What happened to English NHS hospital activity during the Covid-19 pandemic?

What happened to English NHS hospital activity during the COVID-19 pandemic?
Institute of Fiscal Studies 13 May 2021

• This briefing note uses administrative hospital data from across the NHS in England to describe how the use of inpatient (elective and emergency) and outpatient hospital care in 2020 compared with that in the previous year. It shows how overall levels of care changed in the period after the start of the pandemic in March until the end of December 2020 and then examines how changes in activity varied across regions and clinical specialties. Finally it examines how these patterns differ across patient age, ethnicity and local area deprivation.

Socio-economic inequalities in access to planned hospital care: causes and consequences

Socio-economic inequalities in access to planned hospital care: causes and consequences
The Strategy Unit May 2021

• Analysis to explore the extent, causes and consequences of socio-economic inequalities in access to planned hospital care.

Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease

Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies
BMJ 2021; 373 :n604 doi:10.1136/bmj.n604

• Analysis of data from the US National Health and Nutrition Examination Survey and UK Biobank for association between socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) concludes that “ unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.”

Sociodemographic inequalities in patients' experiences of primary care between 2011 and 2017.

Sociodemographic inequalities in patients' experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017.
J Health Serv Res Policy. 2021 Jan 31:1355819620986814. doi: 10.1177/1355819620986814.

• Using data from the General Practice Patient Survey in England this study sought to trace variations in primary care experience over recent year. It considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience of primary care. It concludes that there have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

Considering health inequality impact in decision making: What does it mean for policy makers?

Considering health inequality impact in decision making: What does it mean for policy makers?
Centre for Health Economics 9 December 2020

• When making the decision about whether to fund a public health intervention, information on whether the intervention has different impacts on different population groups is important. However, economic evaluations that provide information on costs and health benefits in order to inform funding decisions do not tend to address whether impacts differ across population groups. This briefing showcases the value of capturing differences between socio-economic groups in the evaluation of how interventions impact on population overall health and health inequality.

Working together for a healthier post-Covid future

Working together for a healthier post-Covid future
The Strategy Unit October 2020

• This analysis, commissioned by the Healthier Futures Academy in the Black Country and West Birmingham, illustrates the effects that a Covid-driven recession could have on population health. Modelling undertaken by the Strategy Unit estimates that the socio-economic impacts alone could generate additional demand of up to 16% for physical health services and 27% for mental health services. It frames a discussion about how the NHS, with other local organisations, can more effectively address the causes as well as the effects of ill health.

COVID-19 and Inequalities: Levelling-up in our post-pandemic future

COVID-19 and Inequalities: Levelling-up in our post-pandemic future
NIHR 16 October 2020

• Recording of a one-hour seminar explores how existing health inequalities and social determinants of health are interacting with COVID-19 to create a Syndemic Pandemic effect – where we are witnessing closely intertwined and mutually enhancing health and social determinants combining to exacerbate the impact of COVID-19. 

Cancer in the UK 2020: Socio-economic deprivation

Cancer in the UK 2020: Socio-economic deprivation
Cancer Research UK September 2020

• This report examines the link between socio-economic deprivation and cancer. 
• “People from more deprived areas are not only more likely to get cancer, they’re more likely to be diagnosed at a late stage for certain cancer types, and have trouble accessing cancer services.“
• Full report here.

The economic influence of the NHS at the local level

The economic influence of the NHS at the local level
Kings Fund 16 January 2020

• This long read looks at the NHS’s role within the wider economy from several perspectives – the level of influence the NHS holds through employment and spending; the relative level of earnings in the NHS compared to the wider local economy; and the provision of training, skills and opportunity.

Social inequalities in multimorbidity, frailty, disability, and transitions to mortality

Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study
Lancet Public Health 1 January 2020, v5(1) PE42-E50

• Analysis of data from the Whitehall I study cohort, n=6425, concludes that socioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health.

Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018:

Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study
The Lancet Public Health December 05, 2019 DOI:https://doi.org/10.1016/S2468-2667(19)30219-1

• A cross-sectional study of 2·5 million premature deaths in England (2003-2018) found that one in three was attributable to neighbourhood deprivation measured by upstream determinants of health including income, employment, education, and crime.The biggest contributors were ischaemic heart disease , respiratory cancers and chronic obstructive pulmonary disease.
• See the tableaux map to explore the data at LA level.

Indices of Deprivation

Indices of Deprivation 2019
Ministry of Housing Communities and Local Government (MHCLG), 26 September 2019

• The Indices provide deprivation scores for each LSOA (including parliamentary constituencies, combined authorities and CCGs) in England and are calculated from thirty-nine indicators grouped under seven different domains or themes, each measuring a different type of deprivation. There are also supplementary indices concerned with income deprivation among children (IDACI) and older people (IDAOPI).
• Easy access to the data (tailored reports etc) is available in LG Inform Plus - free registration is required for full access.

Recent trends in mortality in England: review and data packs

Recent trends in mortality in England: review and data packs
PHE 11 December 2018
A report on recent trends in life expectancy and mortality in England.

• After decades of progress, since 2011 improvement in age-standardised mortality rates and life expectancy has slowed down considerably, for both males and females. For some age groups, and for some parts of England, improvement has stopped altogether. 
• Inequality in life expectancy has widened, and there has been a slowdown in improvement in mortality from heart disease and stroke – 2 leading causes of death. 
• A number of other factors, operating simultaneously, have also potentially contributed to the slowdown in life expectancy.  These include:
• a large increase in deaths in the winters 
• more older people living with dementia and other long-term conditions, 
• an increase in death rates from accidental poisoning, in particular, drug misuse.

Prevention is better than cure: Vision for prevention

Prevention is better than cure: our vision to help you live well for longer
DHSC 5 November 2018

• The document sets out the government’s vision for:
• stopping health problems from arising in the first place
• supporting people to manage their health problems when they do arise
• The goal is to improve healthy life expectancy by at least 5 extra years, by 2035, and to close the gap between the richest and poorest.
• A collection of case studies has been published, showing examples of good practice in preventing health problems from happening.

Read Matt Hancock's speech to the International Association of National Public Health Institutes (IANPHI) when he launched the policy.

Changes in health in the countries of the UK

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
The Lancet 24 October 2018 DOI:https://doi.org/10.1016/S0140-6736(18)32207-4

• This research analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation across the UK.
• Read the response from PHE: How local Global Burden of Disease data can help shift the focus for the NHS

Digital patients: myth and reality

Digital patients: myth and reality
Nuffield Trust 10 September 2018

• A look at five common claims about the use of digital services in the NHS concludes that those likely to continue to have low digital access are people over 75, carers, those over 55 in lower social grades, and people with dementia, stroke and learning disabilities. 
• The five issues are:  
• Older people don’t use technology
• Digital services are less accessible to people with complex health needs
• Socially excluded people are also digitally excluded
• Ethnic groups are digitally excluded
• Internet access is worse in rural areas

Health care costs in the English NHS

Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group
IN Unit Costs of Health and Social Care 2017 p16-21

• This paper describes average health care costs calculated by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12. The results presented can be used when estimating future health care costs and to illustrate how NHS spending is distributed across different subgroups within the population.

The effects of environmental factors on the efficiency of CCGs

The Effects of Environmental Factors on the Efficiency of Clinical Commissioning Groups in England: A Data Envelopment Analysis
Journal of Medical Systems 2017, 41:97

• The performance of CCGs may also be confounded by environmental factors such as deprivation, population size and burden of disease. This study estimates the technical efficiency of 208 CCGs in England using Data Envelopment Analysis (DEA), a linear programming technique that can be used to measure the relative efficiency of a given set of organisations. 
• The inputs and outputs used include budget allocation, number of general practitioners, mortality rates, patient satisfaction and QOF scores. 
• Three environmental factors were statistically significant predictors of efficiency: CCGs with smaller population sizes were more efficient than those with larger ones, while high unemployment rates and a high prevalence of chronic obstructive pulmonary disease led to a decrease in efficiency scores. 
• Comparative deprivation was not a significant predictor of efficiency.

Health care costs in the English NHS

Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group
Centre for Health Economics Research Paper 147, University of York, 22 April 2017

• This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12. 
• The results can be used to estimate future health care costs.

The geography of local authority funded social care

National standards, local risks: the geography of local authority funded social care, 2009–10 to 2015–16
Institute of Fiscal Studies, 5 April 2017

• Analysis of the level of LA social care spending per adult around England in 2015–16, and the extent to which these spending differences correlated with local demographic and socio-economic characteristics, and a description of how social care is organised and funded in England.