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Tackling inequality could save hospitals in Wales £322 million every year

Published: 16 December 2021

Inequality in hospital service use is costing the NHS in Wales the equivalent of a brand new NHS hospital, or the yearly salaries of nearly 10,000 extra nurses every year, according to a new report from Public Health Wales.   

Alternatively, the money saved could provide four times the funding required for the Welsh Government’s flagship programme Flying Start, which seeks to support the most disadvantaged families, communities and young children in Wales.  

The report looking at different hospital services, says preventative action targeted at improving the health equity between advantaged and disadvantaged communities and their timely access to health services could help reduce a £322 million healthcare gap, especially in emergency admissions and A&E attendance. 

The report found that the average annual cost of health service provision was generally higher for those living in our more deprived communities.  Costs were highest amongst working aged adults in all hospital service categories, except for elective inpatient admissions. The reasons for these gaps are complex and will be explored in further studies to expand understanding of how population differences and deprivation influence health service use in Wales. 

This is particularly relevant during the Coronavirus pandemic response and future recovery of the NHS and the wider economy in Wales. 

Minister for Health and Social Services Eluned Morgan said: “This piece of work once again demonstrates the link between ill health and deprivation – a link which will have sadly been deepened by the impact of the pandemic.

“The NHS is only part of the story in reversing deep-seated health inequalities, which mean that people in deprived areas often have the poorest health. We need to look at the everyday causes of ill health, including education, housing and employment. Research has shown that improving these can help to end the cycle of health inequalities. But we also need to continue our work to improve access to healthcare and better management of people’s existing long-term conditions in the community, closer to where they live.” 

Mark Bellis, Director of the World Health Organisation Collaborating Centre at Public Health Wales said: 

“Sadly, for many decades those with lower incomes, less resource and living in more deprived communities often suffer worse health throughout their lives. They can develop more health problems at younger ages including well established causes of ill health and early death such as heart disease and are also more at risk from new threats including COVID-19. In this report from Public Health Wales we have examined how much money could be saved in NHS health hospital care costs if we closed this inequalities gap.  

“The findings identify that around £9 in every £100 spent in hospitals are as a result of continued health inequalities, amounting in Wales to around a third of a billion pounds every year. This is only the cost of inequalities to hospital services and future work by Public Health Wales will examine the savings possible in primary and social care settings if we tackle health inequalities.” 

Other key findings from the report are: 

  • Overall, there is no substantial difference in the costs associated with inequality between men and women 
  • Emergency attendances and admissions experience the highest proportional costs associated with inequality in terms of social pattern of service use - there is a clear social gradient with a larger inequality gap for A&E attendances, followed by emergency and maternity hospital inpatient admissions 
  • Emergency inpatient admissions are the largest contributor to the overall cost associated with inequality, with an additional cost of £247.4 million annually  
  • Deprivation affects the cost for maternity inpatient admissions differently according to age group – higher cost is attributed to women in their early reproductive age (15 – 29 years) from the more deprived areas; and to women in their later reproductive age (30 – 44 years) from the least deprived areas. 

Dr Brendan Collins, Head of Health Economics in Welsh Government, said:  

“This is a really useful piece of work that demonstrates that spend on hospital care is higher on people in more deprived areas; the social gradient is greatest for unplanned care which may indicate a higher risk of trauma, injuries and other unplanned care needs, and may indicate opportunities to diagnose and manage long term conditions better in the community, focusing on more deprived areas. The health system is only one part of the story; we need to look at the everyday causes of health like education, housing, and employment and how we prevent ill health across the life course – issues that have been illuminated even more by the pandemic.” 

An interactive dashboard, will also accompany the report. This will allow the user to explore in detail, the costs associated with inequality by service category, sex, age and level of deprivation.