Abstract
The National Health Service is facing an existential crisis this winter. COVID-19, flu and record demand for emergency services, according to the service’s medical director, are contributing to the pressures. Hospital beds can’t be emptied fast enough of people fit enough to leave for social care.
A research paper from Scotland underlines the substantial disruption that COVID-19 caused to urgent and planned hospital services. 1 A struggling service is left exhausted by a pandemic, and there is no slack in the system to allow staff to recuperate and recharge.
When people are under pressure, bad behaviours can become more prominent. Despite increased awareness among health professionals, patients still complain about experiencing racism in medical settings. Racism is an established contributor to poor health outcomes, and a second study finds a relationship between racism experienced in a medical setting and a loss of trust that leads to vaccine hesitancy. 2
The latest in our series on key concepts for informed health choices from the James Lind Library explains why seemingly logical assumptions about treatments can be misleading. 3 One assumption on their list of assumptions to avoid is that a treatment is better based on how new or technologically impressive it is. In the case of vaccines, that assumption can easily lead to suspicion about a new intervention especially among marginalised communities.
One way out of the quagmire might be through developing a ‘shared definition of self-driven healthcare’. 4 The benefit of such an approach would be in delivering better outcomes for patients and more sustainable health systems. Another way out would be to recognise that we are fighting a losing battle trying to bolster hospital care when public health is damaged and downgraded. 5 Without improvements in baseline population health, today’s efficiency savings will be overrun by tomorrow’s increased demand.
There is no simple fix to the complex challenges faced by health systems in the UK and elsewhere, but the way out is to stop taking a narrow view of the determinants of health, and the solutions to the health crisis, while sharpening our focus on what’s best for staff, patients and trial participants. 6