Health outcomes and experience in the healthcare system – UK Government assessment
The UK Government set out a number of actions to reduce health inequalities and improve outcomes in the NHS Long Term Plan. The NHS response to the coronavirus pandemic has been substantial, although the diversion of resource has led to reductions in service provision that have had a negative impact on health outcomes. Existing entrenched inequalities in health outcomes and experience for different groups have been compounded by the pandemic.
- Since 2010, increases in life expectancy have slowed, especially in more deprived areas. Inequalities regarding life expectancy have been growing among certain groups, especially women.
- On average, the life expectancy of women and men with a learning disability is 18 years and 14 years shorter than for non-disabled women and men, respectively.
- Prior to the pandemic, there were longstanding and intersectional inequalities in health outcomes. People with learning disabilities, refugees and asylum seekers, transgender people, certain ethnic minority groups including Gypsies, Roma and Travellers, and homeless people have worse physical and mental health outcomes compared with the general population.
- Deaths associated with pregnancy and birth have fallen since 2010, but deaths of women from ethnic minorities remain higher than of White women.
- Evidence shows regression in some health indicators for children. Childhood obesity and hospital admissions for malnutrition continue to rise, there is evidence of some decreasing vaccination rates, and new evidence shows that the UK has the highest rate of childhood asthma caused by air pollution in Europe.
- In August 2020, Public Health England found that the pandemic has replicated existing health inequalities and in some cases made them worse.
- The risk of dying from COVID-19 during the first wave of the pandemic was higher for older people, disabled people, ethnic minorities, and those living in deprived areas. The death rate among people with learning disabilities in England was estimated to be up to six times higher than that of the wider population.
- Though the Coronavirus Act 2020 enabled former healthcare professionals to return to work, medical staff, facilities and funding have been diverted during the pandemic to address COVID-19 critical care cases. The impact on other healthcare provision has particularly affected individuals sharing certain protected characteristics.
- In 2019–20 the Care Quality Commission assessed that, prior the pandemic, people in England received care that was ‘mostly of good quality’. However, there were persistent inequalities, including those affecting people from certain ethnic minority groups, disabled people, people from certain religious groups, and people whose preferred language is not English.
- Though a requirement was set out in National Guidance for NHS trusts in England to report on deaths that occur due to failures of care in their premises, the duty does not require collection of data by protected characteristic, which would help identify disproportionality.
- In 2019–20, 23% of cases raised with Freedom to Speak Up Guardians included an element of patient safety / quality, with 36% including an element of bullying and harassment.
- The shift towards more care being delivered via digital and telephone appointments during the pandemic has been received positively by many people. However, it has created accessibility barriers for those who are digitally excluded.
- The NHS Long Term Plan commits to improving outcomes across a number of clinical priorities. It is too early to assess its impact and disaggregated data will be required to demonstrate progress for protected characteristic groups.
Read more about the UK and Welsh Governments’ actions on health outcomes and experience in the healthcare system.