Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)

Lord Patel Excerpts

Wednesday 29th November 2023 Grand Committee

[Lord Patel (CB)]

My Lords, I am pleased to be able to take part in this debate today. I was not a member of the Covid-19 Committee, but I congratulate its chair, the noble Baroness, Lady Lane-Fox of Soho, and her committee on producing an excellent report to address issues on future resilience and, importantly, the well-being of people post pandemic. I also congratulate the noble Baroness on the brilliant way in which she presented her report.

My very brief comments relate to how the pandemic changed and accelerated the use of digital media in healthcare, with online consultations and treatment being widely used now. Paragraph 74 of the report highlights—as the noble Lord, Lord Alderdice, mentioned —the lack of training of health professionals in conducting online consultations. The report rightly points to the need for approving and evaluating online health interventions. Your Lordships may have read the report in the Telegraph today, which points out the problems that have occurred because that was not done in the first place.

In paragraph 75, the report alludes to the possible widening of health inequalities. That is an important point, because we know that people from lower socioeconomic groups already have lower life expectancy and spend a fewer number of years that are disease-free compared to people who are better off, and significantly so. As the report points out, the shift to online delivery of healthcare is likely to deepen the inequalities in health outcomes, emphasising further the need for evaluation. It is estimated that nearly 16% of people do not have the means or ability to be able to take part in digital consultations.

In my view, the report rightly recommends the need for training and continuous professional development of healthcare professionals to deliver online healthcare—in fact, I would go further, in that their competency to do so should also be measured and ascertained. I am pleased that the General Medical Council and the royal colleges, particularly the RCGP, are now beginning to establish training courses for doctors for online consultations and their assessment of the courses.

During the Covid-19 pandemic, patients benefited from remote consultations by GPs—we should accept that—and restrictions in travel because of the lockdown benefited older patients, those at risk of infections, patients who were immunocompromised and those patients suffering from long-term conditions. It might not have been the perfect outcome for them, but it was a way to manage the pandemic. The benefits were thought to be so great that it prompted the then Secretary of State, Matt Hancock, to call for all consultations in the future to be remote except in exceptional circumstances —that was rather too forward-thinking and probably inappropriate. Overall, during the pandemic emergency, online consultations were seen to be beneficial. Only later did the unintended consequences of missed cancer diagnoses and increased prescribing of antibiotics become apparent. Antibiotics prescribing went up by nearly 36%, although we are in fact trying to reduce the prescribing of antibiotics. Again, today’s detailed report in newspapers and the BMJ points to that.

Now with the pandemic under some control, it is important to evaluate what this immense change in technology-driven healthcare means, especially for patient outcomes, safety and equity. It is the last that concerns me most. With the arrival of better data, health records and generative AI, some people think that we have arrived at a tipping point in the use of technology in healthcare. As the report rightly points out, the rapid introduction of a data-driven and digital healthcare may not only make deeper the current huge health inequalities that exist but exclude people who are not able to make best use of technology. To mitigate this, the Government need to ensure that policies are in place that take a more inclusive approach to digital healthcare.

There are several key challenges that will need to be addressed, as highlighted by the report by the Health Foundation and the Ada Lovelace Institute. Policies that focus on key challenges include: digital exclusion and access to healthcare; developing clear metrics for monitoring inequalities in health outcomes in data-driven systems; addressing the lack of public confidence in data use and protection; the lack of social context in data, as the report correctly points out; appropriate communication across all healthcare professionals throughout the data pipeline; and much more. A survey of public attitudes to health technology showed that the public are on the whole supportive of it, particularly when technology enables them to manage their conditions better and to connect more easily with the NHS. Currently, that does not happen with GP appointments, as highlighted by the noble Lord, Lord Alderdice. The public are less happy when technology comes between them and the clinicians. In this context, the report’s recommendations in relation to the patient’s right of access to online healthcare seems appropriate.

A long-term approach to resilience and the well-being of people in vulnerable groups post the pandemic and the rapid introduction of data-driven health system runs the risk of widening inequalities. That is my key worry. The inequalities that already exist in healthcare and outcomes will become worse. To mitigate that requires policies across government departments. I hope the Minister will agree.