This is the 2020/21 edition of State of Care
We have found that most systems had some understanding that inequalities in health and social care existed in their areas before the pandemic, and 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 across some systems were not yet well established.
In the urgent and emergency care review, some providers and systems had little to say about how they were tackling health inequalities, for example stating that COVID-19 took priority or that tackling barriers for Black and minority ethnic communities was not a priority because they had a small Black and minority ethnic population. In the cancer review, the absence of a system-wide strategy meant that some providers were without a clear vision of how inequalities among cancer patients were being addressed in their system.
We found that better data on demographics (for example on age, gender and ethnicity) is needed to make it easier to identify health inequalities and gaps in care for people who need cancer services or urgent and emergency care.
The needs of people with a learning disability had variable consideration within system-level strategies. We heard that sometimes people with a learning disability were not a prioritised group or they were included in the category of vulnerable people, rather than being recognised as people with specific and complex needs. We stressed the importance of having learning disability specialists or champions as part of governance structures.
There were service gaps for people with a learning disability across systems, including: the transition between child and adult services; completion of annual health checks; out-of-hours support; hospital discharge and outreach; and forensic and crisis support.
Overall, across all our provider collaboration reviews, we highlight the strong need for leaders in local systems to work hard to understand the inequalities that exist in their areas, and to develop strategies to specifically address them.