Tackling inequalities was “often not a main priority” for local health and care systems over the past year, the care regulator for England has said.
The Care Quality Commission (CQC) said the pandemic had exposed and exacerbated inequalities, and most services demonstrated some understanding of these.
But it found that tackling inequalities “was often not a main priority for systems, or strategies to identify and tackle health inequalities were not yet well established”. Issues included poor accessibility of information in different languages for some people, varying service provision and access, and a lack of understanding of how people’s individual characteristics affected the care they needed.
The regulator said an example of this was the specific needs of people with a learning disability from black and minority ethnic groups. It also flagged that an increase in remote or digital care could be a barrier to people who cannot access technology or do not feel comfortable doing so.
The report comes as the government announces a £162.5m workforce retention and recruitment fund in an effort to hire and retain workers for the sector.
The ringfenced funding, available through the winter until the end of March, will help local authorities and care providers to go on a recruitment drive. It will also help with overtime payments, and support occupational health teams through a potentially grim winter.
The report found inequalities had also been exposed by the coronavirus vaccine rollout, with take-up lower in all minority ethnic groups compared with in the white population, and variances according to levels of deprivation.
The annual state of care report says: “Providers and representatives from the voluntary and community sector have told us that recovery needs to focus on addressing health inequalities, particularly those that were amplified by the pandemic. However, there were some concerns that a focus on waiting list backlogs for elective care will put the emphasis on clearing these at pace, instead of on where the need is greatest.”
The CQC said better use of data to understand the needs of people locally, and better NHS trust patient records and linkage with primary care data, could help reduce inequality.
It noted an NHS target that by 2024 three-quarters of women from black and minority ethnic groups – who tend to have poorer outcomes in childbirth – should receive care from the same person during pregnancy, birth and postnatal.
It said just half of the nine services it visited where it had concerns had active continuity of carer teams providing support to women identified as higher risk at the time of inspection. It said teams had been put on hold or disbanded, primarily owing to pandemic staffing issues.
The regulator said engagement by maternity services was often not targeted towards women from black and minority ethnic groups, and a lack of funding was a “major challenge to meaningful engagement”.
Jabeer Butt, the chief executive of the Race Equality Foundation, said it was “deeply worrying” that the regulator had said tackling inequalities was not often a main priority.
“Equally worrying is that many health inequalities are longstanding, with some evidence that action to address these has only been partially implemented,” he said. “It is deeply disappointing that while targets were set for ensuring pregnant black and minority ethnic women received continuity of care, the CQC found that only small numbers of women received this support and in some areas the teams were ‘put on hold or disbanded’.”
The CQC also found that the physical healthcare needs of people with a learning disability were not always taken into account. Some people struggled with access to services, which caused them distress and in some cases led to their health deteriorating.
In one care home for people with autism and/or learning disabilities, there was no assessment to consider what adaptations may be required to meet new residents’ needs. Residents were told they were being “silly” and incident reports said people were “whingeing” and “having paddies”.
The CQC said providers and systems would need to understand and manage the impact of the pandemic on people with a learning disability. “This includes ensuring that any health inequalities and specific needs relating to protected characteristics such as ethnicity, age and gender are part of a system-wide strategy,” it said.