By Sarah Woolnough, Chief Executive at The King’s Fund
One of the founding principles of the NHS is that it is free at the point of use, yet our analysis shows the cruel irony that many people living in poverty find it harder than others to access the timely care that could help them better manage their health conditions and prevent future illness.
The recent rise in deep poverty, cost-of-living increases and high pressure on NHS services are all worsening the problem.
There are two sides to this lack of access: barriers that prevent people seeking treatment and a lack of resources to provide this treatment. This lack of resources shows up as the inverse care law – that those who most need medical care are least likely to receive it: waiting longer for treatment, lower uptake of preventative services, poorer outcomes and experience of care.
In terms of barriers, the cost-of-living crisis is worsening the issue. In 2023, 8% of lower-income adults reported not getting prescriptions or other medicines because they were unable to afford it, and 19% reported skipping essential dental care.
The NHS often focuses on the demand for its services and who does come through its doors. A worrying human consequence of poverty is ‘unmet need’: from people not accessing care at all, or until much later in the development of illness.
“[Over-presenting] that’s the bit we talk about, I’m equally worried about the other end of it, which is nobody presents, either because they can’t, because to be honest they’re on £8 a week, they can’t get to services, or because they think they’ll be dismissed.” – Chief executive, NHS trust
NHS systems and administration can be more challenging to navigate when experiencing poverty. Our recent report on patient administration in the NHS found that the burden of poor admin does not fall equally: 47% of people struggling financially say that the NHS is poor at keeping them informed about what is happening with their care and treatment, compared to 29% of those who report to be financially comfortable.
The stigma and shame that surrounds poverty stops people seeking the support they need and accessing services they are entitled to, being open about their lives and establishing trusted relationships – one of the key elements of high-quality care.
“For a lot of people living, particularly in intergenerational poverty, there’s no expectation that public services will be any good or understand this space. It’s kind of wired in that you’ll be useless.” – Chief executive, NHS trust
Poverty is a complex problem that will affect different groups in different ways. For example, NHS staff are also affected directly by poverty and through treating patients who are experiencing the effects of poverty.
While the causes of poverty are often driven by causes outside of the health system, the NHS can play a key role in tackling poverty, both as an employer and as a provider of public services.
This can be done through awareness, action and advocacy. Raising awareness by naming poverty and addressing the NHS’s role in the stigma associated with poverty and what can be done to ensure people who need to access services are supported along every step of the way.
Taking action to think about how people access and experience services and looking at how care is designed and delivered to ensure barriers are broken down.
And finally, through advocacy and speaking up for and working with people experiencing rather than doing to them as services are designed. Responding to the symptoms of poverty is crucial but the health service can also tap into the power of our communities and human relationships to prevent illness, crisis and poverty.
Ultimately, while the NHS can be a force in addressing poverty, it can’t do it in a vacuum. Widening health inequalities and deepening deprivation must be tackled head on by government and wider society.
There are examples of great progress underway right across the country, including the work that Resolve Poverty has been doing with NHS Greater Manchester. This approach to hardwire poverty awareness and action into the governance of a system is a fantastic example for others, including national policymakers, to learn from.
——————————————————————-
This article is featured in our 7 May newsletter.
Want to hear about the latest poverty research, stories and events?
Stay on top of what you need to know. Sign up to our newsletter and join our powerful network of 3.5k+ professionals, volunteers and individuals actively engaged in tackling poverty across the UK.
