Healthcare for all, when and where they need it
The NHS constitution says “The NHS belongs to the people.” but from what we’ve found the NHS belongs to some people more than others. As co-author of the Universal Healthcare National Inquiry, we identified that poorer people, children and young people, and people whose first language is not English don’t get the same access to NHS services as other people do. This is despite all the efforts of hard-working staff to increase access to primary care, and working flat out to respond to demand. Our recommendations call for the NHS to reconfigure itself around identifying and meeting people’s needs, and ensure that everyone can benefit from health and care services.
The Universal Healthcare National Inquiry explored why healthcare isn’t fair. We did so in partnership two communities, in Hastings and Bradford. We brought them together with the NHS, the local authority, and voluntary sector organisations. They’re proving now how the new approach would work.
This report shows that if you start with understanding need (not demand) and develop solutions with people and communities, you can secure change.
Lord Victor Adebowale, Universal Healthcare Network
Those who need healthcare most get the worst healthcare service
The idea that having your healthcare service open to everyone equally sounds fair, but actually it perpetuates existing inequalities. Combined with an attitude of “come to us, we won’t come to you”, this makes healthcare services inaccessible to some people with insecure jobs, low confidence, or who cannot afford transport.
We found that the way the NHS is funded means that poorer people have access to fewer GPs. In fact, the formula is biased so that richer areas of older people could receive more funding than poorer areas of younger people, even where the need for care is the same. Children and young people’s need for mental health support rapidly increased over the COVID-19 pandemic and has stayed high. Despite the number of young people being treated by CAMHS services doubling in East Sussex, waiting lists are still increasing. People whose first language is not English struggle to advocate for their needs. Without English, it becomes much harder for them to access healthcare services like GPs and pharmacies, and they require additional support.
The reason that these people get a worse service: poor people, young people, people whose first language is not English; is not because they’re hard to reach, it’s because they’re easy to ignore. They often lack political power and find it harder to advocate for themselves. As a result, when budgets are set, they aren’t top priority.
More appointments, and longer opening times aren’t going to solve the problem
When you have a one-size-fits-all NHS service, the only ones who are able to access it are those whom the one size suits. Offering more of the same, means those that already get, get more; and those that are struggling to access the NHS still struggle.
Prof. Becky Malby, Inquiry Leader
General practice is designed to address medical needs with medical solutions. So it becomes challenging when at least a quarter of appointments are notably driven by people’s social situations. When general practice is primarily required to offer ten minute appointments, if these aren’t appropriate for a patient, all the practice can do is offer is more 10 minute appointments! As a result some people don’t get their needs met, and they turn up persistently year-on-year. This can lead to just 3% of patients occupying a staggering 20% of appointments each year.
During the COVID-19 pandemic we found that certain easy to ignore communities were hesitant to receive the vaccine. Instead of giving up on them and applying that attitude of “come to us, we won’t come to you”, we instead reached out to those communities to listen to their concerns, build trust and to deliver services to people ‘where they are’. This tried and tested model can be used to ensure that primary care services are available for everyone.
We need to identify healthcare needs, then design and fund services to meet those needs
We must take a much broader, whole system and trauma informed approach when addressing health inequalities, rather than relying solely on medical assessments, especially when it comes to equitably meeting the diverse needs of our communities.
Dr. Sohail Abbas, Deputy Medical Director and Health Inequalities Lead for West Yorkshire Health and Care Partnership
Currently there is limited national data on primary care need, with existing data focussing on appointment access and patient satisfaction, and therefore providing only a partial view of demand. We are calling on ICBs to establish patient-level data, metrics and over-arching model to assess need accurately. And for them to do this in collaboration with communities, academics and primary care professionals. Asking communities “What matters to you?”, and really listening to the answer gathers meaningful qualitative data on their needs. It also fosters trust, and generates enthusiasm for them to be part of meeting these needs.
These needs are likely to include helping people with their social situations, and building trust with ‘easily ignored’ communities, as previously mentioned. And we need to collaborate with the VCSE sector and across the public sector to meet these needs. Finally, we also need to fund primary care based on need so that the those who need healthcare the most get their needs met. We will need to continue to review the level of need, and adapt the funding and service delivery to continue to keep pace with what people’s actual needs are, not just our assumptions about them.
Malby, B., Munson, R.O.A., Kordowicz, M., Boyle, D., 2023. The Universal Healthcare National Inquiry. London South Bank University, London.
