Inequalities are pervasive throughout the NHS, leading to differential outcomes between demographic groups. This is a matter that all of us involved in health care, not just government, must address
"The NHS can often be complex to navigate – knowing, for example, when to see a GP, or to visit A&E or to request a referral to a specialist. This is particularly hard for those who are recent immigrants, or who don’t speak English, or who are simply not well-versed in how the system works." Greg Allen, CEO, FCC
At Future Care Capital we are focused on a vision of a fit for purpose future health and care system. By definition, that includes exploring how the current health and care system meets the expectations of those who need and use it.
There are many challenges and opportunities in realising such a vision for the future. One fundamental issue is inequality.
A new report, commissioned by the NHS Race and Health Observatory, has found widespread ethnic inequalities across a number of health services, including mental health care, maternal and neonatal health care and genomic medicine.
The report also found inequalities in the NHS workforce, with Black and Asian staff earning less than white staff.
The report identified a number of reasons for the inequalities, including poor quality or discriminatory treatment from health care staff, missing data on ethnic monitoring and a lack of appropriate interpreting services. Some people from ethnic minorities delay seeking help because they fear racist treatment from NHS professionals.
It’s good to see these issues being raised. The aim of the NHS from the outset has been to provide fair and equal access to health care for everyone, irrespective of their demographic background or their ability to pay.
In practice, there are clear inequalities to access. A few weeks ago, I looked at the number of services in the NHS, such as dentistry and optometry, that require the patient to pay. The new report has highlighted areas where extra provision is needed for some groups to enable equal access – for example, people for whom English is a not a first language are hugely disadvantaged if they don’t have access to good quality interpreters.
Similarly, people with disabilities or chronic health care problems, or without access to a car, may find it difficult to make it to a GP surgery or hospital.
In poorer areas, there are fewer GPs per head of population.
The NHS can often be complex to navigate – knowing, for example, when to see a GP, or to visit A&E or to request a referral to a specialist. This is particularly hard for those who are recent immigrants, or who don’t speak English, or who are simply not well-versed in how the system works.
The advent of digital systems and technology in the NHS sees a further gap opening up between those who have access to digital technology and the skills to use it (generally younger and/or wealthier) and those who don’t. For those with access to an iPad or a computer, making an appointment or ordering a prescription online is easy: those without access have to rely on lengthy waits on the phone or visits to the surgery.
Similarly, Babylon’s GP at Hand service has seen rapid growth: 100,000 people now use it as their main NHS GP, giving them access to appointments 24/7, with the under 30s making up half of its patients. Meanwhile, other groups are left waiting weeks for an appointment.
The government’s creation of the Office for Health Improvement and Disparities’ (OHID) last year is welcome, and we hope it addresses these issues as a matter of urgency. It must focus on the many different ways in which the NHS structure exacerbates differential health outcomes: lack of GP provision in some areas; lack of interpreters; lack of monitoring data to inform decision-making; and the digital divide.
But addressing inequality is not just about a government agency having the right focus. It is about each and every one of us, as citizens, patients, organisations, professionals challenging inequality when and where we see it. This will help to bring about more of a movement for change which takes root for a better future.