Poorest get worse quality of NHS care in England, new research finds

New QualityWatch analysis finds people living in the most deprived areas of England experience a worse quality of NHS care and poorer health outcomes than people living in the least deprived areas.

Press release

Published: 23/01/2020

New analysis has found that people living in the most deprived areas of England experience a worse quality of NHS care and poorer health outcomes than people living in the least deprived areas. These include spending longer in A&E and having a worse experience of making a GP appointment.

The research, undertaken by QualityWatch, a joint Nuffield Trust and Health Foundation programme, has looked at 23 measures of healthcare quality to see how these are affected by deprivation. In every single indicator looked at, care is worse for people experiencing the greatest deprivation.   

Using NHS and the Index of Multiple Deprivation data, the researchers found that for 11 out of the 23 measures, the inequality gap was widening.

In general, indicators where the quality of care has got worse over time, the inequality gap between the most and least deprived has widened too. They include:

  • 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. 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.
  • 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%.
  • In 2017/18, there were 394 emergency admissions for pressure 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 measures that are heavily affected by issues beyond the NHS’s control such as poor housing and social care. These measures include avoidable deaths, smoking prevalence and emergency admissions to hospital. Measures relating to children and young people also showed large inequalities.

However, for a number of the measures where the quality of care is getting better, the inequality gap has narrowed. 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.

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.”

ENDS

    Notes to editors

    1. The briefing Quality and inequality: How have inequalities in the quality of care changed over the last 10 years. You can scroll through the interactive report here: https://www.nuffieldtrust.org.uk/public/files/2020-01/quality_inequality. You can also find an accompanying briefing here: https://www.nuffieldtrust.org.uk/news-item/quality-and-inequality
    2. The authors used Hospital Episode Statistics, patient survey data, published health statistics and the Index of Multiple Deprivation. Using this data they looked at 23 indicators measuring the quality of NHS care for the 10% of people living in the most deprived areas and the 10% of people living in the least deprived areas of England. From this they constructed an inequality score that is comparable across different performance measures and over time.
    3. The 23 indicators looked at were: Avoidable mortality rate (male), smoking prevalence, avoidable mortality (female), emergency admissions for ambulatory care sensitive conditions, emergency admission for pressure sores, teenage pregnancy rate, emergency admission for pneumonia, obesity prevalence in children, emergency admissions for asthma, diabetes and epilepsy in under 19s, self-harm admissions in children and young people, infant mortality rate, neonatal mortality and stillbirth rate, psychological therapy recovery rate, hip replacement rate, feeling supported to manage long-term conditions, deaths in usual place of residence, emergency readmissions, experience of making a GP appointment, A&E waiting times, experience of GP services, experience of NHS dental services, experience of making an NHS dental appointment and MMR vaccination rate in 5-year-olds.
    4. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate. https://www.nuffieldtrust.org.uk/
    5. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. www.health.org.uk
    6. QualityWatch is a Nuffield Trust and Health Foundation programme providing independent scrutiny into how the quality of health and social care is changing over time. https://www.nuffieldtrust.org.uk/qualitywatch
    7. This report was originally given to The Guardian as an exclusive. 
    8. To arrange and interview or speak to one of the authors please contact the Nuffield Trust press office on 020 7462 0555 or email press.office@nuffieldtrust.org.uk

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