Is this the dark before the dawn?

5 minute read

Our health system is in crisis, but major reform is just on the horizon.

We have the opportunity to make major reforms to our healthcare system, but will we take it?  

BA.5 is here, and you only have to look at last week’s paper with the headline “Albanese calls emergency national cabinet meeting as premiers push for pandemic leave reboot” to realise we are far from out of the covid mess. 

Only last week on my way back from the gym I heard that yet another variant of concern – BA.2.75 – is now emerging in India. Although it’s still too early to tell, we know there will be more mutations before the year is out and we certainly aren’t out of the woods just yet.  

There is a feeling of deja vu about these headlines, but after almost three years of wave after wave, variant after variant, it appears that globally frontline workers are done and internationally healthcare systems are struggling. 

For the first time in recent years the Nursing and Midwifery Council register in the UK reported 25,219 and another 1780 midwives and dual registered nurse/midwives left the profession in 2021-22. That was an increase of 13% from 2020-21. 

A report released in Australia back in March 2022 on the Australian nursing workforce reported that more than two thirds of our workforce were experiencing “burnout”, and there were real fears of a mass exodus from the profession in the coming years. 

Now let’s be honest, working in a hospital wasn’t a walk in the park pre-covid. We often worked understaffed, and regular requests of “can you do overtime” and going without breaks was commonplace in busy departments.  

We as nurses knew this came with the territory and it was apparent to the keen observer that our system was under considerable pressure from chronic diseases well before most of us had heard of Wuhan in China.  

But covid most certainly has accelerated the need for healthcare reform and has highlighted just how on a knife’s edge our system was previously under the strain of chronic disease. 

We are at a real crossroads. The camel’s back was straining pre-covid, the first wave of covid was the straw. We are now deep into the haystack and the poor camel is on its knees. But there is real hope and there are models of care than can reduce this strain (and cost) and maybe make the lives of our frontline workers just a little bit easier. 

The Daily Mail in UK ran an article recently which looked at the rapid increase in usage of in-home patient monitoring and virtual wards across the NHS over the last two years. And for a system which has largely struggled with covid, the results have been phenomenal.  

Between November 2020 and February 2021, data from 37 local health authorities showed no significant impact on patient outcomes – which is fantastic in itself – but it’s the reduction in hospitalisations and cost savings that are most encouraging. 

Of the 3500 patients monitored with COPD, type 2 diabetes and heart failure there was a 22% reduction in emergency department presentations, compared with the matched group who did not receive in-home patient monitoring. 

Heart failure patients, who often put large strains on the tertiary system and can spend weeks in a hospital bed, appeared to benefit significantly well with this model of care. Interestingly, the UK now has over 900,00 people living with heart failure and the average length of stay for patients with heart failure is 10 days in the NHS.  

The data has shown that in-home monitoring and reduced hospitalisation would achieve savings of £4000 per patient per admission. So, by increasing the use of in-home monitoring, which is now the aim of the NHS, this will achieve a triple outcome: 

  1. Patients would receive proactive care in their home and do not end up in hospital.  
  2. Frontline staff would see a tangible reduction in emergency presentations and admissions. 
  3. And the big one! It saves the healthcare system significant money by proactively managing patients and their chronic diseases. 

This hospital avoidance data in the UK isn’t an isolated event. In a systematic review in 2021 of 91 studies into remote patient monitoring, 50% reported a reduction in hospital admissions as well as length of stay when admitted across their cohorts in the studies. 

In Australia we also have another factor we must consider, and that is distance and the failure of our primary care sector across regional, rural and remote communities to meet demand; much noise has been made about this recently in the media.  

Imagine the value that large-scale investment into nurse-led and in-home patient monitoring could have for our most vulnerable communities.  

The time is now: we can no longer wait. Reform and action are needed, and while the media is full of doom and gloom, as the saying goes, “the darkest hour of the night comes just before the dawn”. 

It’s time for the dawn and our investment in new models of care. Our patients, our frontline workers and our system needs it. 

Ben Chiarella is the Director of Clinical Innovation Ramsay Connect. This article was originally published on LinkedIn on July 15, 2022.  

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