Health

Key statistics:

  • By January 2022, there had been 28 COVID-19 positive tests for every 100 residents in London
  • London has the highest age-adjusted regional COVID-19 mortality rate at 171.4 in 100,000 compared to 128.7 in England as a whole
  • COVID-19 mortality has hit some populations harder than others: by April 2021 mortality rates were 27% higher in the 20% most deprived neighbourhoods than in the least deprived ones (even after controlling for a range of neighbourhood characteristics)
  • Mortality rates are also higher in neighbourhoods with higher proportions of Black and elderly residents
  • Just over 60% of London adults have received a 3rd vaccination, 10 percentage points below the UK average with significant variation within the capital
  • There is a 30% difference between the proportion of adults who have received a 3rd vaccination in the 10% most deprived communities and in the 10% least deprived ones
  • By the end of 2021, the number of NHS patients waiting for treatment in London was over 25% higher than before the pandemic; and waiting times were on average 40% longer
  • In April 2021, 58% of all GP appointments in London took place remotely (either via telephone or online).
  • At the end of 2021, the proportion remained high at 43%

The most apparent impact of COVID-19 is on health. At the time of writing, more than 135,000 people across England have tragically lost their lives and in London alone, the death toll surpassed 20,000.39 The pandemic has also had wider impacts on the NHS, with a substantial increase in the number of patients on waiting lists as well as longer waiting periods.

The overall direct health impacts of COVID-19 have not been evenly spread. Morbidity and mortality have been higher amongst older people, individuals living in deprived areas, and those from Black and Minority Ethnic backgrounds. The increase in remote GP appointments is also expected to deepen health inequalities in groups with lower incomes or poor English skills as they struggle to access primary care.

London was one of the first areas of the UK to experience widespread transmission of the virus. By the start of the first national lockdown on March 23rd 2020, 47 per 100,000 London residents tested positive for COVID-19,40 compared with an average of 13 per 100,000 across the rest of England. By 27th February 2021, this proportion had risen to 7,768 per 100,000, compared with an average of 6,186 per 100,000 across the rest of England.

By the summer of 2021, cumulative infection rates in London (standing at 11,280 at the end of August), were similar to those of the rest of England and remained so until the end of January 2022. According to more recent data, London cumulative infection rates stand at 28,233 per 100,000 population. (41)

Figure 26: Cumulative infections per 100,000 population: January 2020 - February 2022 (January 2020 - February 2022)

COVID-19 infections have not been evenly spread across London’s population. In December 2020, started to increase faster among London’s most deprived communities, remaining one third higher than in the least deprived communities until July 2021. Since then, cumulative infection rates have been increasing faster among the least deprived, and by December 2021 they had caught up with, and later surpassed, infection rates among the most deprived communities. (42)

Figure 27: Cumulative COVID-19 infection rates in London by neighbourhood deprivation quintile: March 2020 - February 2022 (March 2020 - February 2022)

With such stark differences in infection rates by neighbourhood deprivation, it is no surprise that some parts of London have fared very differently. This can be seen at specific points in time, where infections have grown rapidly as the virus transmitted quickly in a specific local area. It can also be seen overall, with infection rates varying significantly across different parts of the capital. By 7th March 2022, Hounslow and Ealing had the highest cumulative infection rates (31,856 and 31,846 in 100,000 respectively), with Westminster and Camden the lowest (22,401 and 22,564 in 100,000 respectively). (43)

Figure 28: COVID-19 infection rates per 100,000 in London neighbourhoods (MSOAs) For all weeks between 11th March 2020 and 23rd February 2022

COVID-19 mortality in London

By January 2022, 20,234 Londoners had tragically lost their lives to COVID-19.44 To understand how this compares to other regions across the UK, we look at deaths as a proportion of the population adjusted for the area’s age profile. This is important considering that London has a relatively young population, and so would be expected to experience lower mortality rates than other regions with older populations.

London has consistently had the highest regional standardised mortality rate (SMR) from COVID-19 since the beginning of the pandemic, except during November and December 2020. By January 2022, the cumulative mortality rate in London was 171.4 per 100,000, compared to just 128.7 for England as a whole. This means London saw the highest mortality rate out of all English regions, being almost 150% higher than in the South West, the region with the lowest mortality rate. (45)

Figure 29: Cumulative age-standardised COVID-19 mortality per 100,000 population: March 2020 - January 2022 (March 2020 - January 2022)

Figure 30: Cumulative age-standardised COVID-19 mortality per 100,000 population (ASMR): March 2020 - January 2022 (March 2020 - January 2022)

As with infections, COVID-19 mortality varies significantly between different parts of London and amongst demographic groups. By April 2021 cumulative COVID-19 mortality rates were:

  • More than 60% higher in the 20% most deprived London neighbourhoods (319 per 100,000) than in the 20% least deprived (194 per 100,000)
  • 3.4 times higher in the worst impacted London borough (Newham - 401.2 per 100,000) than the least impacted borough (Richmond-upon-Thames - 145.0 per 100,000)(46)

Figure 31: Cumulative COVID-19 mortality rates per 100,000 population in London by neighbourhood deprivation quintile: March 2020 - April 2021 (March 2020 - April 2021)

Figure 32: Cumulative COVID-19 mortality rates across London - Up to April 2021

Table 1 and figure 33 show how factors like age, deprivation and ethnicity interact to influence COVID-19 infections and mortality.

Table 1: Change in COVID-19 infection and mortality rates in London, for different neighbourhood characteristics
Characteristic This change in the characteristic Leads to this change in the COVID-19 mortality per 100,000 population
Care home residents Increasing by 100 residents 68 increase
Population in process, plant and machine operative occupations Increase by 100 persons 14 increase
Population 65 plus Increasing by 100 persons 13 increase
Black population Increasing by 100 persons 2 increase
Lab-confirmed cases rate Increasing by 100 persons 1 increase
Population aged 0-14 Increasing by 100 persons -1 decrease
Population aged 40-64 Increasing by 100 persons -2 decrease
Population in elementary occupations Increasing by 100 persons -9 decrease
Populations in caring, leisure and other service occupations Increasing by 100 persons -12 decrease

COVID-19 mortality is also predicted by levels of deprivation, even after controlling for a range of neighbourhood characteristics. Mortality rates are 27% higher in the most deprived 20% of neighbourhoods compared to the least deprived 20% of neighbourhoods. (47)

Figure 33: Percentage difference in cumulative deaths per 100,000 relative to least deprived 20% of neighbourhoods: March 2020 - January 2021 (March 2020 - January 2021)

COVID-19 vaccinations in London

In addition to a consistently higher mortality rate than the rest of English regions, London has also lagged behind the rest of the country in terms of vaccination take-up. By the beginning of March 2022, just over 60% of London’s adults had received their 3rd dose of the vaccination, 10 percentage points below the UK average.

Figure 34: COVID-19 third dose vaccinations per 100 adults (aged 18+): October 2021 - March 2022 (October 2021 - March 2022)

There is significant variation within the capital in terms of vaccination coverage, as some mostly Outer London boroughs have percentages close to or above the UK average of 70%, and some mostly Inner London boroughs lag behind the capital’s average, with percentages below 55% or even 50%. The percentage of adults who have received their 3rd vaccination dose is more than 30 points higher in Richmond upon Thames, the borough with the highest percentage, than in Barking and Dagenham, the borough with the lowest. (48)

Figure 35: COVID-19 third dose vaccinations per 100 adults (aged 18+) for London boroughs: Up to March 6, 2022 (Up to March 6, 2022)

There are significant inequalities in vaccination take-up based on neighbourhood deprivation. In London, there is a 30 percentage point difference between the proportion of adults who have received their 3rd vaccination dose in the 10% most deprived communities and in the 10% least deprived ones. London shows lower percentages of boosted adults than the rest of England across all deprivation deciles. (49)

Figure 36: COVID-19 third dose vaccinations by deprivation decile (MSOA): Up to March 7, 2022 (Up to March 7, 2022)

In addition to the direct impact on infections and mortality, the pandemic has also added strain to an already stretched health system

As resources in the NHS had to be redeployed to respond to the large numbers of COVID-19 patients, the pandemic has also affected the NHS’s capacity to continue with routine activities and treatments.

By July 2020, the median waiting time for treatments had increased by 150% compared to February 2020, remaining above 40% by the end of 2021. The total number of patients waiting for treatment had increased by more than 25% between February 2020 and the end of 2021. (50)

Figure 37: Percentage change in patients waiting for treatment and mean waiting time: March 2019 to November 2021 (March 2019 to November 2021)

The NHS responded to social distancing measures by carrying out some of its activities remotely. The percentage of GP appointments taking place either online or via telephone increased more than three times in England, and almost four times in London, between February and April 2020. Since then, this percentage has decreased, although remaining at much higher levels than before the pandemic, standing above 40% by the end of 2021 in London. (51)

Figure 38: Percentage of GP appointments by telephone or online: December 2019 - December 2021 (December 2019 - December 2021)

While the move to remote attendance enabled more GP appointments to take place than would have otherwise been the case in the context of the pandemic, healthcare professionals and civil society have raised concerns about its impact on health inequalities.52 A major driver behind this is digital poverty, defined as “the ability to interact with the online world fully, when, where and how an individual needs to”. Digital poverty “exacerbates and is exacerbated by other socio-economic, educational, racial, linguistic, gender, and health inequalities”, among which income is particularly important: 47% of offline people in the UK are part of a low income household, with 53% of those offline not being able to afford monthly broadband bills,53 and those with an annual income of £50,000 or more are 40% more likely to have basic digital skills than those earning less than £17,500. (54)

National evidence shows that these wider inequalities map onto an uneven access to remote healthcare. Patients in the most deprived areas are less likely to have used the website of their GP practice, and if they do, generally find this process more difficult than patients in the least deprived areas. The former also found it more difficult to get through to their GP practice via phone,55 a process which is much harder for those experiencing literacy or language barriers.56

In London, 18% of Londoners lack some basic digital skills.57 Research from the London division of Age UK revealed that during the pandemic “finding information on health-related issues (...) was the least, or one of the least, common uses of the internet for most older people”, with less than half of over 65s using the internet for these purposes.58 As London is the English region with the highest poverty rate, and the highest proportion of residents who cannot speak English well or at all, the larger rise in the proportion of GP appointments taking place remotely in the capital is likely to have made healthcare less accessible for many Londoners.

ENDNOTES

41. Ibid.

42. Coronavirus cases, Public Health England; Population estimates for MSOAs, ONS; English Indices of Deprivation (2019), MHCLG

43. Ibid.

44. Deaths due to COVID-19 by English region and Welsh health board

45. Deaths due to COVID-19 by local area and deprivation, ONS

46. Deaths due to COVID-19 by local area and deprivation, ONS; English Indices of Deprivation (2019), MHCLG

47. Deaths due to COVID-19 by local area and deprivation, ONS; Regression input

48. Vaccinations in the UK, ONS

49. Vaccinations in the UK, ONS; English Indices of Deprivation (2019), MHCLG

50. Consultant-led Referral to Treatment Waiting Times, NHS England

51. Appointments in General Practice, NHS Digital

52. COVID-19 and the digital divide in the UK, The Lancet; Nuffield Trust, Digital Primary Care: Improving Access for All?

53. UK Digital Poverty Evidence Interim Review, Digital Poverty Alliance

54. Beyond Digital: Planning for a Hybrid World, House of Lords: https://committees.parliament.uk/ publications/5537/documents/56741/default/

55. The Health Foundation: Who Gets In?

56. Locked out: Digitally excluded people’s experiences of remote GP appointments, Healthwatch

57. Mayor of London: Digital access for all

58. Mind the digital gap: older Londoners and internet use during the pandemic, Age Uk