#OpenDataSavesLives Session 35: Health Inequalities

We saw our best turnout yet for this session, with over 100 signed up and 75 attendees joining us for our 35th Open Data Saves Lives event on the theme of Health Inequalities. We’re delighted with how these events are gaining traction and look forward to sharing some of our thoughts on the year ahead over the coming weeks.

If you missed the session, here is the recording. Let’s take a look at some of the highlights below.

Narrowing the gap of inequality in healthcare is a hot topic in the NHS at the moment, in light of recent NHS Guidance that Trusts need to be able to demonstrate how they are delivering services equitably across their region. Delivering this ambition is a huge challenge at national and local levels, with uncertainty relying on data to clear the picture.

We were joined by three speakers who have been doing some great work to identify and address some of these challenges:

• Dr. Elizabeth Vincent - University Hospitals Sussex NHS Foundation Trust
• Dr. Steven Wyatt, Head of Research & Policy The Strategy Unit
• Ruby Nicholls, Outpatient Transformation Intelligence & Insight Lead - NHS England and NHS Improvement

Dr. Steven Wyatt

First up, Steven talked about two reports he has produced over the last couple of years that highlight some of the causes and consequences of health inequalities, along with strategies to reduce them in hospitals.

The picture is pretty clear: the effects of inequalities are widespread, and getting worse over time. Without immediate and deliberate action to target underserved populations, the situation will not improve. The consistent theme emerging from this work is that the individuals who could access these services were those from affluent areas who know how to navigate the system. These inequalities were more evident later in the pathway for referrals and specialist treatment. Pathways to access these services can be complex and tend to favour some groups over others where primary care is slightly skewed in favour of people in deprived areas. However the consequences of poor access to treatment are evident through increased use of emergency services and A&E attendances that could be avoided with earlier diagnosis.

One of the biggest challenges in this area is comparison between regions, Trusts and services. There are so many dimensions and service areas in various combinations to explore, which makes the number of possible metrics immensely complex, so part of the challenge of combatting inequalities is not just understanding their causes but developing a robust strategy for monitoring and comparing performance. The first step to do that is to present the data, which is why we’re here. Alongside the report, there is a series of files on Github aimed at analysts that you can view here.

Ruby Nicholls:

We reached out to Ruby via Twitter, who has been sharing her work with the Outpatient Transformational Intelligence Analysis Team.

During the pandemic, the health service had to completely overhaul its operating model. Now, as we emerge from the pandemic we are starting to see further changes to how the NHS delivers its services. Peer to peer networks have been set up to inform conversations about methods for service delivery post-Covid.

One such example is outpatient consultations which were almost entirely remote throughout the pandemic and have been decreasing in their use over the last few months. Trusts are now being encouraged to do 25% of their outpatient services by virtual consultation. There’s a lot of variation between Trusts, with some doing 7% and others exceeding this ambition. Ruby and her team have been assessing some of the variation they can see across the East of England Trusts and breaking these outpatient virtual consultations down by regional geography and patient demographics. They’ve been interested to see if there are any differences between age, ethnicity, gender or areas of deprivation.

The slide below gives an overview of some of the datasets that Ruby and her team have been working with. The analysis has not yet been published as the work is still underway, but we are looking forward seeing its impact.

We can see a lot of potential to turn what Ruby and her team have done for the East of England into a reproducible analytical pipeline for other regions to pick up and replicate this analysis to compare between trusts. We see this as a fantastic opportunity to experiment with applying RAP principles and facilitating more open collaboration between trusts. We’ll be following up with Ruby on this into the New Year and we are excited to see the impact of this analysis on hospitals in their region.

Elizabeth Vincent: 

We were delighted to welcome Elizabeth Vincent to ‘headline’ this event. Elizabeth gave us an overview of the current state of inequality in healthcare and presented some startling statistics.

Elizabeth rightly highlighted that nobody wants to face the uncomfortable possibility that healthcare is discriminatory, however it is true. The earlier we have the conversation, and present the data to support it, the sooner we can do something about it.

Sometimes people don’t have access to the same services due to regional availability. However some of the inequality in care observed between patients raise questions of how our own internal bias affects how we approach patient care. For example, an arrested man was treated ‘like he was pretending’ before he passed away from multiple seizures whilst in police custody - and deaths for homeless patients have increased significantly over the last couple of years.

Understanding the relationship between characteristics and quality of care is not that simple… you can categorise individuals into groups, but each individual is a combination of factors and a number of factors influence this relationship.

Covid-19 also has a continuing impact on overall public health and inequalities. The pandemic exposed but also exacerbated a number of pre-existing inequalities on metrics such as wait times for elective surgeries. The number of people waiting for elective procedures is likely to triple by 2030 without urgent intervention. 

What next?

The common message from our speakers this time was that we need more meaningful research into the extent of inequalities with robust methods and data to support decision making. This is why communities such as Open Data Saves Lives are essential to convene and provide a platform to share knowledge, methods and data. In light of the recent release of the Goldacre Review, we are particularly keen to see how the work carried out independently by trusts can be shared and replicated remotely. Working in the open will save time, effort and resources, enabling better comparison of performance on equitable delivery of services between trusts. We’ll be sharing more on this over the coming weeks and months.

We were delighted to welcome our three speakers for our more popular session yet. Our next session will be on the theme of AI in Health, and we will be joined by three more passionate and knowledgable experts. Don’t forget to register for the session - we’ll see you there.

As always, a massive thank you to the sponsors and supporters of Open Data Saves Lives.