A new report has highlighted how choices made by NHS hospitals in response to COVID-19 have meant that disadvantaged and marginalised people in the UK will be facing worsening health inequalities.
People in the UK are facing worsening health inequalities as a result of the difficult choices made in response to the COVID-19 pandemic. The report, carried out by public health doctors and published in the Journal of the Royal Society of Medicine, notes that the restriction of non-urgent clinical services and the decline in emergency department attendances, will affect marginalised groups, disproportionately.
Emergency departments, which in March 2020 saw a 44% decline in attendances, are often used for routine care by vulnerable people, such as homeless people and migrants, who can find it difficult to access general practice and other community services.
Health inequalities in the UK
The report explores the nature of health inequalities relating to the response to COVID-19 by hospital trusts and suggests approaches to reduce them. The authors note the inequalities faced by contracted workers who may provide critical hospital functions, such as security, cleaning, portering and catering, and who are more likely to be migrants.
Currently, carbon monoxide screening of pregnant women has been suspended, which the authors cite as another major concern.
Lead author Sophie Coronini-Cronberg, consultant in public health at Chelsea and Westminster NHS Foundation Trust, said: “It remains vital that maternity services continue to ask women (and their partners) if they smoke or have recently quit, and continue to refer those who smoke for specialist cessation support.
“We encourage providers to provide alternative remote services, to ensure these are equitable and to promote these tenaciously.”
Protecting the most vulnerable
The authors also point to the problem of inaccurate baseline data for disease prevalence and progression which, for many conditions, can vary by ethnicity. The authors write that while ethnicity data are generally accurately captured for white British patients, for minority groups only 60-80% of hospital records capture ethnicity correctly.
Coronini-Cronberg said: “It is imperative that we rigorously capture baseline data so that we understand the impact of key risk factors on disease prognosis, including COVID-19. We risk reaching incorrect conclusions based on flawed data.”
The authors conclude: ‘The NHS has taken swift action to expand capacity and reorganise services to help ensure that health services can help with an influx of seriously ill COVID-19 patients. Difficult choices have been made, and some unintended consequences are inevitable. Policymakers, managers and clinicians should take pause during this phase to protect the most vulnerable groups in our society from negative unintended consequences and avoid worsening health inequalities.’