The not-so-lost art of innovation

The positive response to the pandemic has shown that the health service is more adaptive than I believed

In my last column, written in the ‘before times’ of February 2020, I railed against the inertia of the Irish health service, how nothing ever changed or innovated because it never had to. In the background of our lives then were news stories of a ‘novel coronavirus’ circulating in a city in China most of us had previously never heard of, stories of people in lockdown in their houses, only able to leave for grocery shopping. ‘God, that’s mad’, I thought, not being able to remotely conceive that my life would be affected in the same way.

I was proven wrong about that and I was proven wrong about how things cannot change in the health service. Overnight, new emergency departments sprung out of nowhere, ICUs were upgraded, staffing massively increased and working hours changed. GPs quickly adapted to running consultations by phone, community hubs were developed overnight. Thinking back to a time where we didn’t wear scrubs and face masks every day, where we ran outpatient clinics face-to-face, now seems as unimaginable as hearing those initial news reports from Wuhan.

By March, it had landed on our shores and terrified by the stories from Italy, we sprang into action. We were given crash-courses in intensive care medicine and palliative care, expecting a surge that we feared we wouldn’t be able to cope with. Instead, we were met with an eerie quiet and a strange boredom, bizarrely quiet shifts on-call, the overnight disappearance of trolleys on corridors, and the question of what we weren’t seeing come in through the door. Thankfully, these are now filtering through: The STEMIs, the strokes, the funny turns, but the coming disaster of all the not-yet-diagnosed cancers, the under-managed chronic diseases and mental health crises is still looming.

I, like most, naively thought that this was going to be a temporary thing, that we’d all do this until June and then everything would magically go back to normal. As a country, we’ve done so well at flattening the curve (a phrase that didn’t exist mere months ago) that the question arises of how we are now going to get out of this. It’s becoming obvious now that Covid-19 is going to be with us for a long time, and I fear that people are pinning all their hopes on a vaccine that may take years to emerge, if ever.

It may be that we have we just pushed back the surge that will inevitably come. As restrictions are slowly lifting, people are becoming more complacent. It may be that hospitals will be overwhelmed just as we’re running out of energy. However, we can’t run on an emergency war footing forever; ‘Covid fatigue’ among staff is now definitely setting in. I’m personally now sick of PPE, the loss of communication with patients through face masks and that still constant gnawing fear in the back of your mind. Like the rest of the population, I want to see my friends and family again, go out to dinner and on holiday — all the good parts of life that we previously took for granted.

It’s been amazing to see the huge investment in the health service that happened overnight; money suddenly became no object and the things that were previously impossible became possible. Unfortunately, we can’t keep throwing money at this ad infinitum, especially when it’s becoming more obvious that when we do emerge out of this, it will be into one of the greatest recessions we have ever known.

We need to adapt to the next challenge of how the health system is going to cope in the winter, when this is in the mix with the flus and the COPD exacerbations and the pneumonias. Although the rapid adoption of telemedicine has made routine reviews surprisingly efficient, we have to eventually go back to seeing most of our patients face-to-face in our outpatient clinics, our theatres and our GP practices.

It’s becoming clear that we are not at the beginning of the end of this, but rather coming to the end of the beginning. We have to keep going back to the drawing board, we have to keep constantly adapting to new challenges. What we’re doing now in late spring and early summer of 2020 will not be what we do in the autumn and winter. I am sure that our working conditions and lives will keep changing in ways that I cannot yet conceive. I am so grateful that I was proven wrong back in February; it is now clear to me that the health service and the people in it are incredibly adaptable, innovative and well up to the challenges to come.