Read: Equality of access must apply to NHS waiting lists

We know that during Covid many people from the UK’s more disadvantaged communities were hit hardest. And we are now seeing those same communities being further disadvantaged on NHS waiting lists. 

There are currently 5.6 million people waiting for NHS treatment, with some estimates suggesting that the backlog could increase to as many as 13 million over the coming months. Waiting lists in some areas have increased by as much as 90% between April 2020 and July 2021 while others increased by less than 10%. While this does show that referral routes are working – people are coming forward who may not have done so before - new research shows it is those people in the most deprived parts of England who are likely to have to wait longer for their treatment.

A report by the King’s Fund has found that a person living in one of the least advantaged areas is nearly twice as likely to have to wait more than a year - over 7% in the country’s poorest areas, compared to just 4% in more affluent areas. On average, waiting lists have grown by more than half in the most deprived areas, compared to a third in the least deprived.

People living in those communities already tend to have greater healthcare needs and poorer health outcomes. That pattern of health inequality was clear during the pandemic, with those from areas of most deprivation suffering from higher infection and mortality rates than the rest of the country. Before the pandemic, 9 out of 10 people were waiting fewer than 25 weeks in England, but that has now risen to 44 weeks. The impact of those longer waiting times has profound implications on health. A poll by Healthwatch England has found that more than half of adults whose treatment had been delayed, said that the delay had affected their physical and mental health; and almost half said it affected their ability to work, impacting the financial and economic security of individuals and the communities in which they live.

But some NHS organisations have bucked the trend. Through collaboration and with prioritisation of those groups where the need is the greatest, these organisations have been able to limit the number of people waiting more than a year, even in areas that are more deprived. It reinforces what the Purpose Coalition has seen in its work with NHS Trusts and with health providers such as Virgin Care. Strong partnerships with local stakeholders together with the support of their local communities is crucial, not only in healthcare but in areas such as education and employment. 

Different parts of the country face different challenges and a range of tailored solutions will be needed to help address the specific inequalities faced. Although a clichéd phrase, there is no one-size-fits-all approach. The solutions that work are those that take into account local factors. Local health services need to be given the power to operate based on their knowledge and experience of their local communities.   

A poll from Ipsos Mori showed that the public’s top priority for the NHS is improved waiting times. The Government’s recently published Plan for Health and Social Care, endorsed by the Prime Minister in his conference speech last week, has pledged £36 billion over the next three years to provide what it calls ‘the biggest catch-up programme in the history of the NHS’. Crucially this includes a commitment to offer more appointments, treatments and operations, with an increase to 110% of planned activity levels by 2023/24. A reduction in waiting times is a key ambition for the Government, and a crucial element of levelling up.

Governments are judged not on what they say but on what they do and what they achieve. The original architects of the NHS wanted healthcare to be available to all, not just those who could afford it. And it will only be when we see better and sustained health outcomes for the least privileged, that we will also see that ambition realised, with equality of opportunity for all.