England's poorest 'get worse NHS care' than wealthiest citizens

Denis Campbell Health policy editor
Photograph: Peter Byrne/PA

England’s poorest people get worse NHS care than its wealthiest citizens, including longer waiting for A&E treatment and worse experience of GP services, a study shows.

Those from the most deprived areas have fewer hip replacements and are admitted to hospital with bed sores more often than people from the least deprived areas.

With regard to emergency care, 14.3% of the most deprived had to wait more than the supposed maximum of four hours to be dealt with in A&E in 2017-18, compared with 12.8% of the wealthiest. Similarly, just 64% of the former had a good experience making a GP appointment, compared with 72% of those from the richest areas.

While 134 people per 100,000 of the least deprived were admitted to hospital that year because of pressure sores, the rate among the poorest was three times higher, 394 per 100,000 people.

Research by the Nuffield Trust and Health Foundation thinktanks found that the poorest people were less likely to recover from mental ill-health after receiving psychological therapy and be readmitted to hospital as a medical emergency soon after undergoing treatment.

The findings sparked concern because they show that poorer people’shealth risks being compounded by poorer access to NHS care. Moreover, previous evidence showed that, while life expectancy is still improving for the best-off, it has stalled or gone backwards among the poorest.

“Poverty is bad for your health, and people in the poorest parts of England face a vicious cycle,” said Ruth Thorlby, a co-author and assistant director of policy at the Health Foundation.

“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,” she added.

The thinktanks analysed 23 indicators of the quality of healthcare to see what role, if any, is played by the level of deprivation faced by the patient. They found that care was worse for all of them for those from England’s poorest communities.

However, while some related directly to NHS care – which patients should be able to access equally – others involved socio-economic factors over which the service has no control, such as housing and employment.

“These findings show some concerning trends about the knock-on effects an overstretched NHS is having on the people in England who often need it most,” said Sarah Scobie, deputy director of research at the Nuffield Trust and the other co-author.

“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.”

Disclosure of such stark and widening inequalities raises awkward questions for the government and NHS England, both of which have pledged to tackle them.

In the NHS Long Term Plan published last year, service chiefs promised to take “a more concerted and systematic approach to reducing health inequalities and addressing unwarranted variation in care”. That includes putting about £1bn in extra funding into the parts of England with the highest inequalities in health.

More positively, though, the thinktanks also found that, in areas of care where quality is improving, the inequality gap is narrowing, such as in hospital admissions for asthma, diabetes and epilepsy in children, and people being able to die where they live.

The research found large disparities between richest and poorest in measures of children and young people’s health, including take-up of the MMR vaccine in five-year-olds, teenage pregnancy and admissions for self-harm for under-18s.

Dr Stephen Jivraj, an associate professor in the faculty of population health sciences at University College London, said: “These findings point to an inverse care law where those most in need of health services are experiencing the poorest quality.

“They provide context to why the gap in health between rich and poor is getting larger, as shown in recent research from UCL. The increase in the gap between deprived areas and less deprived areas is worrying.”

NHS England declined to comment.

The Department of Health and Social Care 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 £33.9bn 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.”