Blog: Strategies to reduce inequalities in planned care

MDSN responds to recent reports addressing the NHS waiting list crisis

Steven Wyatt, the Strategy Unit

With NHS waiting lists already far exceeding 6.5million, and with some estimates suggesting this number could reach as high as 10million, the need for innovative, evidenced-based solutions are urgently required.  

Long, seemingly ever-increasing NHS waiting lists, has been a significant problem faced by the NHS for many years and, now exacerbated by the pandemic, the problem risks extending out of control.  

The real task for the NHS in trying to address this issue is doing so without comprising the already persistent problem of health inequalities across the country.  

As Steven Wyatt in our recently published Strategies to reduce inequalities in access to planned hospital procedures explains: 

The scale of the challenge is huge. In this context there is a danger that throughput, will overshadow all other considerations, and equity will suffer. However heroic, managing the waiting list down to acceptable levels cannot be seen as a success if it’s done in a way that leads to greater inequities. ICBs must ensure that their short-term strategies to reduce waiting lists are compatible with their long-term objectives to reduce inequalities. 

In the report, Steven proposes various approaches that aim to reduce inequalities with the growing waiting lists in mind. It is an informative piece and recommended reading for any ICB member across the country looking for solutions to tackle the issue. 

The stories below are just a small sample of articles that have appeared in various media outlets over the past few weeks. As this story continues to develop the need for comprehensive solutions will only increase.  

Affluent patients face longer NHS wait in ‘equality drive’. (The Times, 8.7.22)  

‘117,000 die on waiting lists for NHS’. (Evening Standard, 8.7.22) 

Middle-class patients to wait longer for care under health inequalities project. (HSJ, 6.7.22) 

NHS patients to be offered chance to travel for surgery. (BBC, 27.6.22) 

How do waiting times for NHS planned care vary across England? (Nuffield Trust, 14.6.22) 

Peter Spilsbury, Director of the Strategy Unit

To help ICBs and others, in taking the insights from this report into action, the Strategy Unit has commissioned some further perspectives on the possible strategies described. The first of these is a publication from colleagues at Hill Dickinson which provides an up-to-date overview of the legal duties placed upon ICB decision makers in relation to reducing inequalities and then considers the range of possible strategies proposed in our report from that legal perspective.  

Briefing note for Integrated Care Boards on legal duties in respect of reducing inequalities

The second publication is an ethics review produced by Angie Hobbs – the world’s first Professor in the Public Understanding of Philosophy – this paper examines the ethical questions raised by our report outlining strategies for reducing inequity.

Professor Hobbs looks at our suggested strategies with the eye of a professional philosopher, asking: what ethical tensions and issues might arise by following these strategies? How can they be overcome?

Reducing inequities in planned care: An Ethics Review for Integrated Care Boards