Even before the pandemic arrived, life expectancy improvements in England had stalled and health inequalities were widening. The pandemic exacerbated the issue, with people in more deprived areas and some ethnic minority groups having seen disproportionately high mortality rates from the virus, as shown by ONS data published this week.
We are now at a critical juncture. As the huge demand-driven pressures the NHS has faced this winter begin to ease ever so slightly, and trusts begin the task of recovering core urgent and emergency care performance standards, this is the time to ensure recovery is both sustainable and equitable.
The new urgent and emergency care recovery plan sets out some challenging but realistic targets to bring headline waiting times for A&E and ambulance services down toward pre-pandemic levels.
A&E attendances are twice as high in the most deprived areas compared to the least deprived.Policy Advisor (Ambulance and Operational Performance)
In the short term, focusing on the immediate issue of bringing down waiting times and giving the public the confidence that emergency services will be there when they need them is the right approach. However, we also know that the pressures and demands that trusts are facing vary hugely. For example, A&E attendances are twice as high in the most deprived areas compared to the least deprived.
People in more deprived areas experienced worse health both before and during the pandemic and are now facing longer waits for treatment. There is a real risk this translates to health inequalities widening even further, not only impacting the individuals and families concerned but also placing greater demand on emergency care services.
This is confirmed by new data from the ONS, which shows that with the NHS waiting list at over 7 million, people in more deprived areas are most likely to be on a waiting list and are most likely to experience a very long wait. These long waits can translate to deteriorating health; nearly one third of people on the NHS waiting list say their condition has worsened or they have developed another condition while waiting.
We are just now seeing the first green shoots of recovery in the NHS – though demand remains at historic highs, waiting times for both emergency and planned care are too long, and bed numbers are too low while occupancy is too high. All of this is undercut by the fact that the NHS has a workforce shortage of over 133,000.
Recovering urgent and emergency care waiting times will be a long and arduous task. Increasing activity levels in emergency departments and building additional capacity by increasing bed numbers will help bring down waiting times in the coming months. But without addressing the systemic workforce shortages and implementing strategies to reduce demand – by improving health and tackling inequalities – the recovery will be neither sustainable nor equitable.
In short, without these parts of the puzzle in place, the same challenges will return quickly. Improving population health and reducing health inequalities are core aims of the NHS. However, there is a risk that if immediate financial and operational pressures dominate attention, a focus on inequalities and health improvement could be lost.
To really leverage the role of the NHS in reducing health inequalities, it needs to be given as much priority and prominence as reducing waiting times overall.Policy Advisor (Ambulance and Operational Performance)
To safeguard against this, a longer-term strategy for urgent and emergency care is needed: one that looks beyond activity in emergency departments and looks at population health improvement and reducing health inequalities, as well as at preventing demand – particularly in those communities that experience disproportionately worse health. NHS trusts, working closely with their system partners, have a vitally important but under-utilised role here.
To really leverage the role of the NHS in reducing health inequalities, it needs to be given as much priority and prominence as reducing waiting times overall. Trust leaders have an important role to play here, and our work has shown a clear appetite to start making real progress. But a national focus, clear direction and accountabilities at all levels need to be set out to help drive real, sustainable progress as the NHS begins the long process of recovery.
This blog was first published by BMJ.