It has become commonplace to point out that the Covid-19 pandemic shone a light on the stark inequalities that exist between ethnic and socioeconomic groups in this country. The vastly different outcomes experienced by people from ethnic minorities during the pandemic have been well-documented – and rightly so.
But what is less well understood is how the fallout from the pandemic has affected different ethnic groups – and whether the millions of hospital procedures cancelled due to Covid impacted these groups equally. Our new report seeks to address that.
Wide variation, not driven by a single cause
Our findings are as intriguing as they are enlightening, identifying wide variation among treatment rates for hospital care between ethnic groups prior to the pandemic, and a striking gap between the Asian group and other ethnic groups during the first two Covid years.
This variation is not driven by a single cause. Some of it reflects known epidemiology – we know that people from Asian groups have higher health care needs for cardiac procedures, for example. We also know that there is a strong link between health need and deprivation, which has a disproportionate impact upon people from ethnic minorities.
Some of it may be to do with less tangible but important issues of how people feel about health care. Trust in health and other services is vitally important in making them effective, but we know that a lack of trust in the NHS and government among some people from ethnic minority groups can result in them accessing less help and fewer services.
Some may be down to rapid shifts to how care is organised, with the widespread use of remote consultations shutting out people who lack the digital or language skills to engage.
Some must surely be a reflection of institutionalised and structural racism across society.
But much of what lies behind this variation needs more analysis. Inconsistent, incorrect and incomplete coding of ethnicity in health records means that our understanding of this complex picture is limited.
The problems of poor data
Poor data, and the practical constraints of small volumes of activity, limited our ability to delve deeper into these variations, for example looking at particular ethnic groups within the broad categories examined in the research. Understanding how this variation maps across subgroups experiencing deprivation, like Bangladeshi and Pakistani people, would be illuminating.
More broadly, the lack of data also limits progress in understanding how to reduce health inequalities across health care – something the NHS has a legal obligation to do. Quite simply, patchy data means that the NHS is flying blind in its attempts to meet this legal, and moral, obligation.
Useful starting point
Nevertheless, this research provides vital new insight into an under-explored area and should offer local systems a useful blueprint for understanding the variations that exist in their own elective care backlogs. We hope that analysts in integrated care systems and those working at NHS trusts will replicate the methodology to gain greater insight into their areas.
Covid is far from over. And the elective backlog is just one part of the legacy left by the pandemic on the NHS: less high-profile backlogs of care in public health and prevention will leave equally serious challenges for both mental and physical health. As we approach another winter and face the continuing threat of Covid, we hope that this research provides a useful starting point for understanding this legacy.
*Nigel Edwards is Chief Executive of the Nuffield Trust and Dr Habib Naqvi is Director of the NHS Race and Health Observatory. The Nuffield Trust has today published a new report, supported by the NHS Race and Health Observatory, on the elective care backlog and ethnicity.