IFF research: Escalation of care survey findings (July 2024)

Summary

The UK Covid-19 Inquiry's terms of reference include understanding the impact of the pandemic on patients and healthcare staff. IFF Research was commissioned to conduct a survey of healthcare professionals (HCPs) as part of Module 3, which focuses on the healthcare systems of the UK, and specifically their ability to increase critical care capacity, the triage of patients, and the role of primary care.

Content

• This research forms part of Module 3 of the UK Covid-19 Inquiry. It investigates decisions around escalating patients to the next level of care during the first two waves of the pandemic. It involved a survey of 1,683 healthcare professionals (HCPs) from a mix of roles and settings.
• Over half (58%) of HCPs reported that some patients could not be escalated to the next level of care due to a lack of resources during either wave of the pandemic. A&E doctors (71 %) and paramedics (62%) were more likely to have ever been unable to escalate care due to a lack of resources at either wave.
• The primary reasons for the inability to escalate care were a lack of available beds at all levels, including high dependency units, and a lack of staff (overall or at the right level), followed by a lack of equipment or technology and lack of access to an ambulance.
• Four fifths (81 %) of HCPs agreed that more patients were unable to be escalated during the pandemic compared to before and over two thirds (71 %) agreed that patients who were unable to be escalated were more severely ill.
• During each wave of the pandemic, 1 in 3 HCPs said they received instructions from their employer on which groups should not be escalated to the next level of care, although this was the case for a majority of paramedics (55%). About half of HCPs felt supported by their I 4 employer to make decisions about escalation of care, but only a minority felt well-supported by their professional organisation, trade unions, regulatory bodies or National NHS authorities.
• Over two thirds of HCPs (69%) felt they had insufficient staff at their place of work to provide good quality patient care at least weekly during the pandemic. This was significantly higher than 43% who experienced this pre-pandemic. Most HCPs (80%) reported having to act in ways that conflicted with their values during the pandemic. Critical care nurses (92%) and paramedics (84%) were more likely to report these conflicts, with 58% of critical care nurses indicating they faced this issue daily.
• There was a call for clear, consistent, data-driven guidance and supportive management who acknowledge the challenges involved and protect staff from unfair criticism for decisions.