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COVID-19 delivered shockwaves across the globe, disrupting economies and upending lives. That disruption and uncertainty were acutely felt by Australians through lockdowns, closed borders, severe illness and deaths, and fears about the pressure it would place on our health system.
Among the hardest hit were young people. Education was disrupted, aspirations dashed, employment rendered unstable, and mental health concerns exacerbated. Of young people surveyed recently by Mission Australia, 50.3% said COVID-19 had negatively affected their mental health.
Australia’s health aged and social care systems came under the microscope and were tested like they had never been before. We witnessed how our health system can function – and potentially falter – in the event of sudden change.
The Consumers Health Forum of Australia (CHF), the leading national advocate for health consumers and those with an interest in health consumers affairs, saw an opportunity to reshape our health care system.
While an appetite for health reform existed before COVID-19 turned our lives upside down, the pandemic brought momentous change to major aspects of health and social care in ways we could not have imagined. Fault-lines were exposed, and opportunities opened up.
In July 2020, CHF established the Consumer Commission: Beyond COVID-19, a diverse group of consumer leaders. Commissioners considered the biggest health issues facing Australia through the lens of the pandemic and proposed ideas about the future of the Australian health and social care system.
In the report Making Health Better Together, Commissioners “diagnosed” several areas for improvement – consumer leadership and co-design, mental health and wellbeing, integration and care coordination, health equity, and digital health – and “prescribed” a range of structural and practical changes to support the system into the future.
Mental health and wellbeing
Living with the COVID-19 pandemic has been stressful for individuals, families and communities. It has fuelled growing rates of anxiety, loneliness and distress and escalating demand for mental health services, in a system already struggling to cope.
For the workforce – health care professionals, hospital workers, paramedics and other frontline workers in aged care, supply, border control and security – the pressure has amplified. For some, the stress of relentless high pressure work situations, employment and housing instability, or isolation, has pushed them further towards needing immediate mental health support.
For the generation of young people still at school or living through early adulthood, there may be longitudinal effects on their health. We are still to fully understand this without further time and some perspective, but poor mental health is a key impact from isolation or unstable employment and finances.
The gaps in the mental health system are clear, as shown by recommendations from various independent inquiries, but still we are faced with a fragmented system that is confusing and difficult to navigate; expensive for consumers to access timely, preventive care; and not enough trained professionals to meet the need.
The CHF Commission report recommended more early intervention services and an expanded role for peer workers. Adequate access to treatment and mental health support was a key issue highlighted at the recent Youth Health Forum Summit, where young health advocates called for a greater role in policy decision making and design.
Integration and care coordination
If there is ever a time services need to connect and integrate, it is in times of crisis. The pandemic shone the light on the recurring disconnect between parts of the system – aged care, disability, mental and physical health services.
Integration happens best when local service planners, clinicians and consumers work together to develop place-based solutions. They know their local needs, are familiar with local services and can identify gaps and opportunities. Primary health and local hospital networks are uniquely placed to jointly plan, pool funding and co-commission connected, integrated services and should be supported to do more of this.
We need navigator roles to support consumers to connect key services, with a particular focus on support for self-management. A national social prescribing scheme would recognise that many presentations to GPs are for reasons other than medical concerns and go a long way to providing more comprehensive, “wrap around” care.
Health equity or inequity fuelled by a “digital divide”
Health inequity has been around well before the pandemic, but if we fail to address the fractures in the funding models of health, including private health insurance, health care will continue to become unaffordable for part of the population. Early and affordable access to preventive health care is directly translatable to longer, healthier, more self-sufficient lives.
The pandemic put at risk continuity of care particularly for those with a complex mix of conditions. After a decade of pressing for telehealth, when it became imperative for patients in lockdowns to access their health care professionals, telehealth and virtual health was taken up with surprising gusto by both consumers and providers. This triggered us to refine our thinking about how we interact with technology in health care and how it might assist us to re-imagine and modernise care.
Access to reliable infrastructure and good levels of digital health literacy are imperative for successful telehealth or virtual consultations. In rural and remote areas where digital connectivity is still uneven, we once again create a digital divide among members of our community. The same is true for our Indigenous communities and the homeless. We could risk digitally enabled health care widening, not narrowing, health inequities.
Trust in communication
The public thirst for information about COVID-19 was palpable, and the level of misinformation percolating was, at times, concerning. More than just a health crisis, the global pandemic has been referred to as an “infodemic”.
Trust in organisations, news and authorities has been tested. Misinformation circulating across dinner tables, through the grapevine and, most significantly, on social media put a strain on the public’s ability to comprehend and trust information about their health.
The pandemic brought about a state of high alert, which made the constant flow of changing messages even more confusing to follow. Communicating health information requires trust, commonplace or “plain language,” being aware of cultural differences, language barriers and checking in to see how your message is being received.
Research by the News and Media Research Centre at the University of Canberra highlights how technological, cultural and policy shifts have changed the way news as we know it is produced, delivered and consumed. News and social media were fundamental to conveying vital public health information to consumers, and to influencing public understanding of the COVID-19 pandemic.
The Centre’s research found that no topic in recent history comes close to the saturation coverage of the COVID-19 pandemic. Importantly, for the first part of 2020 at least, informational news dominated coverage. Journalists fulfilled their “civic” role as facilitators of public health messaging, co-constructing these messages with political leaders and health experts. When it came to information sources in the early days of the pandemic, 70% of Australians said the ABC was trustworthy; doctors, health experts and scientists were most trusted at 85%.
Consumers are leaders and should be included in design
The consumer voice makes better health care systems – a point underscored by the pandemic experience. This is now enshrined in the National Safety and Quality Health Service (NSQHS) Standards and other professional standards.
With consumer engagement embedded into health system design, both system designers and policymakers need to understand how best to work with consumers. Consumers, in turn, need support and encouragement to be best placed for this transformational process.
CHF has proposed a “consumer leadership academy” to upskill consumer advocates in leveraging their voice in the policy debate.
It takes a crisis
The pandemic has shown the Australian health care system can respond to an immediate threat to the health of our population.
Innovation, flexibility, and modernisation must be seized in readiness to adapt to future changes, including the impact of climate change on health.
A holistic approach to mental health care services is needed, as treatment alone will not prevent illness. Social reforms are also required to ensure all Australians have a secure standard of living and adequate housing by increasing the supply of affordable housing – these are important social determinants of health..
Access to technology through affordability and digital skills are one of the key gaps to a healthier Australia. Not only does access and fluency with digital communication deliver streamlined and cost-effective health consultations, but social benefits also thrive alongside medical advances.
But mostly, we need horizon thinking and the voice of the consumer to best shape our health system of the future. Consumer insights can be the “makers and shapers” of change.
Leanne Wells is the Chief Executive Officer of the Consumers Health Forum of Australia.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.