The Covid-19 knock-on: public health and the impact of delays in non-urgent treatment and diagnosis

Since the beginning of the pandemic, concerns have been raised about the wider public health impacts of coronavirus. In addition to strains on acute NHS care services on the frontline, there are warnings about the additional public health impacts of delays to preventative healthcare measures like screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

At the outbreak of the pandemic many hospitals took the decision to delay or stop entirely routine pre-planned surgeries and preventative screening and diagnostics. Some even suspended treatment for more urgent care like cancer treatment on a short term basis. While many of these services have resumed since the beginning of the pandemic, albeit with a backlog of patients now to be seen, significant strain on the NHS as we come into the winter months because of  coronavirus is still anticipated. As a result, many hospitals are not working at full capacity in order to prepare for potential increases in admissions due to coronavirus or staff shortages over the winter.

In many areas this has led to a backlog of care, both for those patients already in the system awaiting routine surgeries, as well as those who are yet to be diagnosed but would have been through preventative screening programmes run by the NHS.

Delays in healthcare and routine screening programmes 

Even before the coronavirus pandemic took hold, many NHS hospital trusts were under criticism because of the significant length of waiting times for people who required routine operations, which in some parts of the UK can be as long as three years. Doctors across the UK are now warning that these delays could be increased further unless the NHS receives additional support to increase capacity across all areas of care  not just urgent care in the coming months.

Data released by NHS England in October 2020 showed the numbers waiting over a year for hospital treatment have hit a 12-year high, with almost 2 million patients waiting more than the target time of 18 weeks for routine care.

It has been suggested that delays in diagnosis and routine treatments could lead to an increased number of hospitalisations further down the line, requiring higher levels of care, longer lengths of stay, and increased hospital readmissions.

A reluctance to visit hospitals and use primary care services

Government messages to ‘protect the NHS’ may have had the unintended consequence of discouraging people from seeking urgent medical care when it was required for fear of using services unnecessarily or for fear of contracting the virus when attending hospital or primary care settings.

Research from the Health Foundation found that there had been a significant reduction in the number of GP consultations since the start of the pandemic which has led to concerns about the care of non-covid patients, patients with long term health conditions and also the potential for delayed diagnosis. Primary care consultations also reduced and have remained low consistently since the beginning of lockdown.

Figures have also shown a reduction in the number of referrals, medical tests, new prescriptions and immunisations. While some of these reductions are the result of advice to delay routine referrals to free up capacity for hospitals to deal with the potentially large number of cases of Covid-19, routine referrals have still not recovered to pre-lockdown levels.

 

A potential future crisis for the NHS and a ticking time bomb for public health

Doctors are now warning that the treatment backlog which has been caused by the coronavirus pandemic, in addition to diagnostic delays and screening programmes, may lead to a future crisis of care or significant delays in care for people waiting to receive more routine treatment.

Delays in care have not only been reported in cases of physical health. There have also been significant delays in referrals for those seeking treatment for a mental health condition, an area of the NHS which was already facing significant delays in referral and transfer of care even before the pandemic. Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this. People with mental health conditions may have been unable to access appropriate support through primary care pathways, which could potentially impact on their long term health and care.

Finally, concerns have been raised about the wider social determinants of health such as employment and poverty. Public Health England (PHE) published a monitoring tool which looks at the wider impacts of the Covid-19 pandemic on population health, and it is likely that the knock-on impact of the virus could have far reaching consequences for public health in the future as the health implications of lockdown, lack of social interaction and rising unemployment could be significant. 

Where next?

While the challenges of the coronavirus pandemic for the NHS will not be going away anytime soon, it is clear that it will be necessary for the NHS and other supporting services to act now to prevent a longer term public health crisis. It is critical that we not only focus on the acute care of Covid-19 patients, but also proactively manage patients without Covid-19, particularly those with time-sensitive, complex and long term conditions who are postponing their care. We must also consider the knock-on impacts of delayed diagnosis for those people who missed out on routine screening or who were unable or too afraid to visit their GP or hospital. This is important not only to sustain health and life, but to preserve hospital and NHS capacity in the future.


If you enjoyed this article you may also be interested in reading:

Follow us on Twitter to find out what topic areas are interesting our research team.

Living life in full colour: exploring the relationship between colour, design, behaviour and emotion

Seeing red…. green with jealousy….. feeling blue. Associating colours with emotions is not new, but increasingly, psychologists are being asked to explore the relationship between colour, emotion and its impact in a number of different settings, including learning in classroom settings, the design of the built environment, including work spaces and travel hubs, and improving wellbeing as a result.

Colour is a powerful tool. It can be used to get attention, enhance clarity, establish a code, label and differentiate items, as well as to influence behaviour or learning outcomes. For example in schools we are often told to use blue or black ink. Red ink is supposed to be used by teachers to correct assignments, notebooks, and class work. This is a deliberate tool to draw our attention to the mistake we make, designed to help enhance our learning outcomes, in the sense that by drawing attention to the mistake we will remember not to repeat the points highlighted.

“Bad” and “good” colours

Studies have disagreed on how exactly our association between colour and emotions develops. Some have suggested it is an instinctive reaction, something primal which suggests to us that things that are red in colour are dangerous or negative, while blues and yellows signal happier less aggressive colours.

However, others have suggested that the connotations we associate with colour are learned, albeit from a very young age. We associate some colours as being “good” and others as “bad” and this impacts how we interact around them in spaces like classrooms and workspaces. The meaning of colours is culturally-specific and differs around the world in different societies and groups.

However, a third view is that colour theory is much more complex than simply yellow = happy and blue = sad. Colours can have several meanings, and can encourage an audience to feel or act in certain ways depending on when and how they are used, and in some instances depending on personal experiences which people link to specific colours. This is the reason why the literature on colour is so contested; in many instances it blurs the boundary between our instinctive associations of colours and those associations we create ourselves through experiences.

Image “Harvey_Nash_13″ by K2 Space is licensed under CC BY 2.0

How colours are impacting on the design of our spaces

Knowing how colour can affect behaviours is informative for designers and psychologists in a number of environments, including in schools, offices or hospitals. In a learning context, such as in a school using “engaging” hues (warm colours such as red, orange, and yellow) to prevent learners from getting bored, and passive hues (cold colours such as green and blue) to keep learners calm can help with learning, but getting this balance right is important.

A number of studies have looked at the impact of classroom design, including use of colour on the learning and behavioural outcomes of both neurodiverse, and neurotypical children, with many emphasising that overstimulation, particularly of young children through excessive use of bright colour can create a disruptive classroom environment and make it difficult to encourage concentration and staying on task. However, some colour in specific areas of the classroom is good to help with engagement and stimulation.

Similarly, colours have been used by architects and designers in their choice of building material or building design to help encourage feelings of calm or reflection. This is particularly the case in transport hubs like airports and in hospitals or care facilities. Using fresh and calming colours which relate strongly to nature is also a technique used by office designers to help create the feeling of open calm and fresh spaces to help improve working environments and improve productivity.

The design of the built environment and how “green” and “blue” features which incorporate natural materials (green spaces and water have a positive impact on mental and physical wellbeing) has been widely discussed by planners and architects. The evidence generally supports the view that the inclusion of green spaces, promotes health and wellbeing across the life course. This combination of colour and the integration of nature into spaces is being used increasingly in the design of buildings and  in master planning for large urban projects.

Final thoughts

Colour and emotion both play important roles in our capacity to learn and be productive. The association between colour and our emotions and actions is complex and a source of disagreement for some psychologists. Colour has been found to affect how people feel both psychologically and physically. Understanding how colour and emotion relate and how colour can be used to change environments to encourage particular feelings of calmness or concentration, particularly in schools and workplaces is something that will be further explored by designers.

Colour should be understood as part of a wider “toolkit” used by designers and architects to ensure that we are building better places that create environments which support and promote wellbeing, encourage positive emotions and create more effective spaces for us to work, learn and interact in.


Follow us on Twitter to see which topics are interesting our research team

A message to all subscribers to
The Knowledge Exchange information service

We are open for business and continue to provide current awareness and enquiries services to our clients. If you have any questions, please get in touch.