England’s poorest ‘get worse NHS care’ than wealthiest

New research by the Nuffield Trust has found that England’s poorest people receive worse NHS care, including spending longer in A&E and worse experience of GP services, than wealthier citizens.

The research, undertaken by QualityWatch, a joint Nuffield Trust and Health Foundation programme, looked at 23 markers of healthcare quality, including avoidable mortality rate, emergency admissions for pneumonia and admissions for bed sores, and found that care was worse for poor people in every measure.

The think tank also said that for 11 out of the 23 markers, the inequality gap was widening and that as the quality of care in certain areas has worsened over time, the divide has also increased.

For example, in 2014/15, there was almost no difference in the proportion of people missing the four-hour A&E target in the most deprived areas versus least deprived. But in 2017/18 a gap emerged where 14.3% of people from the most deprived areas of England who attended A&E were not seen within the target compared to 12.8% of people from the least deprived areas.

While between 2011/12 and 2017/18, the proportion of GP Patient Survey respondents from the most deprived areas reporting a ‘very good’ or ‘fairly good’ experience of making an appointment decreased from 77% to 64%. For those from the least deprived areas it fell from 81% to 72%.

And in 2017/18, there were 394 emergency admissions for bed sores per 100,000 people from the most deprived areas, compared to 134 per 100,000 people from the least deprived areas – almost three times as many. In 2008/09, this was just more than twice as many.

The researchers also found that the inequality gap is greatest for markers that are heavily affected by issues beyond the NHS’s control, such as poor housing and social care.

These markers include avoidable deaths, smoking prevalence and emergency admissions to hospital, while markers relating to children and young people also showed large inequalities.

However, for a number of the markers where the quality of care is getting better, this includes unplanned hospital admissions for asthma, diabetes and epilepsy in children, recovery rate following psychological therapy and people being able to die at their usual place of residence, the inequality gap has narrowed.

Responding to the findings, Nuffield Trust deputy director of research Sarah Scobie said: ‘These findings show some concerning trends about the knock-on effect an overstretched NHS is having on the people in England who often need it the most.

‘My worry is that continued pressure on the NHS is only going to exacerbate inequalities, despite the very best of intentions from staff to provide fair and equal care.

‘The NHS Long Term Plan, which the new Government is embracing, makes reducing inequalities a priority. This is absolutely right, but achieving this will require quite a turnaround.’

Health Foundation assistant director of policy, Ruth Thorlby said: ‘Poverty is bad for your health, and people in the poorest parts of England face a vicious cycle.

‘Poor living conditions, low quality work, and underfunded local services lead to worse health. These findings show that added to this, those in the most deprived areas are routinely experiencing longer waits in A&E, lower satisfaction and more potentially avoidable hospital admissions.

‘Relieving growing pressure on the NHS must be part of the solution, but as important for the new government is investing in housing, education and good work to keep people healthy in the first place.’

A Department of Health and Social Care spokesman said: ‘Everyone should have access to good quality NHS healthcare no matter where they live. We’re determined to narrow the gap between the richest and poorest, with people in England now living for 30 years longer than they did a century ago.

‘Our NHS Long Term Plan, backed by an extra £33.9 billion in cash terms a year by 2023/24, puts tackling health inequalities at its heart. We know prevention is better than cure which is why we recently published our Green Paper, looking at how to give our children a good start in life and ensuring everyone can lead a long and healthy life.’

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