provide further evidence of the impact of the pandemic on waiting times for surgery with inherent concerns about quality of life and preoperative risk. ⁶

Maintaining good outcomes during the pandemic has largely been the business of clinical teams in secondary and primary care, the briefly clapped but long unsung heroes of the world after COVID-19. In that context, for example, identifying individual excellence isn’t straightforward. It’s also controversial when it comes to selecting nominees for national awards for clinicians, with the jury still being out on whether the latest reforms have fixed the problems. ⁷

What’s clear though is that the global crisis of trust, accelerated by the pandemic and the cost of living crisis, is so entrenched that it has begun to weaken the once breakable bond of trust between patients and doctors. Trust is a barometer of the state of our world and the barometer is reading red.