Title: Learning from the national management of the pandemic: The health economic impact of COVID-19 on care and support for people over 65 years old
Funder: Health and Care Research Wales (Welsh Government)

Abstract: The proposed research will disseminate new knowledge on the health economic, sociological and ethical consequences of Welsh Government measures to mitigate transmission of COVID-19 upon those aged 65 and over. The study will develop an ethical framework drawn from the lessons learned from such measures, offering guidance on how best to minimise harm for older people in future public health emergencies or ‘shocks’. This will be achieved through a multidisciplinary, multi-method and stakeholder-involved approach addressing the research question: For people over the age of 65 in Wales, did COVID-19 management lead to unintended consequences in terms of effects on health and care resource use, costs, population health outcomes and experiences?’ BACKGROUND Growing evidence suggests that the Welsh and wider UK pandemic response provoked an array of unintended consequences. Management of the COVID-19 pandemic led to many elective surgeries suspended, with social distancing impacting access to a range of other services throughout 2020, more so for older people and especially more vulnerable groups (1, 2). Patient behaviour also notably changed in this period, particularly in older populations, with anxiety around health and care access due to fears of catching the virus, as well as partial or complete service closures (1, 3). Alongside this, the long-term economic impact of the pandemic is most likely to impact on the physical and mental health outcomes of the older population (5). Understanding the unintended effects on mortality and morbidity from conditions other than COVID-19 during this period, as well as upon social contact and isolation, is crucial to ensuring lessons are learned in the advent of future crises. PLAN OF INVESTIGATION Adopting a multi-method approach, the study will consist of four interlinked work packages: WP1. Scoping exercise including a rapid literature review of COVID-19 management in Wales intended to protect older people, stakeholder mapping of these measures, and the development of a logic model and measurement framework outlining potential short-, medium- and long-term outcomes. WP2. Health economic modelling of short- and longer-term consequences of COVID-19 management measures on cost and impact on quality of life, morbidity and mortality in people aged 65 or over in Wales. WP3. Qualitative interviews exploring the lived experiences of those aged 65 or over, as well as their informal carers, during the pandemic, and associated restrictions on health and social care services. WP4. Development of a principle-driven, ethical framework synthesising the findings of previous work packages and outlining future responses to public health crises that mitigate short and long-term harm. SUMMARY OF BENEFITS The key benefit will be new knowledge and guidance, synthesised in the form of an ethical framework, enabling Welsh and UK governments to plan efficiently for any future public health emergencies, especially for those aged 65 or over. As a backdrop, we will also develop health economic and qualitative insights into the unintended consequences of the prioritisation of COVID-19 patients during the pandemic, enriched by the input of public research partners and other key stakeholders throughout.

Lay abstract: Aim(s) and objective(s) of the research The project aims to understand the effects of prioritising the care of COVID-19 patients and trying to reduce transmission on the health of the people of Wales aged 65 and over. Background to the research In March 2020, the UK and Welsh Government introduced measures to attempt to stop the spread of Covid-19. People were asked to stay at home, some health and social care services were cancelled or delayed, especially for older people. Some older people avoided visiting their doctors and which may have made their health worse. We wish to look at the unplanned effects of these measures on the older population in Wales. What we hope to discover We will look at the current scientific evidence and summarise what happened during the early stages of the COVID-19 pandemic in Wales. We will look at what happened to health and care provision, the ‘lockdown’ measures, and the effect of these, on the older population. Once we have a broad view of the evidence and data available, we will focus our research on a specific group of older adults, asking the public to guide this. The information we find will be brought together in a plan for how to measure changes that happen. The data and the scientific evidence found will be used to build a health economic model. This model will map out what happened during the pandemic and its impact on health and resources. The model will give a better understanding of the costs and consequences of the actions of governments on older adults and will provide a useful tool for future pandemics. Alongside the model, we will interview older people about their experiences and perceptions of the ‘lockdown’. We will target people whose health and care were disrupted by the pandemic and their carers. We expect that the interviews will provide rich data to form a deeper understanding of what the health economic model provides. Finally, the outcomes from the evidence review, health economic model and interviews will be combined. We will construct a set of principles, and a set of questions and answers to which will form guidelines. These guidelines will be helpful to policy makers to respond ethically to future pandemics by reducing short- and longer-term harm. Public involvement Public involvement is crucial to this research. We have an unpaid carer as a co-applicant who helped write the application. Other members of the public have also been involved from the beginning of the application process. They have guided us in deciding to keep the focus of the research broad and they will help to narrow down our research questions after the initial literature searches have been finished. We will check with the members of the public throughout the project that our research stays on track and is in line with the aims of the study. Dissemination We would like the findings from this study to be shared across Wales, the UK and internationally. We intend to submit our key findings for publication in scientific journals and present our research at national and international conferences. The health economic model, interview analysis and ethical guidelines will be available to Public Health Wales, NHS Wales, and Welsh Government to help inform their decisions in the future.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE