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Covid-19: an opportunity to reduce unnecessary healthcare

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2752 (Published 14 July 2020) Cite this as: BMJ 2020;370:m2752

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Re: Covid-19: an opportunity to reduce unnecessary healthcare

Dear Editor,

A microorganism, Covid-19, has shocked the world, not only because of the suffering it has brought to so many, but also by jolting so many people to reconsider what is necessary and what is not. [1] Emotions have driven behaviour both in health professionals and in the general public. Behaviours have changed; eyes have been opened.

I believe we must pay as much attention to harnessing the good that has come from changed behaviours as we do to thinking of ways to change systems. Behaviours have been modified by both fear of the virus and the lockdown steps taken to deal with it. Now is the time to encourage the self-reliance that has been engendered, and the rediscovered pleasures closer to home: the increase of exercise through only being `allowed` 1 hour a day; use of bicycles and shanks-pony; use of parks; the benefits of breathing less polluted air; a change of pace; more time with less commuting.

The public has seen the compassionate, gruellingly hard work that the profession is doing, their ability to get things done quickly when freed of red tape. Respect for `our` NHS has inspired people to stand back and not go to A&E for minor problems, freeing up capacity for vital care. Yes, many have avoided attending when they should have sought help and there is a backlog of patients queuing for treatments and surgery, but this should lead to planning that concentrates on those needing healthcare, utilising resources wisely. Time for prioritisation, a culling of procedures that are unnecessary or reliably shown not to be of benefit. Top of my list would be untargeted population breast screening [2], and stoppage of the unethical NHS Breast Screening Programme AgeX (so-called) trial, both hugely wasteful of resources, as well as causing known harms. [3] [4].

Let us not lose this opportunity, especially now that the public are more aware, motivated and enlightened. Involve them.

[1] Moynihan R, Johansson M, Maybee A, Lang E, Légaré F. Covid 19: an opportunity to reduce unnecessary healthcare. BMJ 2020;370:m2752

[2] Goetzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Sys Rev 2013;6;CD001877.23737396

[3] ISRCTN Register. Evaluating the age extension of the NHS Breast Screening Programme – trial registration 2010. www.controlled-trials.com/ISRCTN33292440

[4] Bewley S, Blennerhassett M, Payne M. Cost of extending the NHS breast screening age range in England. BMJ 2019;365:l1293

Competing interests: No competing interests

15 July 2020
HAZEL Thornton
Honorary Visiting Fellow, Department of Health Sciences
n/a
University of Leicester
"Saionara", 31Regent Street, Rowhedge, Colchester, CO5 7EA