Preserving enough of normality: person centred care in a pandemic

In just a few short weeks day-to-day life in the United Kingdom and in many countries around the world has changed almost beyond recognition. Schools and shops closed; sporting seasons and events suspended; travel forbidden for all but essential purposes. Venturing out into deserted streets seemed eerie at first: now it feels incredible how quickly that sensation of strangeness has passed. The COVID-19 pandemic has turned our idea of ‘normality’ on its head.

Reports from Holyrood suggest that Scotland’s exit plan for the current lockdown is likely to involve phased lifting of restrictions, with some measures remaining in place into 2021 or beyond. The country’s First Minister, Nicola Sturgeon, explicitly said that “a return to normal as we knew it is not on the cards in the near future” – and citizens would instead need to get used to yet another ‘new normal’. This announcement is unlikely to surprise anyone who has read the epidemiological modelling work of the Imperial College COVID-19 Response Team, who have shown that a rolling cycle of lockdowns may be needed to control the average reproduction rate of the virus and prevent a second or subsequent peak from overwhelming critical care services.

We all need to get used to the idea that current events represent not a brief interval but a protracted departure from business as usual. But this is the dull end of the crisis. At the other, sharper, point, health services and users have a different set of changes to adjust too. There’s a tendency here to focus on critical care, on the huge challenges faced and sacrifices made in acute hospitals and especially by intensivists. In doing so, we risk overlooking some of the other profound changes that have been taking place:

• The number of face-to-face GP appointments taking place has dropped by more than a half, with remote consultations – previously accounting for only a small proportion of all appointments – now more common than face-to-face.
• The rate of attendances at A&E departments has, similarly, dropped by close to a half. This includes major falls in the number of attendances for events where hospital treatment is essential. Stroke attendances have fallen by a third; suspected heart attacks by a half.
• In a minority of cases, pregnant women have been blocked from having birthing partners present during the birth of their child (BBC News).

These are just three examples but the latter two are very worrying. People haven’t stopped having heart attacks or strokes and foregoing a hospital visit in these circumstances puts lives at risk. And for mothers and fathers anticipating the birth of a child, the threat of a new mother experiencing this alone can be incredibly frightening and distressing. When we think about ‘the new normal’, then, we have to find a way to balance taking every action to protect the public and health services from COVID-19 and to preserve enough of our old normal.

This applies to research, too. Recently the Care Quality Commission (CQC) have announced the cancellation of this year’s national maternity survey. We support this decision: some NHS trusts will not have the capacity to engage with a survey this year, and a request from the regulators to do so would put them in a very uncomfortable position. Equally, though, there is good reason to think that the COVID-19 crisis may have a negative effect on women’s experiences of maternity care and on the quality of person centred care the service is able to provide. Given that the NHS’s definition of service quality places patient experience on equal footing with patient safety and clinical effectiveness, we cannot afford to overlook this impact – and we need to hear the perspectives of service users to be able to understand it.

This argument applies all across the health service, and to patients and staff alike. We know that this pandemic will demand a great deal of a great many people, and it is not unreasonable to want to sweep away any potential burden that might be considered non-essential. What we cannot afford to do is to stop listening to staff and to patients; hearing and acting on their views and experiences. Without this, we cannot hope to fully understand the impact of COVID-19 on our services – and nor, when ‘normality’ is restored, can we assess whether any changes we observe then should be considered part of a recovery or a continued deterioration.

Picker remains committed to our vision of person centred care for all, always – and we are dedicated to helping health service organisations understand and improve people’s experiences, even in the most challenging times. For that reason, we are planning to run a voluntary maternity survey for those organisations who do have the resource to commit to it and that want to continue hearing about mothers’ experiences. We will also be on hand to provide any other support that organisations need – so please do not hesitate to contact us with any questions or requests you might have.