Access to healthcare – UK Government assessment

Record NHS waiting lists and worsening waiting times before the coronavirus (COVID-19) pandemic have limited access to healthcare. There is evidence that certain groups experience persistent inequalities in accessing healthcare, but a lack of data separated by protected characteristic makes it difficult to fully understand these disparities. Though the NHS Long Term Plan commits to addressing variations in access to care, it is too early to assess its impact. The COVID-19 vaccination programme has achieved widespread coverage, but access to treatment for other conditions has been severely restricted due to the pandemic.

• The number of people waiting to start hospital treatment in England reached record levels in July 2021, with waiting times across many health services increasing considerably over the past decade. The percentage of patients in A&E that were admitted, transferred or discharged within four hours reached an all-time low of 64% at ‘type 1’ A&E departments in September 2021.
• Rising waiting times, prior to the COVID-19 pandemic, were in part due to increasing demand, but ongoing delays mean that more people are unable to access healthcare when they need it.
• Before the COVID-19 pandemic, there were well-established inequalities in access to healthcare for different groups, including people with learning disabilities, refugees and people seeking asylum, transgender people, same-sex couples, ethnic minority groups, including Gypsies, Roma and Travellers, and homeless people.
• Changes to the NHS charging policy in England have restricted access to healthcare for people refused asylum and other groups of migrants.
• A shortage of data recording protected characteristics and inconsistent data collection make it difficult to review certain disparities in access.
• It is too early to review the impact of the NHS Long Term Plan, which includes proposals to improve access to health services.
• There have been NHS funding increases, but spending has grown at a historically slow pace since 2009–10. Funding in some key areas has reduced, such as the public health grant, which shrank by £850 million in real terms between 2015–16 and 2019–20.
• Following NHS funding announcements in September 2021, it has been estimated that this will be insufficient to cover the medium-term impact of the COVID-19 pandemic.
• By September 2021, more than 78 million COVID-19 vaccinations had been administered in England. However, some population groups have had lower vaccination coverage.
• The COVID-19 pandemic has disrupted access to healthcare for certain groups more than others, including older people, ethnic minorities, people who are socio-economically disadvantaged, trans people, women and young children. The diversion of resources has had a significant impact on access to healthcare for people with other life-threatening conditions. Disabled people and older people were more likely to report disruptions in accessing treatment and there have been reports of specific challenges accessing medicines.
• NHS England announced support for individuals experiencing ‘long COVID’, but evidence suggests there are long waiting times to access treatment.
• Some people with long-term health conditions report that the move to online and telephone healthcare services during the COVID-19 pandemic helped facilitate access to healthcare, while others report feeling isolated or excluded by it.
• The Health and Care Bill might facilitate improved collaboration in the delivery of health and social care, but concerns include that the reforms will not adequately address challenges such as workforce shortages.
• The UK Government’s plans to tackle the backlog in elective healthcare are welcome, though it is not yet clear if they are sufficient to address record waiting times.