Tacking inequalities in health is a long-standing NHS policy objective. Variation in the experiences and outcomes of different communities during the COVID-19 pandemic served to bring this issue back into focus.
In the summer and autumn of 2020, as the first wave of the pandemic subsided, concern grew about reduced access to routine hospital care: diagnostics, outpatient care and planned surgery. Waiting lists and waiting times began to grow. The network of decision support units in the Midlands recognised the potential for this issue to exacerbate existing inequalities. They jointly commissioned this analysis to explore the extent, causes and consequences of socio-economic inequalities in access to planned hospital care. The recent NHS Planning Guidance emphasises the importance of identifying and tackling these inequalities.
What do we know?
Describing socio-economic inequalities in access to planned hospital care
- Rates of access to planned care have increased substantially in recent years
- Rates of access are higher among those living in the least deprived areas. This was not always the case
- This pattern holds for most major causes of morbidity and in most STPs
Where in the pathway do inequities in planned hospital care emerge?
- We explored four pathways: chronic obstructive pulmonary disease, heart failure, arthritis of the hip and cataracts Having adjusted for levels of need, activity in the early parts of each the four pathways was skewed towards the most deprived
- This pattern was reversed towards the very end of the pathway, when secondary care treatment occurs
In this report we have provided evidence of inequalities and inequities in access to planned hospital care. These effects are significant and widespread. Our pathway analysis suggests that these inequities emerge late in the care pathway, and we highlight as potential causes policies to improve and control access to planned hospital treatments. These inequities have implications beyond the planned care system. It appears that poor access to planned care plays a part in generating demand in the unplanned care system. Increasing access to elective care for those in the most deprived areas is likely to lead to reductions in emergency care overall and to fewer inequalities in the levels of emergency care.