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Slow progress in tackling inequality on hospital waiting lists, finds report

Slow progress in tackling inequality on hospital waiting lists, finds report
By Julie Griffiths
9 November 2023

Those living in more deprived areas of England have a greater likelihood of long waits for planned hospital care than people from less deprived areas, finds a new report from The King’s Fund yesterday.

And the health and care think tank warns that these inequalities could become further entrenched unless the government makes a firmer commitment to taking a more inclusive approach to tackling hospital waiting lists. 

The report Tackling health inequalities on NHS waiting lists finds that while some local NHS organisations have made progress in understanding the unequal experiences of people waiting for planned hospital care, others are yet to take this first step.  

There has also been limited action in addressing inequalities in access to planned care.

The King’s Fund’s report, which was funded by the Health Foundation, has been based on evidence from three in-depth case studies and a review of board reports from 13 NHS trusts and 13 integrated care boards (ICBs).

Following the first wave of the Covid-19 pandemic, NHS England asked local NHS organisations to take a more ‘inclusive approach’ to recovering planned hospital services, such as knee or hip replacements.

The aim was to understand if and why groups of people – including people from minority ethnic groups – were systematically waiting longer for care and, if so, taking action to address those inequalities. 

But the King’s Fund report concluded that inclusive recovery is not yet embedded within NHS organisations.

Ruth Robertson, senior fellow at The King’s Fund, said the research showed ‘considerable variation’ in how local NHS organisations are interpreting and implementing the call to action made in 2020 to tackle hospital waiting lists more inclusively.

This was for a range of reasons, including a lack of analytical resources, the need to better engage clinicians and other staff in the rationale for new approaches, and NHS organisations not being held to account for this work.

The authors also found that, critically, there has been a lack of a clear vision from national leaders as to why inclusive recovery is important for delivering better and fairer services for patients and the public.

The report calls on the government to pay greater attention to inclusive recovery to ensure progress is made so that people can be treated fairly, no matter their background. 

Ms Robertson said: ‘It is possible for the NHS to tackle long waits for care and to do this in a way that doesn’t widen the already shameful inequalities that have plagued the NHS in England for decades.

‘But to help realise this ambition and make good on its promise to ‘build back better’ after the pandemic, the government must now provide greater emphasis and clarity on how it expects waiting lists to be tackled more fairly.’

She added that an inclusive approach should be at the heart of elective recovery. 

‘In the years to come, when we judge how well the NHS dealt with recovering waiting lists in the aftermath of the Covid-19 pandemic, we should look at whether and how health inequalities were addressed. Addressing inequalities in the backlog is good for patients, good for communities and good for the NHS,’ said Ms Robertson. 

The report also outlines examples of how trusts and ICBs are taking an inclusive approach to elective recovery.

These include Cheshire and Merseyside Integrated Care System using AI to target prehabilitation support to people at highest risk of poor health outcomes from their treatment, and University Hospitals of Leicester NHS Trust identifying inequalities in ‘do not attend’ appointment rates linked to deprivation and other factors and offering extra support to people to help them attend.

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