Why poverty is one of the biggest challenges for NHS

Tackling poverty "must be as much of a priority as bringing down waiting lists" when it comes to getting the NHS back on track.

That was the message this week as the King's Fund think tank and the Joseph Rowntree Foundation published a joint report on health inequalities.

One of the key findings was that people living in the poorest areas were twice as likely to turn up at A&E compared to those in the wealthiest areas, with a lack of GP access often blamed.

Among those who took part in the study, 8% of respondents in the most deprived postcodes said they had gone to A&E after struggling to get a GP appointment compared to just 1% of those in the most affluent communities.

The analysis was mostly based on data from NHS England, but there are clear parallels here in Scotland which demonstrate how far closing the gap between rich and poor would go to creating a more sustainable health service.

A&E

According to Public Health Scotland, individuals living in the most deprived areas of Scotland "account for more than twice as many attendances [at A&E] as those from the least deprived areas".

In January – the most recent month for which full data is available – that was a difference of 32,052 attendances compared to 16,430.

There are many reasons why people in the poorest areas will be more likely to end up in A&E: rates of violent crime, drug overdoses, suicides, and road traffic accidents are all substantially higher.

Figures published on Tuesday show that, in 2022/23, the rate of hospital stays for alcohol-related conditions was seven times higher in the most deprived areas, compared to the least.

People living in poorer areas are also much less likely to take up cancer screening, and in turn much more likely to be diagnosed at a late stage – for example when they present with symptoms at A&E.

On March 12, a new medical advocacy and research group – Emergency Medicine at the Deep End – was formed specifically to raise awareness about the extent to which health inequalities are feeding into A&E pressures.

As one member of the group – a Scotland-based emergency medicine consultant – noted: "The biggest factor creating workload for [emergency departments] and misery for patients is inequality... to reduce 'demand' (actually unmet need) in healthcare we need to reduce inequalities."

But how big a problem is lack of GP access?

General practice

Access to GPs is not evenly distributed. In fact, people living in the most deprived areas have fewer GPs per head despite living with a far higher burden of chronic disease.

Rates of obesity, diabetes, and smoking are all much higher in more deprived communities, but research shows that GPs spend comparatively less time dealing with these patients than they would if their practice was located in a wealthier postcode.

One recent study, led by Glasgow University, found that patients living with three or four long-term health conditions in the more deprived half of Scotland spent 28 minutes less on average with their GP over a three-year period compared to patients with the same number of conditions in the more affluent half.

Read more:

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This reflects the fact that the ratio of GPs to the number of patients living with multiple chronic ailments is so much lower in deprived areas. Had the analysis been re-run specifically to compare the most deprived 20% of postcodes to the least deprived 20%, it is likely that the disparity would be even greater.

It is also worth noting that the study period covered 2013 to 2016, long before the impact of the pandemic accelerated both a real-terms decline in the GP workforce and a rise in remote consultations – something that the King's Fund notes will impact more negatively on poorer patients who are less likely to have home internet.

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It adds: "If people cannot access the services they need when they need them, they may either access other NHS services (there is a strong correlation between deprivation and patients reporting that they used other NHS services as they had problems making an appointment with a GP), or they may get sicker and need more costly services."