This is the 2020/21 edition of State of Care
We have previously highlighted the ongoing issues that people from particular groups face in accessing and receiving high-quality care.
Over the last year, the pandemic has both further exposed and exacerbated these inequalities. Public Health England data shows that inequalities in COVID-19 case rates became evident early in the pandemic and persisted. At the end of June 2021, cumulative age-standardised case rates were higher in more deprived areas than less deprived ones, and highest among people from the Asian ethnic group – particularly people from the Pakistani and Bangladeshi groups.
At the end of May 2021, the cumulative age-standardised mortality rate in the most deprived areas in England was 2.4 times the rate in the least deprived areas. The mortality rates in people from the Black and Asian groups were more than double the rate in people from the White group.
This inequality in terms of ethnicity also applied to health and care staff. The Health and Social Care Select Committee reported on workforce burnout and resilience in the NHS and social care, and heard evidence that staff from Black and minority ethnic backgrounds were disproportionately affected by COVID-19 compared with staff from white backgrounds, in relation to both deaths and other work-related challenges. In April 2020, BMJ reported findings that two-thirds of healthcare workers who had died from COVID-19 were from a minority ethnic background. The NHS Staff Survey 2020 found that 47% of staff that reported working on a COVID-specific ward were from Black and minority ethnic backgrounds, while 31% were White. Among those staff who reported working from home, 29% were from Black and minority ethnic backgrounds, while 38% where White.
Feedback in the urgent and emergency care and adult inpatient surveys show that some differences in patients’ experiences of hospital treatment have endured. People with dementia or Alzheimer’s disease, and those with mental health conditions, continued to report consistently poorer experiences of acute care when admitted to hospital. Those with pre-existing mental health issues also had poorer experiences across the board when using emergency departments. These differences have been found in previous acute patient surveys and cover many areas that are essential to good patient experience: being treated with dignity and respect, having confidence and trust in doctors and nurses, being given appropriate emotional reassurance, and being able to access help when needed while in hospital.
Over the last year, we have been looking at how local systems are working together to address inequalities, as part of our provider collaboration reviews. Most systems had some understanding that inequalities in health and social care that existed in their areas before the pandemic, as well as how they had worsened or changed due to the pandemic.
But tackling inequalities was often not a main priority for systems, or strategies to identify and tackle health inequalities were not yet well established.
Issues included poor accessibility of information and guidance in different languages during the pandemic for some people, variation in service provision and access to services, and a lack of understanding of how people’s individual characteristics affected the care they needed – for example, the specific needs of people with a learning disability from Black and minority ethnic groups.
The pandemic has led to an increase in remote or digital care in many sectors. While this has worked for some people, our provider collaboration reviews highlighted how this could prevent some people from accessing the care and support they needed because they did not have access to or feel comfortable using digital technology.
Inequalities have also been exposed through the vaccination programme. As at 31 August 2021, NHS England vaccination data showed that the percentage of people vaccinated in the 18 and over, and 50 and over age categories was lower among all minority ethnic groups compared with the White-British and White-Irish population.
Vaccine confidence and uptake among Black ethnic groups has also been recognised as a particular concern. As at 31 August 2021, government figures showed that among those aged 50 and over, people from Black ethnic groups had the lowest vaccination rates in England, with 68% of Black or Black British – Caribbean, 74% of Black or Black British-African, and 71% of Black or Black British-Any other Black background having received at least one dose. This is compared with 96% of people from the White-British group. As highlighted by the King’s Fund, lower vaccine uptake among Black and minority ethnic groups could further perpetuate health inequalities.
Variances in vaccine uptake have also been seen in relation to levels of deprivation. Public Health England reported that, at the end of June 2021, 95% of those living in the least deprived areas had received both doses compared with 87% in the most deprived areas.
Providers and representatives from the voluntary and community sector have told us that recovery needs to focus on addressing health inequalities, particularly those that were amplified by the pandemic. However, there were some concerns that a focus on waiting list backlogs for elective care will put the emphasis on clearing these at pace, instead of on where the need is greatest.