NHS success in tackling health inequality varies hugely across England

Researchers find some clinical commissioning groups are much better at tackling health inequalities than others

The social divide in hospital admissions – which means far more poor people end up in hospital for preventable conditions than richer people – varies dramatically across England, researchers have found.

Data compiled by the University of York for NHS England revealed that the performance of a clinical commissioning group (CCG) in tackling the social divide in these preventable hospital admissions is not always linked to how rich or poor the CCG’s patient population is.

Liverpool clinical commissioning group, which appears on the worst performers list, and Tower Hamlets and Portsmouth CCGs, which appear on the best performers list, each serve some of the most deprived neighbourhoods in the country.

At the wealthy end of the scale, South Cheshire performs badly on inequalities, while East Surrey CCG performs well, appearing in the top 10.

Prof Richard Cookson, of the Centre for Health Economics (CHE) at York, led the team that helped devise the indicators for NHS England. “For the first time, you can now find out how fair your local NHS is, compared with similar local areas, in terms of tackling health inequalities between rich and poor,” he said.

“It’s not simply that Brexit-voting deprived areas do badly, and posh southern suburbs do well. Some deprived areas do well at tackling local health inequalities – such as Tower Hamlets, Stoke-on-Trent, Portsmouth – and some affluent areas do badly - such as South Cheshire and Windsor.” The information is available on a CCG website.

The indicators show how well a CCG is doing in reducing the inequalities that exist between the rich and poor in an area. Although poorer people are likely to have worse health than richer ones, local NHS efforts can reduce this.

“These emergency admissions are not just a barometer of wider social ills, but also an indicator of how well the NHS is succeeding in delivering out-of-hospital services to deprived patients with complex long-term conditions,” Cookson said. “This is important for NHS managers to know, because social inequalities in potentially avoidable emergency hospitalisation impose large and rising costs on the NHS, as well as raising important concerns about social justice.”

The work was funded by the National Institute of Health Research. Between April 2015 and April 2016, the York team found there were 264,000 preventable hospital admissions in England associated with socioeconomic inequality.

The best performing CCG was City and Hackney in London, followed by Fareham and Gosport, East Surrey, Crawley and the Isle of Wight. Tower Hamlets in London was seventh.

The worst performer was Central Manchester. North Manchester and South Manchester CCGs were also in the bottom five, as were Blackburn,Darwen and Islington.

Miqdad Asaria, the CHE’s lead analyst, said: “There is a social gradient in preventable emergencies meaning everyone, not just the poorest, is affected. The further down the gradient a person is, the greater the chances of suffering a preventable emergency hospitalisation.

“The NHS can now start producing our equity indicators on an up-to-date, annual basis to help improve the coordination of care and reduce preventable hospitalisation and mortality arising from social inequality.”

Ruth Passman, the deputy director for equality and heath inequalities for NHS England, said being able to compare the performance of the NHS around the country on the issue was of major importance.

“For the first time, NHS managers can now find out how well their local CCG area is doing in tackling these inequalities, compared with similar CCG areas, and see how these inequalities are responding to local healthcare initiatives,” she said. “This will help NHS managers learn about the best ways of reducing costly health emergencies associated with social deprivation.”

Islington CCG, which was the fifth most deprived borough in London, said: “There are areas of great and increasing affluence next door to neighbourhoods experiencing some of the most significant deprivation in the capital.”

It said it was working to improve the diagnosis and management of long-term conditions, keeping people in or close to their homes, and had set up programmes to identify people with complex needs who were at risk of ending up in A&E. It had made “significant and sustained progress on reducing inequalities in cardiovascular disease in recent years”, it said in a statement.

A statement from Manchester’s CCGs said: “Manchester has a lot of high-intensity pockets of deprivation. Other ‘norm’ areas, for example Trafford, will have extremes, ie, areas of affluence against areas of deprivation, which is normally shown in findings like this.

“The NHS results are not performance indicators – and the rankings are based on values. Manchester CCGs see that the tool is useful in highlighting inequality and will see it as an indicator of variables of the current picture – and will continue with their work, especially via the neighbourhood teams, to reduce health inequalities across Manchester.”

• This article was amended on 20 August 2016 to correct some inaccuracies in the headline and text.


Sarah Boseley Health editor

The GuardianTramp

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