Updated 22 May 2020
By Stu Babbage, Health Practice Partner
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COVID-19 is currently the top priority for Australia’s healthcare system. While there is still uncertainty about how the pandemic will unfold, the implications for our healthcare system could be long-felt. We all owe a massive debt of thanks to our health sector leaders, health professionals and health and aged care workers for all they are doing right now in this response. There have been huge efforts put in across the sector (following so soon after the bushfires over summer) with lots of positive actions.
Actions taken against COVID-19 so far include establishing clear protocols and pandemic response teams; agreeing $2.4 billion in funding including paying for telehealth; conducting more than 80,000 tests (by 17 March 2020) and contact tracing; fast-tracking increases in capacity of the workforce, beds, equipment and diagnostics; and much more. It is likely that it will take some time post pandemic to achieve what could be considered ‘business as usual’. In addition to getting things back to working normally, it will be important to use the experience of this pandemic to help us be better prepared for the next one, and use the experience of dealing with this crisis as a way to also consider other sustained improvements to our healthcare.
Australia is currently in a propagation phase of the coronavirus. At some point in coming months Australia will be in a post peak period and will then eventually settle into a post pandemic period.
Specialist epidemiology and pandemic response will be required to help Australia successfully make this transition. The impacts, however, will be broad across these phases.
During this propagation phase, our health services are well placed to judge how to respond. We expect to see - and in some cases have already seen - key issues and actions the healthcare sector will take in responding to the COVID-19 pandemic at this stage.
It goes without saying that there will be a need for hospitals to optimise patient flow (especially through intensive care beds) to maximise the number of patients that can be treated. This may drive innovative delivery of non-COVID related services - particularly of those where a hospital visit may be able to be removed.
Some lower priority services and activities will be put on hold whilst attention is devoted to the management and treatment of coronavirus disease. Clinical staff will need to work to the top of their license, and innovative solutions found. These impacts will be felt not only inside health services, but in different parts of the community as planned treatment is delayed.
It is expected that Australians presenting with COVID-19 will not be uniformly distributed across the country. It therefore may be possible to relieve pressure on individual health services by moving patients to locations with lower demand, and/or co-opting private health system capacity.
Workforce reallocation may also be appropriate to consider, noting that this could have flow-on industrial relations impacts which need to be quickly worked through.
It is possible that rural and remote communities will be protected from the coronavirus due to their separation from clusters of virus infection. In the event of a virus outbreak, however, these communities could be particularly vulnerable due to limited on-the-ground health services. Such circumstances are likely to require tailored solutions to meet healthcare needs and manage the spread of disease.
With uncertainty as to the nature and duration of the impact of the COVID-19 pandemic, and additional pressures created when staff themselves need to self isolate or care for family, managing staff wellbeing will be important. Actions such as optimising rosters, using locums and contingent labour arrangements beyond what normally would be permitted could all help.
With global supply chain disruption, alternative sources of supply for disposable items are having to be explored. Additional equipment, such as supporting ICU, may also be required.
Clear community and clinical guidance on what is happening, and what people should do, is critical to managing the pandemic. This is particularly important because of the nature of our healthcare system - with loose connections and coordination between primary and acute care providers. This also needs to extend beyond COVID-19 specific impacts - such as how Australians should expect healthcare to operate for non-COVID-19 treatment.
Smaller aged care facilities and organisations are likely to have less capacity and capability to deal with issues in their facilities. There is also an overall system pressure that could arise if aged care places are unavailable - such as due to management of a COVID-19 cluster, workforce constraints, or the inability to support families looking to visit a potential home.
As social distancing measures are applied in the community and families are impacted, managing the implications upon healthcare workforces and patients will be a priority. This goes beyond in-patient services - ongoing in-home, rehabilitation and disability related services could all be affected. These impacts could not only arise due to workforce restrictions, but also as patients or clients are less willing to have carers visit their home due to perceived risk. It also raises the need to have robust business continuity plans in place for governance and management of health services.
It is likely that small businesses will come under pressure during the pandemic, and this pressure could also affect individual pharmacies. Conversely, pharmacies need to play a role in helping triage of patients presenting with COVID-19 symptoms, and potentially providing compounding products.
Hopefully it will not be long before Australia enters a post peak period. New cases of COVD-19 will still emerge, but the most critical period of health system pressure would be over. At this stage, there will be a number of areas requiring attention.
It is possible that actions taken now could move Australia into a post peak period, but additional waves of virus transmission could occur. Actively preparing for this possibility will be important, particularly as social isolation requirements are reduced.
As already mentioned in the context of community pharmacy, small businesses are vulnerable to economic shocks like a pandemic. A range of allied health, aged care and community health services may experience significant issues with their viability, as could private hospitals if non-critical elective surgery demand has dropped off.
It is unclear how the COVID-19 pandemic will affect the demand for private health services, including extras. It is possible that insured Australians will make less use of their insurance for a period of time, but that there will then be a returning demand post peak of the virus.
As capacity is returned to the health system, it will be important to have a clear understanding of elective surgery demand and make strategic decisions on whether there are particular priorities that should apply. Utilisation of private hospital capacity may help address built-up demand for public system care.
There is likely to be a significant physical and mental toll on clinicians and administrators through the pandemic period. A range of support may be required, including a critical need to allow a break. Proactive measures should also be taken to understand what other needs may exist.
Once Australia (and the world) has achieved a post pandemic state, attention can turn to some of the consequences of COVID-19. These are potentially broad-ranging, and some will only emerge in coming weeks and months.
Australia’s national resilience has been tested recently - significant regional bushfires and now nation-wide virus risks. For some on the front-line, significant mental health issues could arise requiring support. More broadly in the community, proactive action may mitigate mental health issues emerging in the Australian population, particularly if some parts have experienced significant social isolation.
Australia is experimenting with new funding for telehealth, supporting use of this technology in ways that have not previously been supported through government funding. It may be that this experience can help provide a pathway to fund ongoing use for specific circumstances, improving Australia’s ability to deal with communicable disease.
The connections established or modified across the health system to better govern, manage and deliver during the pandemic are ones that could be useful to continue to a modified form, particularly as Australia prepares for any future crisis.
Beyond the agreements around funding and emergency assistance, annual price determinations are likely to be impacted by the activity changes from COVID-19 treatment.
Whilst it may be difficult to prioritise supplementary data collection during a pandemic, where data is not normally captured, it is vital that there is objective information available for use when we achieve a post pandemic phase. This will help examine issues such as:
Optimal ways to manage initial diagnosis of those affected, and those with whom they may have had contact.
Treatment pathways, and how best to manage the impact upon non-pandemic related healthcare.
Whether there were particular parts of the community disproportionately impacted compared to what the epidemiology would indicate - for example related to social determinants of health.
Preparedness for next time - across all aspects of coordination, governance, supply chain, stockpiles etc. This could also extend to fully understanding the reasons for and nature of transmission, and what actions could better mitigate these in future.
Partner, PwC Australia
Tel: +61 2 6271 3021
NSW Government and Australia Health Leader, PwC Australia
Tel: +61 2 8266 5091
National Health & Wellbeing Consulting Lead Partner, PwC Australia
Tel: +61 2 8266 0990