2x as Many NHS Surgeries Were Closed in Lower Income Areas. Is This as Bad as it Sounds?

Between 2013 and early 2019, for every one NHS surgery closed in a higher-than-average income area, two were closed in a lower-than-average income area. See the details of our analysis below.

2 out of 3 NHS Surgery Closures Occurred in Lower Income Areas

Analysis of data shared with us by Pulse showed that 66% of the NHS surgeries closed between 2013 and early 2019 were located in local authority areas with lower-than-average income for the region. The other third of closed surgeries were located in areas with income levels higher than the regional average.

The results vary by region, however. In 8 regions of the UK, the majority of closed surgeries were located in lower income areas: the North East, North West, Yorkshire and the Humber, the West Midlands, East of England, London, the South East and Northern Ireland. On the other hand, in the East Midlands, the South West, Wales and Scotland more surgeries were closed in higher-than-average income areas.

What Proportion of Affected Patients Live in Lower Income Areas?

Surgeries come in a range of sizes—how many patients were impacted by closures in lower income areas? Across the UK, 66% of impacted patients lived in lower income ares. When examined on a regional basis this is not necessarily the case. For example, in the South East 50% of patients lived in lower income areas but 70% of closed surgeries were located in lower income areas, implying that the surgeries closed in lower income areas of the South East were smaller (i.e., impacting fewer patients) and the surgeries closed in higher income areas were larger.

Income Profiles of Patients Affected by Closed NHS Surgeries

Just how low (or high) were typical patient incomes for surgeries that closed? To better understand the financial wherewithal of patients who've lost local a surgery over the past 6.5 years, we compared the average gross domestic household income (GDHI) per head in a surgery's local authority to that of the region. We then grouped each closure into an "income band" (e.g., a surgery in the "70% to 80%" income band means that patients in a surgery's local area earn 70% to 80% of what is typical in the greater region—this band, by the way, would count as a "lower income" closure).

For example, take two boroughs of London, where the regional GDHI per head was £27,151 in 2016. A surgery closure in Hillingdon, London, where the average GDHI per head was £23,439, falls into the "80% to 90%" income band because the local authority income of £23,439 divided by the regional London income of £27,151 is 84%. In other words, the average income per person in Hillingdon is 84% of the average across the London region. (A closure in Hillingdon would count as a "lower income" closure.)

At the other extreme, Kensington & Chelsea falls into the "Over 130%" income band because the average GHDI per head of £62,66 in that royal borough divided by the regional London income of £27,151 is 225%. In other words, the average income per head in Kensington & Chelsea is 2.25X that of the average Londoner. (A closure in Kensington & Chelsea would count as a "higher income" closure.)

Surgery closures can have a more pronounced impact in lower income areas where people may be less able to afford private health care/insurance, and the cost to travel a greater distance to another surgery may be a larger financial burden. Unfortunately, the data shows that NHS surgery closures have occurred more often in lower income areas.

Methodology

We started with exclusive data on the NHs closures in the UK from 2013 to early 2019, shared with us by Pulse. According to Pulse, the data on NHS surgery closures was collected based on FOI requests to NHS England, health boards and CCGs asking how many surgeries had closed either as a result of practices closing altogether or as part of a branch closure following a merger.

To find economic trends in the data, we needed to gather data on the income levels of people living in the same local authority as each closed surgery. To do this, we first determined the local authority for each closed surgery based on its geographic location. Using each surgery's local authority, we then found the average Gross Domestic Household Income (GDHI) per head for each surgery's location using income data from the Office of National Statistics.

To determine the number of closures in lower income or higher income areas, we compared the GHDI per head for each surgery's local authority to the average for the area's region (i.e., North East, North West, Yorkshire and The Humber, East Midlands, West Midlands, East of England, London, South East, South West, Wales, Scotland or Northern Ireland). In cases where a surgery's local authority income was lower than the average for the region, we counted the closure as a "lower income" closure; when a surgery's local authority income was higher than the average for the region, we counted the closure as a "higher income" closure. From there, we could determine the number of lower income or higher income NHS surgery closures in each region of the UK, and for the UK as a whole.

Next we looked at the number of patients affected by "lower income" and "higher income" surgery closures. While patient data was not available for all surgery closures, it was available for 460 out of the 604 closures.

Finally, to get a sense of just how "low" or "high" incomes were in areas affected by surgery closures, we grouped the closures into different income bands (i.e., Under 70%, 70% to 80%, 80% to 90%, 90% to 100%, 100% to 110%, 100% to 120%, 120% to 130% and Over 130%). By taking the ratio of local authority income to regional income, we determined the band in which a closure should fall. For example, if the typical local income was 75% of the regional income, a closure in that local authority fell into the 70% to 80% band.

Limitations: While this analysis seems to show that lower income households have been affected more than higher income households by the surgery closures of the past 6.5 years, it must be noted that other factors are in play. For instance, this analysis does not take into account whether or not there is another local surgery equidistant from a patient than the closed surgery (in which case a patient may not be any worse off by a closure). Additionally, we do not presume to know the financial situation of actual patients affected by surgery closures. Using the average GDHI for the local authority in which a surgery was located should be a good proxy, however, as patients tend to live in the same area as their surgery. Finally, while we were able to obtain GDHI per head data on a local authority and regional level for 2013 through 2016, and regional data for 2017 as well, this data was not available for more recent years. As a result we used the most recent 2016/2017 income data when categorizing 2018 and 2019 surgery closures.