HSJ Cancer Virtual Forum

15 March 2021

COVID-19 effect on cancer referrals: a portrait of health inequalities

Following her talk at the HSJ National Cancer Virtual Forum on 11 March 2021, Heather Humphreys, updates about what we can learn by analysing the delivery and recovery of urgent cancer referrals in 2020/21, and the picture painted of the state of the NHS and health inequality in England.

“The NHS should use its wealth of analytic capability to direct resources towards reducing inequalities and in doing so, prevent them from being exacerbated by future shocks.”

We hear from Heather below.

What the data tells us

Using the data aggregated in the cancer equality data packs produced by the National Cancer Intelligence Network (NCIN) from Public Health England (PHE) data, I compared the number of cancer referrals made in 2019 with the number of referrals in 2020. As we have no reason to expect numbers of cancer referrals and related diagnoses to be significantly different from one year to the next, this was a useful equity factor proxy for what happened in the pandemic during 2020/21.

A picture soon became very clear – in 2019, there was a lower rate of cancer referrals for people in areas of high deprivation than elsewhere. When cancer services came to a halt during the first lockdown, referrals plummeted to the same universally low level in all.

However, as services began to resume, referrals for those with lower levels of deprivation returned to normal levels more quickly, with a slower rebound for those in the quintiles of higher deprivation (those who were already suffering from health inequalities).

Inequalities chart Heather Humphreys ONS

A small percentage; a big impact

The small differences in the percentages of referrals between the deprivation quintiles – that is, the ‘missing patients’ – could represent tens of thousands of people receiving referrals. Later referrals could result in later diagnoses, which, in turn, could potentially have a significant impact on their health outcomes.

So, the pandemic has provided further quantifiable evidence of who is being left behind and to what degree. Covid has impacted us all – but the specific challenges we’ve faced have been different depending on our circumstances. We have an excellent opportunity to recognise why COVID-19 impacted certain groups more than others, and to recognise what systemic processes contributed to that disparity so that we can incorporate a focus on equity into the recovery process.

This responsibility extends beyond the NHS; integrated care systems, ideally, will encourage local authorities, voluntary sector organisations and community groups to work together with health services, bringing their knowledge and expertise into the planning and delivery of services to their population.

Making the ‘new normal’ a ‘better normal’

The publicly available data packs that I referenced for my presentation are updated monthly and are being used to directly inform activity in the restoration and recovery of cancer services, including targeted messaging in the national ‘Help Us, Help You‘ campaign to support people going to their GP with symptoms indicative of cancer. The reports are also being shared with cancer alliances and regional teams to support the targeting of local campaign messages.

The U.K. is fortunate to already have a plethora of detailed, integrated health data available for complex analysis and capable analysts and researchers with the skills to make use of it, as discussed in the Economist on 27 February 2021. We have an opportunity to leverage this data to identify the gaps that we know exist, and to develop and implement strategies to address them. The NHS should use its wealth of analytic capability to direct resources toward reducing these inequalities and in doing so, prevent them from being exacerbated by future shocks.

There’s much talk of creating a ‘new normal’. Let’s use the insights we’ve gained from the COVID-19 crisis to create a new normal for health equalities – where we finally narrow the gap so that everyone can get the same access to the same great care.

Full presentation

Further information

The HSJ Cancer Virtual Series brings together the cancer community to focus on restoring and maintaining cancer services and improving cancer outcomes in the wake of covid-19 and beyond. Find out more.

To keep up to date with our latest work on health inequalities remember to follow us on Twitter and Linkedin.

Author – Heather Humphreys

Heather Humphreys- AboutHeather Humphreys is passionate about using data to address health economics topics. With experience in qualitative and quantitative datasets, Heather is particularly interested in population health and allocative efficiency.

As a lifelong learner, Heather has degrees in biochemistry and in economics from Florida State University and a Masters in Public Health from Imperial College London. She’s also currently studying for an MSc in Health Economics, Policy and Management from the London School of Economics.

Meet Heather


Our specialist services

This is a small selection of all the solutions we can provide.

Evidence generation

Understanding whether new care pathways and interventions are effective, efficient, and deliver value for money

Population health management

Using allocative efficiency techniques and population health analytics to improve value and deliver the best care possible

Advanced analytics

Using advanced techniques in machine learning, data science and casual inference to understand the biggest questions in health


Sharing our vast knowledge to develop NHS capability through training, research design advice and quality assurance