People from Asian ethnic groups experienced a much larger fall in planned hospital care during the pandemic than those from white, black, or mixed ethnic groups, according to an analysis by the Nuffield Trust and the NHS Race and Health Observatory.1
A 3.7 million drop in planned hospital procedures were reported over the pandemic’s first two years, and this worsened existing disparities in care, analysts said. They estimated that people from Asian ethnic backgrounds have missed out on more than 23 000 procedures compared with their white counterparts.
The research looked at variation in treatment rates for routine hospital care both before and during the covid-19 pandemic. It found that before the pandemic, the white group had higher rates of planned hospital procedures overall, when compared with black, mixed, and Asian groups, with the white group having almost a fifth (18%) more procedures per person than the Asian group. However, 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 procedure rates fell in all groups but that the drop was not even across ethnicities. 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 also saw a decline, and although smaller when compared with the 2020 drop, the differences between ethnic groups remained, with the Asian group missing the equivalent of over 6000 procedures, the report said.
Looking at specific procedures, 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.
No single causeThe report said that the variation in care was not driven by a single cause, but is likely to be because of several factors, including epidemiology, deprivation, 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.”
Commenting on the findings, NHS Race and Health Observatory director Habib Naqvi said that the government must now uphold its pledge to “deliver on the NHS” by tackling the backlog as 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. 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,” he said.
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