Access to care is a major barrier to good health and wellbeing
The link between poverty and ill-health is widely recognised. Recent research from the Institute for Public Policy and Research (IPPR) described “bad health black spots” where there was a direct correlation between deprivation and poor health.
So, a survey by Healthwatch England which has found that poorer people find it much harder to access NHS care when they are experiencing ill-health than those who are well-off and have a worse experience when they do get it, should concern everyone who is committed to reducing health inequality.
The survey found that 42 per cent of respondents who described their situation as ‘really struggling’ said they had trouble getting to see a GP, double the percentage of those who were ‘very comfortable’. The worst off also found it difficult to get NHS dental care - 38 per cent compared to 20 per cent. Accessing mental health treatment was difficult for 28 per cent of the very poor, compared to just nine per cent of the very comfortable. There was also a gap in A & E care, with 26 per cent of poorer people saying they found it hard to obtain compared with 19 per cent of those who were comfortable. Overall, 19 per cent of those on very low incomes reported difficulty accessing NHS care, compared to eight per cent of the well-off.
The experiences of the least well-off once they saw a health professional were also different to those who were financially comfortable. Twenty-one per cent of the really struggling felt they were not listened to by the last health professional they saw, compared to just seven per cent of the better-off. Twice as many poorer people felt that the person they saw last did not involve them in decisions about their care.
Poorer people can face challenges in taking unpaid time off work, the expense of travelling to appointments and the stigmatisation of poverty, all of which play their part in worse experiences of healthcare.
Although GPs’ increased workloads mean that many people find it difficult to access a doctor’s appointment, it is the poorest who are being disproportionately affected. Healthcare professionals also acknowledge that people from deprived backgrounds often need longer than the standard 10-minute GP appointment because of the impact of poverty on both their physical and mental health.
Breaking down these barriers to good health and wellbeing is crucial to levelling up health inequalities for a fairer – and more prosperous - society. That includes making sure that NHS services are accessible for everyone, especially the most vulnerable. It is the focus of all Purpose Health Coalition partners.
South Warwickshire University NHS Foundation Trust’s work is centred on addressing societal inequalities and changing behaviours in the communities it serves, spanning school years, post-16, working age and retirement. Its Stop Smoking in Pregnancy initiative, infant feeding service and nutrition programmes include opportunities for volunteers who can go on to take up permanent roles with the Trust. Its uses technology to deliver virtual outpatient activity and mental health support, developing initiatives to help the care and management of chronic conditions, including remote monitoring for patients with diabetes. Its partnership with Warwick Business School monitors the effectiveness of its innovations in care and assesses if they can be accessed equally by those from different backgrounds.
Kent and Medway NHS and Social Care Partnership Trust focuses on the mental care of its communities in one of the most deprived areas of the country. It recognises that digital inclusion and accessibility are key to reaching those people who need support the most. It has improved its website accessibility and provided digital resources to ensure that its services are available to everyone, regardless of ability or technology usage, to reach as wide an audience as possible. Its work with the Purpose Coalition has encouraged it to go even further, tracking and measuring its work and developing new strategic partnerships with other organisations that will benefit the local community.
As a rural hospital with a large catchment area, Airedale NHS Foundation Trust operates with a high degree of community engagement to deliver the quality of care that leads to healthier communities. It aims to develop a more personalised approach to care as part of its integrated and community offer that is available at the right time in the right place for all patients, focusing on self-care and prevention and ensuring that it meets its population’s needs.
Access to healthcare is one of the key social determinants of health. Being able to access NHS care when and where it is needed, and feeling that their voice is heard, is crucial for disadvantaged communities to facilitate the better health and wellbeing that will allow them to take advantage of opportunity. Poor access presents barriers that impact educational attainment, choice of job, earnings, financial stability and retirement age. That is a loss for the individual but also for the economy which can only grow effectively if it makes use of all the talent that exists across the country.