Asians had biggest fall in UK elective care

UK: Patients from ethnic Asian backgrounds experienced a significantly larger drop in planned hospital care during the pandemic than those from other racial groups, according to an analysis by the Nuffield Trust and the NHS Race and Health Observatory.

The publicly funded National Health Service (NHS) is one of the four National Health Service systems in the United Kingdom. The NHS Race & Health Observatory works to identify and tackle ethnic inequalities in health and care through facilitating research and making health policy recommendations.

Worsening disparities in care

The healthcare organisations estimated that ethnic Asians missed out on more than 23,000 procedures as compared with their white counterparts. According to the analysts, a 3.7 million drop in hospital-based elective care procedures was reported over the pandemic’s first two years, and this worsened existing disparities in care.

Studying the variation in treatment rates for routine hospital care both before and during the covid-19 pandemic, they found that before the pandemic, the Caucasian group had higher rates of planned hospital procedures overall, when compared with black, mixed, and Asian groups. The Caucasian group had almost a fifth (18%) more procedures per person than the Asian group.

Analysis between treatment procedures

Measured by treatment categories, cardiac and cataract procedure rates were highest in the Asian group and dental procedure rates were highest in the black group.

During the first year of the pandemic, the analysis found that people from Asian ethnic backgrounds experienced a fall of 49%, while white and black groups saw a 44% drop — equivalent to 17 000 missed procedures.

The second year of the pandemic saw a smaller decline, however, the disparity between ethnic groups remained, with the Asian group missing the equivalent of over 6000 procedures, the report said.

The largest variation was seen in cardiac care, where therapeutic cardiac procedures fell by 45% for the Asian group, 35% for the black group, and 28% for the white group.

Complex picture with limited understanding

According to the analysts, the variation in care was driven by multiple factors, including deprivation, epidemiology, trust in health services and the government, and the rapid shift to digital care which can shut out people who lack the digital or language skills to engage.

“Some [of the variation] must surely be a reflection of institutionalised and structural racism across society,” the report added. “But much of what lies behind this variation needs more analysis.

“Inconsistent, incorrect, and incomplete coding of ethnicity in health records means that our understanding of this complex picture is limited. Patchy data means that the NHS is flying blind in its attempts to meet this legal and moral obligation.”

Elective care backlog needs to be tackled

On the findings, NHS Race and Health Observatory director Habib Naqvi commented that tackling the backlog should be a priority.

“Inequalities in elective care recovery will not only impact people’s lives, but will also have detrimental financial consequences for the NHS in the long term,” he said. 

“Analysing how treatment differs between ethnic and socioeconomic groups needs to be a first step in understanding why variations exist and is key to identifying potential solutions.”