Why funding boosts for hospitals won’t help health inequalities

The Labour Party Manifesto 2024 committed to reducing health inequalities with goals to halve life expectancy gaps between the richest and poorest, modernise discriminatory mental health legislation and make progress closing the Black and Asian maternal mortality gap. These goals seek to address short and long term impacts of health inequalities, and yet Labour’s recent budget seems to prioritise reacting to immediate crises over addressing the causes of inequalities.

Rachel Reeves committed ￡22.6 billion to the NHS day-to-day spending budget, earmarked to help reduce the hospital elective care waiting lists. And a ￡3.1 billion top up for NHS capital spending was announced, allocated to new surgical hubs, increased diagnostic capacity and tackling the most unsafe hospital buildings.

Such a large cash injection is seen by many sector leaders as being necessary to keep the NHS on its feet. Yet nearly all the funding allocations pertain to secondary care provision. There was a comparative lack of attention to primary care, social care and public health, with only ￡100 million specifically allocated to GPs and ￡600 million to social care. In addition, it appears most GP practices, hospices and some care home providers will not be exempt from increased employer National Insurance contributions which will hit these providers hard. The lack of support for these fundamental pillars of health will not only undermine the Government’s goal to shift healthcare from sickness to prevention, but could contribute to a further widening of health inequalities in England.

Health inequalities are impacting health outcomes now. In maternity care, Black women have an almost three times higher mortality rate during and after pregnancy, compared to White women and Asian women have an almost two times higher mortality rate. Additionally, Black mothers are four times more likely to die during a childbirth with complications than White mothers.

Ethnic minority patients experience poor access to mental health support and harsher treatment in residential mental health settings. Ethnic minority patients are less likely to be referred by their GPs for talking therapies when presenting with the same symptoms as White patients. This is true for ethnic minority children too, seen especially severely for Black children. Black children are almost 10 times more likely than White children to be referred to NHS children’s mental health services through involuntary routes like social services, instead of via the voluntary and quicker GP referral route. A high incidence of such involuntary referrals indicates the presence of barriers that prevent access to GP referrals.

Further inequalities are seen in outcomes for ethnic minority patients across many other measures, for example in sexual health, strokes, hypertension, diabetes and obesity. And unequal outcomes similarly abound across differences in socioeconomic deprivation.

Addressing health inequalities has long been a stated high-priority matter for the NHS. Yet measures targeting these issues have had limited success. The Government should now take the opportunity for a rethink.

A fundamental cause of health inequalities is well evidenced institutional racism recognised by the NHS itself, with detrimental consequences for ethnic minority NHS staff as well as patient outcomes. A comprehensive programme of anti-racism training is advocated to begin tackling this.

Additionally, many of these outcome inequalities can be improved by primary care. Resource allocation across health and care services should thus be reconsidered. Many of the health conditions more prevalent in ethnic minority and socioeconomically deprived patients are conditions typically managed by primary and community care services. These services are under prioritised compared to hospitals in England, despite the fact that effectively managing these conditions outside of hospital settings produces better health outcomes and is less costly for the NHS.

Rachel Reeves’ budget continued the prioritisation of hospital care. If Labour maintain this approach, it is possible that these funding choices will facilitate the continuation of current trends — with persistent prioritisation of hospital care and inconsistent provision of primary and community care across England — and could contribute to widening of health inequalities. A rethink of policy and resource allocation is crucial.