the LSBU Confucius Institute

NHS one size fits all approach is not fair for all

03 October 2023

The NHS should be fair for all, but it turns out its not. Poorer people, children and young people, and people with English as a second language are not receiving the same access to the NHS as other groups. This is despite the NHS increasing access in primary care and working flat out to respond to demand a report from the Institute of Health and Social are at London South Bank University (LSBU) has found. The report’s eight recommendations include a call for the NHS to look at what local healthcare needs actually are and make sure health services can be equally accessed – rather than focusing on meeting perceived demand or assuming that needs never change.

The ‘Universal Healthcare National Inquiry’ explored why some people have better access to the NHS than others, in ways that can’t be explained by how ill they are. It did so in partnership with two communities, plus local NHS, local government and voluntary sectors – in Sussex and Yorkshire – who are even now proving how the new approach would work.

This report shows that if you start with understanding need (not demand) and develop solutions with people and communities, you can secure change,” said Lord Victor Adebowale, Universal Healthcare Network

Report findings include:

  1. ‘One-size’ service does not fit for everyone. Providing the same service to everyone perpetuates existing inequalities. If the availability of GP appointments is increased, it benefits those who already access them more, and those who do not regularly use them benefit less.
  2. People whose first language is not English need extra support. These people find it harder to communicate their needs and advocate for their needs and ultimately find it harder to access services.
  3. The VCSE (voluntary, community and social enterprise) sector is crucial to build trust and reach out to communities, as well as meeting social need. By co-designing services with the sector, the NHS is able to build better services and respond to people’s social needs better.
  4. Children and young people are underserved, particularly in terms of mental health services. They don’t access as much care as they need and make fewer and shorter appointments. Where children and young people are actively involved in designing health services, outcomes are improved.
  5. Primary care in poorer communities is unequal and different. In deprived areas, there are fewer primary care professionals, making care hard to access. There tend to be lower screening levels, fewer planned hospital admissions and more emergency admissions, indicating that services are less preventative, despite these areas having greater health needs.

Professor Becky Malby, the inquiry leader and Professor at LSBU, said,

What we have found is that not everyone will get what they need because not everyone has the same resources to access the NHS, or the NHS services are were designed for a different time. When you have a one-size-fits-all NHS service, the only ones who are able to access it are those whom the one size suits. Offering more of the same, means those that already get, get more; and those that are struggling to access the NHS still struggle.”

Children and young people’s mental health

Children and young people’s need for mental health support has rapidly increased since Covid 19, and is staying high. The traditional model of services for children and young people just can’t meet this need, and is probably not the right solution.

The approach to funding for Primary Care was set many years ago when it was primarily older people who had complex needs and so the funding was weighted to age.

Nowadays it’s not just older people who need more support from a range of members of the team, the report found that young people also have complex needs, but the funding formula hasn’t kept pace with this change. This means practices in poorer communities, where there tend to be a younger community, also tend to get less funding from the core allocation than those in wealthier communities (which tends to have an older population).

Dr. Sohail Abbas, Deputy Medical Director and Health Inequalities Lead for West Yorkshire Health and Care Partnership, who led the universal healthcare inquiry in Bradford District and Craven welcomed the report findings and emphasised the importance of listening to people to truly understand their needs and developing equitable services, working alongside communities to meet those needs.

He said: "We must take a much broader, whole system and trauma informed approach when addressing health inequalities, rather than relying solely on medical assessments, especially when it comes to equitably meeting the diverse needs of our communities. Further discussions on these important report findings are planned for the West Yorkshire Clinical and Professional Forum in October. Our focus will be on addressing the recommendations of this inquiry alongside ongoing work, while developing a targeted approach to effectively address the findings, in collaboration with people and communities.

Recommendations from the report include:

  1. General Practice needs to be provided with the data on its own practice population’s health (not just illness) needs so that it can proactively design an appointment system that meets needs.
  2. Providing more quick GP appointments will not solve the problem, rather, the one-size-fits-all which actually increases inequalities and fails to meet needs.
  3. Children and young people are underserved in the community by the NHS. They get less than adults. The NHS needs to make sure funding and service provision is based on needs not age.
  4. Multidisciplinary teams need to be designed around known needs, for instance increasing mental health needs, or younger people who are ill because of their living conditions, not historic assumptions, which steers these teams primarily to older people.
  5. Remember how relationships were forged in the Covid vaccine programme. Rekindle these relationships and reach out to people who are not accessing the NHS.
  6. Sort data sharing so the community can help the NHS. There is a wealth of resources in communities and people are really willing to help.
  7. The NHS needs to make the problem of poverty visible to the public, so that the real costs of poverty (in terms of for instance impact on waiting lists) are understood.
  8. The NHS needs to collaborate with other sectors to help solve social circumstances that are generating ill health.
  9. The NHS needs to involve the community from the outset as it solves these problems.

“Everything in this report is doable from providing targeted continuity in general practice to meet need, to funding services fairly, to reaching out to easy to ignore communities,” said Lord Victor Adebowale.