Health inequalities and gender: Briefing for a new government

Funding

• The 2010s saw the longest spending squeeze in the history of the NHS: growth in spending was 1.6% during 2010-2019 (annual average), down from 3.7% each year since it began in 1948.
• The NHS has not been able to make up for the impact of the pandemic on treatments. There were 7.54 million people on an NHS waiting list for consultant-led care in March 2024.

Workforce

• The NHS workforce is made up of 1.44 million employees. Women comprise three-quarters of the healthcare workforce, and 31% of staff are Black, Asian or ethnic minority. Whilst women make up 53% of doctors in training, only 37% of consultants, 27% of surgeons and 6% of health and community service doctors are women.
• NHS hospitals, mental health services and community providers have reported a shortage of nearly 121,000 staff, including 34,700 nurses. The pandemic increased the pressures on existing staff, exacerbating long-standing issues of chronic excessive workloads and burnout.
• It has been estimated that the NHS needs an additional 5,000 internationally recruited nurses every year to prevent worsening staff shortages.

Women’s health

• Despite living longer than men, women spend a greater proportion of their life in ill health or disability. This has a significant impact on the economy, with over 1.5 million women being economically inactive due to long-term sickness.
• Admission to hospital to give birth is the single largest cause of admission to NHS hospitals in England. The Care Quality Commission found almost half of maternity services rated as either ‘inadequate’ or ‘requires improvement’ in 2023.
• Waiting times for gynecology have gone up by 109% since 2020, while investment in Sexual and Reproductive Health Services has decreased by 40% in the last decade.
• Women are more likely than men to have a ‘common’ mental health problem (mixed anxiety and depression). Research in England, Scotland and Wales has shown a correlation between mental health disorders and level of personal debt.
• Gender inequalities intersect with inequalities along lines of class, race, disability, sexual orientation and gender identity, often resulting in worse access, outcomes and treatment for those experiencing multiple forms of inequalities.

Recommendations

• Funding for the NHS should be restored to the long-run average once the backlog of treatments has been cleared. An initial injection of funding is needed to clear it.
• Public Health spending should be reinstated, and a new Women’s Health Strategy should ensure that the fragmentation of services is reversed.
• For a gender-equal health service, the needs of a diverse range of groups must also be prioritised, including those of older, Black, Asian and ethnic minority, migrant, disabled, and LGBT people and those living in deprived areas.
• Any initiatives to improve productivity within health and social care should ensure that care is not transferred from formal services onto informal carers and families.
• The ban on overseas care workers bringing dependents with them should be reversed.
• Increase pay and improve conditions for NHS staff. Ensure that any workforce strategies go hand in hand with improvements to funded childcare and wrap around care.

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