Healthwatch England report: Faster progress needed to tackle barriers to care

The report examines ten key areas of care, including GPs, dentists, hospitals and social care, based on the experiences of 65,000 patients.

While much of the support the NHS provides is good, the research has found accessing this support in the first place remains the biggest challenge people face.

The public's perspective: The state of health and social care highlights the following:

• barriers and delays to timely care affect nearly every part of the NHS and social care system;
• and when combined with issues such as the cost of living, this situation risks widening existing health inequalities.

For example, people in deprived areas wait longer for some care than those in affluent areas. Financially struggling individuals often avoid healthcare due to additional costs like travel. And many people are turning to private dental care due to a lack of access to NHS dentists.

In order to further explore access discrepancies between better-off people and those on lower incomes, Healthwatch England commissioned a poll looking at the use of private care today.

Key findings

• People who are more financially comfortable were much more likely to be able to access free or discounted private GP appointments through their work than those who were less financially comfortable. 
• People in better jobs/financial positions were much more likely to access health-related workplace perks and healthy living perks. ​
• Some, particularly young people, were advised to consider paying for private care by NHS staff. 

What people told Healthwatch England

The poll conducted by Savanta on 24 and 25 September with 1,758 adults living in England from a nationally representative sample of the UK, highlights the following:

People in better-paid jobs are more likely to have private care provided through work

People with higher incomes are more likely to have work-based or private health insurance, free or discounted access to private healthcare, and healthy living perks than those with lower incomes.

• Two in five (40%) of employed people describing their financial status as 'very comfortable' have access to free or discounted private GP appointments through their place of work. 
• This compared to 16% who described themselves as 'quite comfortable', and around 10% as 'just getting by' and 'really struggling'. 
• Private GP appointments through work are available to a third, 33%, of the highest earners (those earning over £76k), compared to just one in 25, four per cent, of those earning up to £21k. ​
• Private mental health appointments through work are available to 23% of the highest earners (those earning over £76k) compared to just 3.5% of those earning up to £21k. ​
• Private physiotherapy appointments through work are available to one in eight, 13%, of the highest earners (those earning over £76k) compared to just one per cent of those earning up to £21k.

People turn to private care when unable to get NHS treatment

Nearly a third (28%) of all the respondents said they had accessed private healthcare in the last year (either private health or dental care).

The most common reasons given for accessing private healthcare were: 

• people felt they'd receive better quality care (37%) 
• the waiting list was too long (34%)
• they paid for a procedure available on the NHS but not in their region (22%).

One in five (18%) of those who hadn't used private healthcare in the last year had considered doing so. ​The most common reasons given for considering private healthcare were: 

• Over half, 52%, of the respondents felt they might receive better quality care.
• Over a third, 34%, said there was a long waiting list on the NHS; and 15% said the service they wanted wasn't available on the NHS.

Some people are being signposted to go private

One in seven (14%) of the respondents reported that an NHS professional had advised them to consider paying for a private health service in the last year.

The largest group advised to go private were young people below 30 years. We know this group is already more likely to avoid accessing NHS services, such as dentists and GPs, due to associated costs and travel fares.

Louise Ansari, CEO at Healthwatch England, said: "With access to NHS care remaining the most significant challenge people report to us nationwide, we're seeing a two-tier system emerge where access to healthcare services is often available faster to those with money to pay for it.

"Our polling shows, for example, that people who are more financially comfortable are much more likely to be able to access free or discounted private GP appointments through their work than those who are less financially comfortable. We are also concerned that one in seven people who answered our poll said they have been advised to consider paying for a private health service by NHS professionals, which many cannot afford.

"We know that many people, especially those on lower incomes, disabled people, carers and younger people, face real challenges accessing care and if they can access services, they sometimes choose not to attend GP or dental appointments or buy prescription medications to avoid extra costs."

Two-tier health system 

Healthwatch is seeing a two-tier system emerge, where healthcare services are accessible only to those who can afford it. The ongoing struggles to access care are deepening the existing health inequalities while putting the lives of many people at risk.

There's a body of research showing that people who live in deprived areas face ongoing challenges in accessing care and have poorer health outcomes. 

According to the Office for National Statistics (ONS) data, GP practices in the most deprived areas have around 300 more patients per fully qualified doctors compared to the least deprived areas.  

Healthwatch England's research on the cost of living earlier this year showed people struggling financially or who received income from benefits, and young people were more likely to avoid going to the dentist, attending/ travelling to a GP appointment or buying over-the-counter medication.

Healthwatch England want to see a health and care system that works for everyone and have issued calls to action setting out immediate solutions for the NHSE, commissioners and service providers.

While healthcare leaders have recognised growing health inequalities and have taken some action to tackle access issues, faster progress is needed with national recovery plans, and a greater focus on ending inconsistent experiences across different areas and demographics.

1. Improve access for the most vulnerable by ensuring that:

• Commissioners and providers take all opportunities to provide early or ongoing support through additional staff roles, including mental health practitioners, peer support workers, and school-based teams. 
• The NHS covers transport and accommodation costs where patients choose to travel for quicker treatment at another setting
• Better signposting to support services, including voluntary organisations and services that support unpaid carers.

2. Improve patient communications by ensuring that:

• There are improvements to online referral trackers, so people waiting for care know what is happening with their care. 
• More proactive NHS communications with patients while they wait for treatment.
• Single points of contact, either in person, over the phone, or via the NHS app, so patients waiting for care can give feedback about issues or changes in their condition.