People from deprived backgrounds ‘get worse treatment at A&E’, Manchester University research suggests

People from poorer and more deprived areas may get worse treatment at A&E than patients from better-off places, research by Manchester academics have suggested.

Researchers from The University of Manchester have published a paper which shows there may be evidence that unconsciously emergency care departments may treat people differently depending on where they are being brought to hospital from.

It is the first time expert research has suggested there may be income-related inequalities in A&E departments.

The authors have suggested that unconscious bias against people from poorer areas needs to be addressed among NHS staff in order to reduce inequality.

What did the research show?

The team from The University of Manchester used national data on patients arriving by ambulance at all major English A&E departments during 2016-17 in order to compare waiting times, treatments, and health outcomes for patients.

They found that patients from more deprived areas waited longer to receive treatment, and received less complex treatment, than those from more affluent areas, even when presenting with the same health conditions and at the same hospital.

Though the inequalities in waits were fairly small for an individual patient (around a 2.2% increase in waiting time for the start of treatment), the differences were systemic and represented a substantial amount of delay when considering England’s population as a whole.

Patients from deprived areas were also less likely to be admitted to hospital and less likely to be referred on for follow-up care, the researchers have suggested.

The findings have been published in the Journal of Health Economics and the project was funded by the National Institute of Health and Care Research.

What do the findings mean?

This is the first time that there has been evidence of income-related inequalities in how patients are treated at A&E.

Previous research has found patients from more deprived areas also wait longer for planned operations such as knee replacements despite having the same level of need for treatment.

However, waiting times are likely to be more important in A&E because the severity of conditions patients are coming in with may have very serious health consequences, and prioritisation decisions must be made quickly.

This pressure may also lead to higher fear of litigation, which could subconsciously affect how doctors interact with some patients.

Patients from the most deprived areas, who are more likely to have underlying health conditions, accounted for more than twice as many attendances at A&E as those from the more affluent areas.

Their conditions were equally or more severe than those off their better-off peers on arrival, despite being younger in age on average.

Patients from the most deprived areas are also almost 6% more likely to attend A&E again within seven days and almost 5% more likely to die within 30 days, compared to those from the least deprived areas.

The researchers found the differences in treatment were present even when A&E departments were less crowded. This, they have suggested, means there is more going on here than staff simply being under most stress and pressure due to workloads.

This, the academics say, means unconscious bias against people from poorer areas should be considered as a reason for the outcomes observed.

What have the researchers said?

Lead author Dr Alex Turner from The University of Manchester said: “Our results suggest the NHS principle of ‘equal access for equal need’ is not being upheld in English emergency departments.

“Adding to evidence from previous studies that patients from more deprived areas wait longer for planned operations, we find these patients also wait longer for care in A&E where extended waits are more likely to have severe consequences for health”

“And though the magnitudes of inequalities are smaller in an A&E setting than in planned care, we also found patients from deprived areas were substantially more likely to choose to leave without treatment while waiting in A&E.

“Not only do patients from more deprived areas receive less timely care, they also receive different care, with physicians less likely to provide these patients with complex care within the A&E and less likely to refer them for subsequent care.”

Co-author Dr Ruth Watkinson added: “We find evidence that suggests patient-staff interactions, and particularly unconscious bias towards patients from deprived areas, may contribute to unfair inequalities in A&E. Policies designed to improve these interactions should be prioritised.

“Inequalities in mortality following A&E attendance suggest the healthcare system may be exacerbating already-entrenched inequalities.

“Addressing this is especially important given reducing health inequalities is a key priority for the NHS.”

NHS England has been approached for comment.