New evidence finds no improvement in health care inequality across England and Wales

A new study has revealed that people living in the most deprived areas were nearly two and a half times more likely to need a hip replacement but far less likely to receive the treatment than their more affluent counterparts.

The research included analysis of the number of hip replacement procedures carried out for patients aged 50 years and over in England and Wales between 2002 and 2018, which more than doubled from 47,971 to 117,726 during that time.

The research and analysis for Wales was undertaken by Senior Research Officer & Statistician, Rowena Bailey of the Health Data Research (HDR) UK centre at Population Data Science, and used individual-level, population-scale, anonymised data from the SAIL Databank.

The study was conducted in partnership with NHS Midlands & Lancashire Commissioning Support Unit, Health Economics Bristol at University of Bristol, The Royal Orthopaedic Hospital NHS Foundation Trust and was funded by HDR UK.

The researchers found no evidence that these substantial inequities had reduced between 2006 and 2016. This would suggest that with respect to hip-replacement surgery in England and Wales, policy ambitions to reduce healthcare inequities have not been realised.

The research has been published here in the Lancet –

In an article published by The Strategy Unit, lead author, Steven Wyatt, commented on potential solutions toward fairer health care delivery.

Inequalities in access to healthcare – what’s our next move?

Last year marked the 50th anniversary of Julian Tudor Hart’s famous Lancet paper, The Inverse Care Law. The law states that “the availability of good medical or social care tends to vary inversely with the need of the population served”.[i] Tudor Hart pointed out that these effects were most strongly expressed when access to health care is dictated by an individual’s ability to pay, but that it is present even in fully insured systems such as the NHS. Perhaps one of the most rigorous demonstrations of this effect, was published 40 years later in the BMJ.[ii] Andy Judge and colleagues showed that having adjusted for need, people living in the least deprived parts of England in 2002 were more than three times as likely to receive an NHS-funded hip replacement than their counterparts living in the most deprived areas.

Successive governments have pledged to reduce inequalities in health and inequities in access to health services. So, we might expect that the inequities, highlighted by Judge, would have been addressed or at least moderated in the intervening period. In our recent publication in the Lancet (Regional Health Europe), a collaboration with colleagues from the Royal Orthopaedic Hospital NHS Foundation Trust, and the universities of Swansea and Bristol, we explored whether inequities in access to NHS-funded hip replacements improved between 2006 and 2016.[iii] We found no evidence that these substantial inequities had improved in either England or Wales. 

This is just one analysis, but the evidence of persistent inequities in access to healthcare is overwhelming. Indeed, some papers have suggested that access to NHS services became even more inequitable during the pandemic.[iv] Perhaps the time has come to adopt more potent and direct strategies to address this issue. Should, for example, payment mechanisms be aligned with our policy objectives, so that providers working with under-supplied populations receive higher payments? Perhaps access to funds to tackle the growing waiting list should be dependent on reducing inequities. Whatever we choose to do, we can be fairly sure that continuing with existing approaches alone, is unlikely to bring about the change that’s needed.