NHS’s ‘inclusive approach’ to tackling waiting lists failing deprived communities

People from the most deprived areas in England are up to twice as likely to wait for more than a year for elective care as people who lived in the most affluent areas, according to a report from the King’s Fund.

This is despite an NHS target that was bought in after the first wave of the Covid-19 pandemic which aimed to take an ‘inclusive approach’ to waiting lists by disaggregating waiting times by ethnicity and deprivation.

The report found 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.

The King’s Fund is now warning that these inequalities could become further entrenched unless the government makes a firm commitment to taking a more inclusive approach to tackling hospital waiting lists.

An inclusive approach to elective care waiting times ‘not yet embedded’ within NHS organisations

Over the past year, the King’s Fund gathered data from three in-depth case studies and a review of board reports from 13 NHS trusts and their related integrated care boards.

The think tank looked at whether the NHS’s policy to reduce regional disparities in waiting times has been successfully implemented, and interviewed a range of people about using artificial intelligence (AI) to help prioritise care.

The report suggests that an inclusive recovery is not yet embedded within NHS organisations and there has been a lack of clear vision from national leaders as to why inclusive recovery is important for delivering better and fairer services for patients and the public.

While there were examples of effective interventions that offered support to waiters, prioritised patients for treatment, and made appointments easier to attend, there was a lack of overall progress.

Reasons for the lack of progress included:

• a lack of clarity about the case for change
• operational challenges such as poor data
• cultural issues including different views about a fair approach
• a lack of accountability for the inclusive part of elective recovery.

An approach which only considers clinical need risks widening inequalities

The report found that in August 2022, people in the most deprived areas were 2.1 times more likely to wait more than a year for elective care.

The researchers say this may be because appointments can be more difficult to attend if you cannot to time off work and do not have a car or access to public transport, and that people who find it difficult to articulate a health concern and advocate for treatment may find the NHS difficult to navigate.

People in deprived areas are also more likely to reach the waiting list in worse health states, and are more likely to deteriorate quicker and develop more conditions while they wait.

The King’s Fund says an approach to managing waiting lists which is solely based on treating people with clinical needs “risks missing other factors which might widen inequalities.”

A failure to prioritise equality, diversity and inclusion training

NHS leaders say the report highlights why equality, diversity and inclusion work is so important, despite the government suggesting that it should be deprioritised.

Matthew Taylor, chief executive of the NHS Confederation says there seems to have been a “failure to prioritise” this work by the government, with Steve Barclay announcing last month that NHS organisations should stop using external providers to carry out EDI training.

Taylor says the findings “serve to highlight why EDI roles are so important, and everyone should have equitable access to care.”

Addressing inequalities is good for patients, communities and the NHS

The authors of the report are now calling 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.

Ruth Robertson, Senior Fellow at The King’s Fund, 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 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. An inclusive approach should be embedded at the heart of any future plans for 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.”