July/August 2023 • PharmaTimes Magazine • 26-28

// NHS //


Balancing act

Levelling up – the NHS’ healthcare equity campaign and why pharma should back it

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Let’s first of all define what we’re talking about.

‘Health inequalities’ refers to all the inequalities that occur in a population around mortality and morbidity.

This could be for a variety of reasons around a marginal group, and be affected by housing, transport, education, the environment, social care, the economy and more – it’s not just to do with healthcare and the NHS.

‘Healthcare equity’ is what the NHS is striving for, and what it can actually do something about. It may require special local interventions and targeted means of access to allow these marginalised groups to achieve outcomes comparable to the best.

It’s been on my mind as I recently attended HSJ’s Health Inequalities Forum. Many speakers were of the opinion that addressing this was informing everything the NHS leadership is doing. And that it was also an area where pharma could help in a big way.

North v South and Rich v Poor

I’ve been reading Health Equity North: 2023, the latest report from HEN, a virtual forum of NHS influencers.

It reveals a stark north-south divide. The North has higher rates of bad/very bad health with 6.9% of people in the North East, 6.4% in North West, and 5.9% in Yorkshire and the Humber reporting bad/very bad health – compared to the English average of 5.3%.

One statistic that jumped out: in the North, if you’re old, male, and poor – you’re twice as likely to die of lung cancer.

There are similarly stark nationwide discrepancies by socio-economic group, race, disability and gender.

My colleagues in the healthcare community are sometimes cynical about the prospect of healthcare equity being properly addressed by NHS decision-makers.

There’s an idea that, although poorer people, older people and certain ethnicities experience poorer health outcomes – ‘it was ever thus’ – and, therefore, addressing this will never be on the top of any chief executives’ to-do lists.

It’s certainly a time when increasing activity and reducing the backlog take that priority position in secondary care. But elsewhere, challenges around healthcare equity are taking up a lot of NHS brain space.

It’s a national priority, after all – according to the Operational Planning Guidance 2023/24, all systems must continue to address healthcare inequalities and deliver on the Core20PLUS5 approach – ensuring support for the most deprived and unequal 20 per cent of their populations in five key clinical areas, as well as meet locally derived targets.

If you’re in cancer, mental health, cardiovascular, respiratory or maternity, then you are already dealing with one of those five core areas. Vaccines, oral anticoagulants and smart inhalers are all products that help the NHS with its agenda here.

More and more, the NHS is making noise around healthcare equity and it’s something industry should definitely get behind. There are lots of opportunities for partnership on patient identification, reaching vulnerable groups, disease awareness and pathway change in struggling areas, to name just a few.

What the NHS is supposed to be doing

The NHS long term plan set out the ambition to reduce inequalities in healthcare provision and outcomes, focusing on specific measures to address marginalised population groups.

The disproportionate impact of the pandemic on people from the most deprived areas, ethnic minority communities and other vulnerable groups, has also highlighted the urgent need to tackle inequity.


‘Diagnostic blocks, poor access to information and closeness to services mean there are missing patients that pharma could help’


This focus on healthcare equity has not been without controversy, as to properly address these inequalities, some areas will require a bigger resource envelope, which in turn means more affluent areas would have to give it up. Funding mechanisms for healthcare equity are very much a work in progress.

However, many of our pharma clients at Wilmington Healthcare are taking an interest in this now, wanting to know how they can align with and support this agenda.

What you are supposed to be doing

The first element is to properly understand healthcare inequity – what regions and systems it is affecting, what the discrepancies in access and outcomes are for patients in your therapy area, and what the total system costs are for inaction.

For example, poorer access to diagnosis services in cancer are connected with patients entering the system with later-stage tumours – which are more difficult to treat and require far more use of healthcare resources.

It’s advisable to engage with the NHS on the likelihood of patients with inequality markers appearing at more advanced disease stages, and to be able to explain the impact this will have on services relating to your therapy area going forwards and how a further wave may continue to build a bubble of patients that remain uninvestigated and untreated.

Health inequalities dashboards

Wilmington Healthcare has been creating dashboards for our clients demonstrating such inequity, allowing them to visualise, interpret, assess and engage around the impact of the inequities on the NHS.

Using this type of tool can help you benchmark a target system against the national picture – or other organisations – to demonstrate value in providing effective care in the most appropriate setting, freeing up capacity for secondary care providers to perform surgery and other priority treatment that have been put on hold up until now.

These also make it possible to understand the areas where patients accessing certain services have changed since the pandemic, what populations are going back to old flows, where access may still be an issue.

Among providers, you can view admission rate difference between those most and least deprived appearing in your target organisation, to start conversing around access, and community care options.

Health equity – the COPD case study

One client, with in interest in COPD, was shown that avoidable mortality from COPD is roughly 2.5 times higher in the most deprived quintile, compared with the least deprived quintile.

The rate of emergency admissions (per 100,000 population) in the most deprived quintile is roughly three times higher than in the least deprived quintile.

We’ve already seen that reducing unnecessary admissions to hospital is uppermost in NHS minds. So it becomes simpler to argue that earlier and more accurate diagnosis, increasing access to pulmonary rehabilitation, encouraging better disease control and enabling better self-management will improve outcomes and reduce exacerbations.

All these are areas pharma can leverage, by showing ideal pathways, supporting disease awareness and patient education, identifying appropriate patient groups, and of course through the appropriate use of drugs and disease management therapies.

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The final analysis

There are three major benefits to pharma from aligning with the health equity agenda.

Firstly, it’s about both NHS and industry needing to identify patients. Diagnostic blocks, poor access to information and closeness to services mean there are missing patients that pharma could help and the NHS must treat.

Better diagnostic throughput, via more accurate testing, more appropriate staffing and more evidence-based parameters suits both sides, and we’re now aware that these blocks disproportionately affect deprived communities.

So, through disease awareness campaigning, and data management via the use of such tools as Wilmington’s Healthcare’s Inequalities Dashboard, patients can be brought forward.

Secondly, it’s about outcomes. Medicine’s overall benefit is better realised when used at the appropriate point in patients’ journeys, and when they turn up late, as is happening, they’re less effective.

We’re finding that rural communities are particularly hard to reach. Many patients are coming into the system far later than they should, when medical interventions are less effective.

Certain ethnic groups may have barriers in language that may also affect their understanding of their treatment plan. Deprived communities often suffer poorer mental health that creates barriers to effective self-management.

Thirdly, it’s about partnership. This is an agenda that is super-important to the NHS, but there isn’t always the bandwidth or capacity there to properly address it within systems.

Pharma, with its data management skills, patient mapping, pathway flow information and awareness of unnecessary variation can really collaborate with the health service here on one of its most pressing needs, doing the heavy lifting on research to create a compelling story for NHS decision-makers to drive forward in their own systems.

Feedback from our clients and NHS networks reveals that communicating on healthcare equity can make all the difference when engaging with decision-makers – it really is an area of shared interest and a way of starting – and continuing – vital conversations with your customers.


Oli Hudson is Content Director at Wilmington Healthcare.
Go to wilmingtonhealthcare.com