Addressing disparities in patient outcomes post-COVID

The COVID-19 pandemic brought significant disruption to the healthcare service. Specifically, we have seen major disruptions and changes in patient pathways, which has led to deteriorating outcomes for cancer patients across NHSE Trusts.

We are beginning to see disparities in the health services and health outcomes amongst those from the most deprived populations. Those from underserved populations may be more likely to experience delays in diagnosis, treatment and follow-up care due to varying factors, including limited access to healthcare resources, financial constraints, and difficulties in navigating the healthcare system. Difficulties accessing timely healthcare interventions may be contributing to the increased volume of non-elective (emergency) presentations. Non-elective admissions of cancer patients who are presenting to seek treatment for their cancer often indicate a more advanced stage of the disease, and have been linked to high mortality rates.

Following the recovery period of the COVID-19 pandemic, we have seen increases in the volume of elective and non-elective activity for patients presenting with cancer. Figure 1 shows that the total volume of elective activity has steadily increased since 2021-Q1. Figure 2, however, reveals that the volume of non-elective activity has fluctuated since the COVID-19 pandemic. The latest data period, 2023-Q2, shows an increase in volume of non-elective activity following a period of decline.

Significantly, we can see a striking disparity in the volume of activity across both admission types between ‘Q1 Least Deprived’ and ‘Q5 Most Deprived’ groups:

In national (acute, non-specialist) Trust’s, we can see that cancer patients from the most deprived populations have fewer hospital attendances. Cancer patients classified as ‘Q1 Least Deprived’ constitute a higher proportion of the total volume of activity to NHSE Trusts. This group are also presenting more frequently than in the pre-pandemic period. Since the recovery period of the COVID-19 pandemic, the gap between the volume of activity when comparing the two deprivation quintiles has widened, with the greatest difference noted in the most recent quarter (2023-Q2). Figure 3 records that 98,635 elective admissions were made by Q1 patients (making up 65.63% of elective admissions), whereas 51,655 admissions were made by Q5 patients (just 34.37% of elective admissions). Likewise, Figure 4 records that 7010 non-elective admissions were made by Q1 patients (56.83%), in comparison to 5325 non-elective admissions made by Q5 patients (43.17%).

Concerningly, we continue to see a notable disparity between patients’ mortality outcomes across the Q1 and Q5 populations:

The figures above display crude (mortality) rates for both Q1 and Q5 cancer patients, for elective and non-elective admissions. Where previously we could see that least deprived (Q1) populations constituted a higher percentage of admissions (see figures 3 & 4), we see that nationally, the most deprived (Q5) cancer patients have higher crude mortality rates. We are observing the biggest disparities in mortality outcomes in the most recent post pandemic periods. Most notably, we can see the biggest discrepancy in non-elective admissions. The largest variance between Q1 and Q5 groups can be found during the 2022-Q4 data period of non-elective admissions, which records a 3.06% difference in mortality rate. Comparatively, the average difference across each quarter is 0.74%.

The top 5 NHSE ICB’s with the highest crude rate for Q5 cancer populations are ranked below (ordered by highest):

Moving forward, targeted interventions need to be made to address the disparities in the patient outcomes of those from the most underserved populations. This calls for a collective effort from policymakers, government officials and health professionals to ensure a comprehensive healthcare service for all.

This work uses data provided by patients and collected by the NHS as part of their care and support

Author: Cerys Naden, Support and Insight Executive, Telstra Health UK