At the time of writing, the UK has passed its (first) peak of the coronavirus (COVID-19) crisis. Lockdown has begun to ease and as data starts to become available, we will begin to learn more about the impact the crisis is having on patients who need regular health care because of their long-term conditions.  

Before this crisis, around 85% of the burden of disease in the UK was from long-term conditions which are not passed from person to person, such as cancer, heart disease and depression. Most NHS services were under considerable pressure before the pandemic. Since the outbreak took hold, the NHS has diverted resources to hospitals so they could manage high numbers of COVID-19 patients – rising from virtually no admissions in early March to a peak of just under 21,000 patients in UK hospitals with COVID-19 by mid-April. Accommodating the surge in admissions has led to redeploying staff and facilities and suspending most planned care for patients with pre-existing health care needs. But there are growing concerns about the impact of the COVID-19 outbreak, and the policy response to it, on the health care needs of those with longer term health conditions.

Although the government has put measures in place to protect and support vulnerable people with long-term health conditions, there might still be several reasons that access to care has been restricted during the peak of COVID-19 and lockdown. These include:

  • patients may choose not to access care or treatment, through fears they might contract or transmit COVID-19 or concerns about breaking the lockdown measures, or
  • they are unable to get an appointment or the care they feel they need.

To examine the impact of COVID-19 on access to and use of health care services for people with pre-existing health conditions, the Health Foundation supported an online YouGov survey* of members of the public, designed by the Resolution Foundation. 6,005 UK citizens responded to the survey between 6 and 11 May.1

What has been the reduction in access for care management?

In this blog we focus on the respondents that reported at least one pre-existing condition.2 Those with pre-existing conditions were asked about their use of health care between January 2020 and the end of February 2020: whether they, at any point, accessed any health services to manage their condition(s) (eg NHS 111, pharmacist, GP practice, etc).

The same group were then asked if they had accessed any health services since the end of February 2020 and what it was for. The figure below shows the extent of the reduction in access to care for people to manage their long-term illness. Access to health services for people with pre-existing conditions was 20% lower (51% to 31%) during the COVID-19 peak period. Some of the largest falls in the use of health services are for mental health and cancer with falls of 25% (59% to 34%) and 22% (60% to 38%) respectively.

The survey also found a difference in the reduction in the use of health services between men and women and, to a lesser extent, by age. Women’s access to services for their condition fell by 4% more than men, and the drop off in access to services was very slightly more pronounced for those aged older than 55.

Understanding the reasons behind the reduction in access

Those patients with pre-existing conditions, who reported that they have not accessed care, were also asked the reason. The results for this question are summarised in Table 1 below.

Table 1: The reason given for not accessing health care since end of February 2020

  People with any condition Sex Condition
Men Women Asthma Cancer Diabetes Heart disease Mental health illness
Number 1, 480 726 754 396 76 138 59 469
Could not get an appointment 10% 11% 9% 9% 12% 15% 12% 14%
Condition improved / did not need to use it 47% 50% 44% 54% 50% 35% 37% 36%
Concerned about coronavirus / breaking restrictions 22% 19% 25% 19% 18% 27% 28% 30%
Other 20% 18% 21% 17% 16% 20% 22% 22%
Don't know 6% 6% 6% 5% 6% 11% 10% 6%

Note: These figures do not add up to 100% as respondents can give multiple answers. Base: All UK adults aged 18 to 65 who have a health condition and are not accessing services.

While many patients (47%) reported that they did not need access to health care, 10% said that they were unable to get an appointment and 22% cited concerns over contracting/transmitting the virus or worries about breaking the lockdown. Interestingly, concerns about COVID-19 appear higher for women than men, in contrast to the mortality risks for each group.

There is much more variation in the proportion of people who decided not to risk accessing care on account of the disease than could not get an appointment. But what is particularly striking is that this number is higher for patients with diabetes (27%), heart disease (28%) and mental health illness (30%).

Conclusions

Throughout the COVID-19 crisis, the NHS has attempted to maintain access to essential services for patients who need care for other conditions. But the upheaval of responding to the pandemic has been profound, with many services suspended, postponed or changed to remote methods. As the NHS prepares to move to the next phase of its response and restart more services, these survey findings offer some insight into the task that lies ahead. It will be important to know why some patients are struggling to book appointments, but even if this can be made easier, tackling people’s fear of infection is likely to be a harder task. NHS England have already indicated their concern about the reduction in people seeking medical care for urgent conditions.

Many patients with chronic conditions will have heard the government’s repeated messages about protecting the most vulnerable from infection because they are at higher risk of illness and death. They will also have seen weeks of media coverage of deaths in hospitals. Even if the numbers are coming steadily down, many people will be understandably frightened of going into NHS services. A well-targeted communications campaign will be needed alongside careful monitoring of those who have not had contact with health care as expected.

*The survey that these results are drawn from was designed and commissioned in partnership with the Resolution Foundation, but the views expressed are those of the authors and not necessarily the Resolution Foundation. The figures have been analysed independently by the Health Foundation and are not reflective of YouGov statistics.

Anita Charlesworth (@AnitaCTHF) is Director of Research and the REAL Centre at the Health Foundation.

Toby Watt (@TLSWatt) is Senior Economist, at the Health Foundation.

Ruth Thorlby (@RThorlby) is Assistant Director of Policy at the Health Foundation.

1. These conditions include: Alzheimer's, Arthritis – Osteoarthritis, Arthritis - rheumatoid arthritis, Arthritis - other / unsure, which type, Asthma, Autism, Cancer, Cerebral Palsy, Cystic fibrosis, Dementia, Diabetes, Dyslexia, Epilepsy, Erectile dysfunction, Heart disease, Hearing impairment, High blood pressure, High cholesterol, HIV/ Aids, Incontinence, Mental health illness, Multiple Sclerosis, Osteoporosis, Parkinson's disease, Premature ejaculation,  and Stroke among others.

2. The survey was conducted using an online interview administered to members of the YouGov Plc UK panel, which is made up of 800,000+ individuals who have agreed to take part in surveys. The total sample size was 6,005 adults aged 18–65. Fieldwork was undertaken during 6–11 May 2020.  The survey was carried out online. The figures presented here have been weighted and are representative of all GB adults (aged 18+) according to age, gender, and region.

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