Evidence Hub

Poverty proofing healthcare: a study of barriers to accessing healthcare for low-income families with children in northern England.

Quick-read summary

Poverty impacts negatively on children’s health and future life chances. Poverty also causes barriers to accessing healthcare services – despite the NHS being free at the point of delivery.

By talking to parents and Voluntary Community Social Enterprise sector (VCSE) staff this study aimed to understand what things make it difficult for families living on low incomes to attend appointments at their GP surgery, hospital, dentist and other places where healthcare is provided. We wanted to understand this so that we can help to make it easier for people on a low income to get the healthcare they need.

We found that many of the difficulties that people experience when trying to access NHS healthcare services are due to a lack of provision, but low income was also an issue. People talked generally about the daily struggle of living on a low income – “living in poverty”; about the unexpected costs they faced when they wanted to access an NHS service – “hidden costs”; about how hard they found it to get an appointment – “securing appointments”; and how they felt about the NHS staff that they encountered – “relationships with health care providers”.

Who is this evidence useful for?

Anyone with an interest in health inequalities and in improving access to healthcare for families living on low incomes.

What is the issue

Children born into the poorest fifth of families are far more likely to experience poor physical health which continues into adulthood and increases the risk premature death.

Poverty also impacts children’s mental health; children and young people in the UK report that poverty has a negative effect on their wellbeing and causes feelings of exclusion, shame and unfairness.

Access to the UK’s National Health Service (NHS) is based on medical need rather than the ability to pay but poorer families face barriers in accessing healthcare.

Richer people access healthcare earlier and get more preventive and specialist care, whilst poorer people access healthcare later and experience worse health outcomes.

Research summary

The research was done by researchers from Newcastle University and the University of Cumbria, in partnership with Children North East.

The research design was qualitative. Using interviews and focus groups we talked to twenty-four parents on low-incomes and eight professionals working in the VCSE sector who support people on low-incomes.

Topic guides prompted participants to think about different aspects of healthcare, including getting appointments, accessing appointments, emergency situations, and staff attitudes; it also allowed participants to introduce issues significant to them in addition to those covered by the guides.

Anonymised transcripts were subjected to ‘practical thematic analysis’.

What the research found

Living in poverty

People talked about living in poverty and said they found it hard, stressful, embarrassing and stigmatising.

Parents told us they felt embarrassed when they had to ask for financial help and that sometimes people made them feel bad about themselves; that:

“You’re useless … You’re timewasters and scroungers.”

People who work in VCSE organisations told us that they saw how trying to manage with little money can become overwhelming for families:

“It’s an overwhelm, isn’t it? It’s an overwhelm with lots of different factors that eat you away, until you feel like you have few options.”

Hidden costs

Although NHS care is free, parents told us there are lots of “hidden costs” that make it difficult for people living on low incomes to go to their doctor, hospital etc. These costs were things like:

• The cost of travelling to the surgery or hospital
• The expense of buying food and drinks when people had to spend long periods of time at hospital
• Losing money because people had to take time off work to go to appointments.

We also found out that often people don’t know about the financial help with costs they are entitled to.

Securing appointments

People said that they found it hard to get appointments with doctors, dentists and mental health services. This was often because of long waiting lists, but there were other reasons that caused problems for families, for example:

• The costs of waiting on hold when telephoning for appointments, or not having enough credit on their mobile phone to telephone or contact their surgery online
• Appointments only being available at times when they had to be at work or were looking after children
• Difficulties in finding suitable childcare so that they or their other children could attend health appointments
• Difficulties in working their way around the health care system when they needed to make a number of appointments with different doctors or nurses for different reasons.

Relationships with health care providers

Both parents and people who work in VCSE organisations told us that often people find it hard to trust healthcare staff and find it particularly hard when they don’t always receive their care from the same people. Parents told us they find it much easier to talk about their health with people they know and trust.

Why is this important?

Despite NHS services being free at the point of delivery, inequalities in access to healthcare exist for children living in families on low incomes resulting in them experiencing:

• Less preventative healthcare
• Poorer health outcomes
• Reduced life opportunities

These barriers are not inevitable and through greater attention to lived experiences of barriers, we are equipped with understanding about the steps that can be taken to address these.

What’s next?

Children North East are using the information we gained from this research to develop a toolkit which providers of healthcare services can use to make sure they are doing everything they can to address the problems that people told us about. This is called ‘Poverty Proofing’ healthcare.

Poverty proofing helps healthcare providers to look at ways they can:

• Reduce the impact of financial background on patient outcomes.
• Increase uptake of early intervention services.
• Reduce the financial burden of healthcare on low-income households.
• Demonstrate a commitment to inclusive, accessible services.

The people we talked to told us some things that healthcare providers can do to make it easier for families living on low incomes to use NHS services. The main ones were:

• Make sure information on financial support that people are entitled to is easy to find
• Making it easier for people to get to appointments by offering them at different times of the day and at weekends
• Having pre-bookable appointments for families with ongoing health care needs
• Training health care staff so that they are aware of the problems families living on low incomes face when they need healthcare and so that they treat families sympathetically

Get in touch about this research

Lead researcher name: Elaine Bidmead

Email address: [email protected]

Read the full paper in PLOS One – published April 2023

Others researchers who contributed to this work:

Louise Hayes (Newcastle University)¶,

Laura Mazzoli-Smith (Durham University)

Josephine Wildman (ScotCen Social Research

Judith Rankin (Newcastle University)

Emma Leggott (Children North East)

Luke Bramhall (Newcastle Carers)

Funding information

The study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NIHR200173). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.