How have inequalities in the quality of care changed over the last 10 years?

The NHS aims to provide high quality care for everyone that needs it. But inequalities in health care persist. The recent NHS Long Term Plan made it a priority to address ‘unwarranted’ differences in the care people receive.

QualityWatch has been looking across a whole range of services and performance measures to find out how inequalities in health care have changed over the last decade.

There are different types of inequalities in health care that might arise from the region of the country you live in, your ethnicity, gender, or socio-economic status. This data story takes a closer look at the association between deprivation in the area that a patient lives and quality of care.


Measuring inequality

We compared 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 to see how the results differ.

We constructed an inequality score that is comparable across different performance measures and over time. A positive score means that the most deprived areas are doing worse, and the closer to 1 the score is, the greater the inequality between the least and most deprived.

How has the size of the inequality gap changed over the last decade?
For some measures
the inequality gap has widened...
The inequality gap
has remained static for some ...
For other measures,
the inequality gap has narrowed ...
On one measure, the overall trend
is worsening yet the inequality gap is narrowing ...
What do these trends tell us?

People who live in the most deprived areas have worse access to, experiences of, and outcomes in their care.

It is concerning that inequalities have widened for a number of measures of care quality over the last decade, although it is encouraging that for some it has narrowed.

In general, where the overall trend shows that the quality of NHS services is getting worse, the inequality gap widens. And when the trend shows that quality of care is improving, the inequality gap narrows.

How does the size of the inequality gap compare when we look across more measures?
Across all of the indicators studied, three distinct groups emerged ...

Hover over the points to see each measure

The indicators at the top of this chart, where the inequality score is greatest, show the effect that wider social factors have on inequalities. These tend to be measures where the NHS has less influence, like avoidable mortality and emergency admissions to hospital. A society-wide approach is needed to reduce these inequalities.

Measures of children and young people’s care quality, such as infant mortality and teenage pregnancy rates, are clustered slightly lower. But they still show large inequalities between people living in the most and least deprived areas of the country.

Measures of patient experience and access to services show smaller inequalities. These indicators are more related to the quality of NHS care and less to wider social factors. At present an inequality gap remains for these measures, and many have shown an increase in inequality over the last decade.

What can we learn from this?

The size of the inequality gap is greatest for measures that are more influenced by the wider link between deprivation and ill health, such as emergency admissions to hospital.

However, measures of patient experience and access, where the NHS is able to make more of an impact, show smaller inequalities – though there is still scope for improvement.

With pressure on NHS services growing, there is a risk that inequalities in access, experience and outcomes of care will continue to increase, despite commitments to support people with greater health needs from more deprived areas.

Efforts in the NHS also need to be supported by long-term pledges on the wider determinants of health, with greater investment in things that keep people healthy in the first place, like housing, education and support networks.

Explore further

Sign up to the Nuffield Trust weekly newsletter

* indicates required

Our privacy notice explains how we store and use your data.

© Nuffield Trust and the Health Foundation