Geographic Disparities in Contraception Access
Geographic disparities ('postcode lottery') in primary care access to long-acting reversible contraception.
Source spread
Where this theme appears
This theme appears across 8 independent accountability sources, so the source mix matters as much as the headline total.
18 PFD reports
93 committee recs
1 NAO rec
6 PHSO decisions
1 LGO/SPSO decision
Browse by source
Source-grouped records are useful for tracing where a concern came from. Large sections show the 50 strongest matches for that source; counts still show the full theme total.
Prevention of Future Deaths reports(18)
Emmanuel Akinmuyiwa
Concerns: The coroner identified a lack of clear protocols in the West Midlands for managing sickle cell disease patients, noting that hospital staff had insufficient knowledge of crisis signs and treatment. This was compounded by a lack of funding to implement a regional 'hub and spoke' approach with consistent guidelines.
Overdue
Robert Lloyd
Concerns: The coroner noted difficulties in providing supportive treatment for alcohol abusers on the Isles of Scilly due to limited face-to-face support. This was exacerbated by reduced transport services, making it challenging for professionals to travel and engage with service users.
Response (The Health Centre): • The Health Centre met with the Drug and Alcohol Action Team of Cornwall Council to discuss future services and undertook training for two pharmacists. • A new Addaction worker … (AI summary)
Response (Drug Alcohol Action Team): • The Drug Alcohol Action Team has appointed an Adults Recovery Co-ordinator who has commenced fortnightly visits to the islands. • The contract with Addaction will require fortnightly island visits … (AI summary)
Overdue
Constance Robinson
Concerns: The coroner noted that the limited operating hours of two Hyper Acute Stroke units in Greater Manchester lead to extended ambulance journeys and potential delays in urgent overnight treatment. Patients would benefit from 24-hour access and medical staff availability at all units.
Overdue
Susan Adams
Concerns: Difficulties arise in accessing consistent secondary psychiatric care for individuals residing near county boundaries where services are split, potentially impacting the quality of treatment.
Response (St George's University Hospitals NHS Foundation Trust): • The Trust undertook an investigation into the care delivered following Mrs Adams' death. • The Trust forwarded the coroner's concern regarding commissioning difficulties for patients near county boundaries to … (AI summary)
Responded
Sean Kay
Concerns: The coroner identified a significant gap in mental health service provision in Norfolk and Waveney for patients identified as At Risk Mental State (ARMS). These patients, despite high risk, did not meet criteria for existing services and consequently received no appropriate care.
Response (NHS Norfolk and Waveney CCG): • Norfolk and Suffolk NHS Foundation Trust confirmed it had improved communication channels and education between its teams. • Norfolk and Suffolk NHS Foundation Trust stated it had a policy … (AI summary)
Responded
Violet Howard
Concerns: The coroner noted a gap in commissioning arrangements for dermatology services covering inpatients at Royal Oldham Hospital who are from outside the Oldham area, unless they become emergency dermatological cases.
Response (NHS Greater Manchester Integrated Care): • The Oldham Care Organisation has actioned a service level agreement (SLA) with Salford Royal NHS Foundation Trust to address the provision of dermatology services for inpatients. • Learning from … (AI summary)
Responded
Anthony Reedman
Concerns: The coroner noted the absence of a 24/7 thrombectomy service at RCHT, resulting in an estimated 75 stroke patients in Cornwall not receiving this procedure. A lack of a service level agreement with the nearest 24/7 thrombectomy service further limits treatment options.
Response (North Bristol NHS Trust): • North Bristol NHS Trust expanded its thrombectomy service to operate 24/7 from December 2022. • The Trust will explore with University Hospitals Plymouth NHS Trust and Royal Cornwall Hospital … (AI summary)
Overdue
REDACTED
Concerns: The coroner raised concerns about limited public awareness regarding the risk of stroke from cocaine use and the variable availability of thrombectomy services across different geographical locations and times.
Response (NHS England): • NHS England is rolling out national access to thrombectomy services through specialised neuroscience centres. • A bespoke training programme is being developed to address the shortfall in practitioners for … (AI summary)
Response (UK Health Security Agency): • PHE will ensure that stroke is included in the health risks of cocaine use on the FRANK website. • Phase two of the independent review of drugs will focus … (AI summary)
Responded
Sarah Read
Concerns: The coroner noted a lack of provision for Thrombectomy Service after 5pm in Lancashire and that neighbouring Trusts cannot accept patients, raising concerns about access to this urgent treatment.
Response (NHS England): • Lancashire Teaching Hospitals NHS Foundation Trust increased its thrombectomy service to operate seven days a week, 8am to 6pm, from September 2023. • The Trust plans to further extend … (AI summary)
Responded
Charlotte Burton
Concerns: A nationwide shortage of trained cardiologists means District General Hospitals lack out-of-hours, in-person assessment for suspected cardiac problems, relying instead on non-specialist staff and often impractical transfers.
Response (NHS England): • NHS England published the NHS Long Term Workforce Plan in June 2023 to address workforce training, retention, and reform over fifteen years. • The Medical Speciality Distribution programme, which … (AI summary)
Overdue
Anthony Williams
Concerns: The coroner identified national shortages of specialist scanning facilities and significant delays in the two-week cancer pathway, leading to delayed diagnoses and treatments, which impacts patient outcomes.
Response (NHS England): • NHS England published guidance on diagnostic imaging reporting turnaround times in August 2023, setting maximum turnaround times for services including PET CT scans. • NHS England published the Delivery … (AI summary)
Responded
Jasbir Pahal
Concerns: The coroner notes the thrombectomy service for stroke patients operates only during limited weekday hours, denying access to this time-sensitive treatment for those suffering a stroke outside these times. This creates a disparity in access based on when a stroke occurs.
Overdue
Christine Booker
Concerns: The coroner noted the absence of out-of-hours interventional radiology at Dorset County Hospital, requiring patients needing urgent treatment to be transferred to the Royal Bournemouth Hospital.
Response (Dorset County Hospital): • The Trust is carrying out an investigation into the management of the case. • The Trust is auditing transfer times for interventional radiology between sites and compliance with decision-to-transfer … (AI summary)
Response (NHS England): • Colleagues within the Clinical Reference Group for Vascular Disease were consulted. • South West regional colleagues engaged with NHS Dorset Integrated Care Board and NHS England Direct Commissioning South … (AI summary)
Responded
Locket Williams
Concerns: Insufficient psychiatric inpatient beds for children in Surrey, noting a new unit's limited capacity and scope. The new risk assessment system also lacks a clear suicide risk alert on medical records, potentially leading clinicians to miss vital information.
Response (Surrey and Borders Partnership NHS): • The Trust opened Emerald Place in March 2024, stating it has sufficient bed capacity for General Adolescent Unit inpatient beds, and is accessing beds through independent providers while admissions … (AI summary)
Responded
Phyllis Hart
Concerns: The coroner noted the absence of a vascular team at the County Hospital in Stafford, which meant urgent vascular opinions could not be obtained.
Response (University Hospitals of North Midlands): • The Trust confirmed it provides a 24/7 vascular on-call service based at the Royal Stoke Hospital site. • Vascular surgeons are present at County Hospital every weekday. • The … (AI summary)
Responded
Michelle Mason
Concerns: The coroner notes the absence of a 24/7 thrombectomy service in Lancashire and a lack of understanding among non-stroke specialist clinicians regarding its availability. Additionally, there is no regional mutual aid for thrombectomy services.
Response (Lancashire Teaching Hospitals): • The Trust expanded its mechanical thrombectomy service to operate 7 days a week, 08:00–22:00, and is working towards a 24/7 service by 28 February 2026. • The Trust updated … (AI summary)
Response (Lancashire Teaching Hospitals): • The Trust extended its thrombectomy service to operate 7 days per week from 08:00 to 22:00. • It updated its stakeholder communications policy to inform non-stroke clinicians of current … (AI summary)
Response (NHS England): • NHS England's Regional Specialised Commissioning Team engaged with Lancashire Teaching Hospitals NHS Foundation Trust (LTH) to expand its thrombectomy service, which has operated consistently on a 7-day basis (8am-10pm) … (AI summary)
Response (Northern Care Alliance NHS Foundation Trust): • The Trust stated it would continue to work with NHS England, Lancashire Teaching Hospitals, and the Walton Centre to explore options for providing overnight thrombectomy service access to the … (AI summary)
Response (University Hospitals of Morecambe Bay NHS Foundation Trust): • The Trust shared learning from the case and inquest feedback with staff via email, WhatsApp, and at a clinical governance meeting. • Thrombectomy service hours are now distributed more … (AI summary)
Responded
Greta Lewis
Concerns: The coroner noted a gap in the availability of the time-critical thrombectomy emergency procedure for severe stroke patients in the South West region.
Response (NHS England): • NHS England developed a national credentialing programme for non-INR specialists to perform thrombectomy, published in June 2023, and enrolled the first cohort of trainees. • NHS England conducted site … (AI summary)
Response (NHS England): • NHS England supported the development and implementation of a national thrombectomy credentialing programme, which has enrolled its first cohort of trainees. • NHS England conducted site visits to all … (AI summary)
Responded
Keith Reynolds
Concerns: The coroner notes that mechanical thrombectomy services are unavailable outside of 9 am to 5 pm in the region due to insufficient neuroradiologists, potentially leading to preventable deaths.
Response (Newcastle upon Tyne Hospitals NHS Foundation Trust): • The Trust has established a Mechanical Thrombectomy Steering Group which has agreed a plan for a 24/7 service. • It has secured sufficient interventional neuroradiologists for a 24/7 service … (AI summary)
Responded
Select committee recommendations(93)— showing 50 strongest matches
#58 —
Recommendation: In response to this report, the Foreign, Commonwealth and Development Office should set out the extent to which the announced cuts to the UK’s aid budget will affect overseas development assistance for family planning and reproductive healthcare. We recommend that …
Response attribution not verified
#57 —
Recommendation: Professor Dasgupta has emphasised that family planning and sexual and reproductive healthcare is a neglected feature of public policy. The unmet demand for family planning is huge and addressing human population numbers is also key to reducing our demands on …
Response attribution not verified
#46 — Develop funding and training strategy to address insufficient LARC provision in general practice.
Recommendation: The Government should develop a funding and training strategy to address the lack of LARC provision in general practice, particularly in those areas not covered by a women’s health hub. This should include an assessment of whether the current fee …
Response attribution not verified
#45 — Postcode lottery in primary care access to long-acting reversible contraception creates delays and burdens.
Recommendation: There remains a postcode lottery of access in primary care to long-acting reversible contraception. As a result, some women are having to seek care from secondary or community services, leading to delays in treatment and an unnecessary burden on secondary …
Response attribution not verified
#45 — Significantly increase BFI funded short film schemes in the nations and regions.
Recommendation: We recommend that the BFI significantly increase the number of funded short film schemes in the nations and regions. This could be rapidly delivered though BFI Skills Clusters by targeting funding to schemes giving the next generation of filmmakers the …
Response attribution not verified
#24 — Split British Film Commission and Film London CEO roles to address London-centric bias.
Recommendation: To address the industry’s perceptions of organisational London-centric bias, the Government should split the roles of British Film Commission CEO and Film London CEO the next time that the existing contracts are negotiated or the roles advertised. (Recommendation, Paragraph 88)
Response attribution not verified
#2 — Inconsistent FGM survivor services and poor referral pathways create postcode lottery
Recommendation: Services for FGM survivors and access to them remains inconsistent across the UK. While some variation in access to services may be expected in line with local prevalence, there is a lack of effective referral pathways. This has created a …
Response attribution not verified
#20 — Significant regional disparities exist in family court case durations, particularly in London.
Recommendation: In some regions, particularly London, children have to wait much longer than in other areas to have their cases concluded.41 In December 2024, the average duration for public law cases was 24 weeks in Wales but 53 weeks in London; …
Response status not verified
#32 — Concerns remain that \
Recommendation: We asked whether choices labelled “local” are genuinely relevant to smaller communities, particularly in radio and local news. We underlined that local radio remains a “lifeline” for older audiences, and emphasised that, for example, “in Sheffield, local means Sheffield” rather …
Response attribution not verified
#13 —
Recommendation: Access to sexual and reproductive health services is an essential element of healthcare, providing lifesaving services to women and girls and empowering them to make choices about their futures. The FCDO should publish an assessment of the effectiveness of current …
Response attribution not verified
#16 —
Recommendation: We asked DHSC if it had created a postcode lottery of support, and if people with certain conditions in some areas, would have different support to people in other areas with the same conditions.32 DHSC told us that it did …
Response attribution not verified
#65 —
Recommendation: Policy in Practice submitted written evidence outlining how there are practical issues for claimants to address in accessing job centres and their services in the more rural areas of Scotland. In their research, Policy in Practice found that uptake of …
Response attribution not verified
#25 —
Recommendation: The FCDO should continue its work on family planning in Pakistan and reconsider cuts to UK aid programmes in this area.
Gov response: Response: Family planning is recognised as one of the ‘best buy’ investments in development, providing a highly cost-effective way of giving women agency and control over their reproductive health. Increasing family planning has a direct …
Position Not Stated
#24 —
Recommendation: UK aid in Pakistan has funded vital family planning projects. However, despite its own statements reiterating the importance of family planning in Pakistan, UK aid spending has been cut in this area, leading to worse outcomes for women and girls …
Response attribution not verified
#41 —
Recommendation: The renewed Women’s Health Strategy should include a refreshed national commitment to women’s health hubs across England. We recommend the Government invest at least the same amount as in 2023–25 (£25 million) in ringfenced Integrated Care Board funding for women’s …
Response attribution not verified
#40 —
Recommendation: We are concerned that women’s health hubs have not been specified in the 2025/6 operational planning guidance. There is a high risk that without a central requirement to deliver women’s health hubs, and with Integrated Care Boards (ICBs) required to …
Response attribution not verified
#38 —
Recommendation: A key success of women’s health hubs is that they have facilitated co- commissioning of long-acting reversible contraception (LARC) by public authority sexual health services and NHS services. This can be an effective workaround for a dysfunctional LARC commissioning system …
Response attribution not verified
#37 —
Recommendation: The renewed Women’s Health Strategy must include increasing access to long-acting reversible contraception (LARC) as a top priority. There must be a shift across the healthcare system to view LARC as a tool for menstrual health management, not only for …
Response attribution not verified
#36 —
Recommendation: The fragmented commissioning system for long-acting reversible contraception (LARC) is preventing many women from accessing LARC, which can be an effective treatment for menstrual problems. The current system results in many women being added unnecessarily to huge elective gynaecology waiting …
Response status not verified
#19 — Embed comprehensive age-appropriate sex education into FCDO ODA-funded education programmes.
Recommendation: Access to SRHR services and comprehensive sex education is vital to adolescents; however, adolescents may often face barriers to accessing sexual and reproductive health services. Ensuring that women and girls are fully educated on sexual and reproductive health can empower …
Response attribution not verified
#13 — Integrate female genital schistosomiasis care into UK SRHR programming with education and WASH.
Recommendation: Female genital schistosomiasis is a painful and debilitating but treatable condition affecting up to 56 million women. FGS is best tackled through an integrated approach with wider SRHR programming, as well as with other areas of programming such as education, …
Response attribution not verified
#12 — Incorporate gynaecological disease care and HPV vaccine provision into FCDO SRHR programming.
Recommendation: The FCDO has not sufficiently addressed the threat of gynaecological disease in its SRHR programming, despite the risk it poses to the SRH of women and girls. The prevalence of cervical cancer among women and girls in lower-income countries is …
Response attribution not verified
#11 — Support menstrual health by providing WASH services, menstrual products, and age-appropriate education on menstruation.
Recommendation: The FCDO should support menstrual health by supporting the provision of WASH services and infrastructure and access to menstrual products. In particular, the FCDO should ensure that its work in the education and WASH sectors complement its SRHR work in …
Response attribution not verified
#10 — Inadequate menstrual health information and WASH services hinder women and girls in low-income countries.
Recommendation: To meet menstrual health needs, women and girls must be able to access accurate, timely and age-appropriate information about menstruation. In addition, they need access to WASH services and inclusive infrastructure. Without adequate services and facilities, managing menstruation can be …
Response attribution not verified
#26 — Collect comprehensive data on reproductive health delays, referrals, and treatment outcomes to address inequalities
Recommendation: Data and analysis must improve. The NHS should collect data on where there are delays in the system, where women are being referred from, which could highlight areas where community provision is lacking, which groups of women are most affected …
Response attribution not verified
#25 — Prioritise longest elective surgery waiting lists and provide financial support for women's travel
Recommendation: Measures to reduce waiting lists for elective surgery should prioritise areas where waiting lists are longest and disparities greatest. The NHS should provide financial support to women to allow them to travel further to access care earlier.
Response attribution not verified
#21 — Commission women's health hubs to include mental health support in core specification in underserved areas
Recommendation: Women’s health hubs situated in areas where access to appropriate mental health services is lacking should be commissioned to include mental health support as part of their core specification.
Response attribution not verified
#15 — Mandate NHS practitioners to stay updated and address regional disparities in reproductive health treatments.
Recommendation: The NHS must take steps to ensure healthcare practitioners keep up to date with the full range of diagnostic and treatment options available for reproductive health conditions. Those options, as well as waiting times and potential outcomes of surgical procedures …
Response attribution not verified
#17 — NHS funding mechanisms create perverse incentives, disadvantaging deprived areas for childhood vaccinations.
Recommendation: We asked about the equity of NHS funding mechanisms and the risk of perverse incentives, using as an example the distribution of money for childhood inoculations. GP surgeries receive a payment for every child that gets a vaccine.29 In our …
Response attribution not verified
#4 — Ensure all FGM survivors access timely, essential support and specialist care nationwide
Recommendation: The Government should ensure that all FGM survivors can access the essential support and care they need in a timely manner. While some variation in service provision may be necessary to reflect local prevalence rates, higher-prevalence areas should offer funded …
Response attribution not verified
#28 — Provide a timeline for place-based business case pilot projects and national rollout, ensuring Green Book reforms benefit all …
Recommendation: In response to this Report, the Government must provide a timeline for when it will launch its pilot projects using place-based business cases, and when the new model will be rolled out nationally. It must also set out how it …
Response attribution not verified
#8 — Rural bus service recovery remains challenging, requiring LTA-led improvements
Recommendation: We asked the Department what action it is taking to support rural areas which have seen significant cuts to bus services and poor performance, leaving would-be passengers stranded.13 The Department acknowledged that the recovery in bus usage was particularly challenging …
Response attribution not verified
#144 —
Recommendation: New public services including libraries, diagnostic centres and local government buildings should be located on the high street in the first instance, with the same sequential test applied to retail being applied to these services. The Government should amend the …
Response attribution not verified
#13 —
Recommendation: The government should ensure the CMA’s remedies are fully rural proofed. The government should instruct the CMA, in partnership with the Royal College of Veterinary Surgeons, to establish a monitoring framework by September 2027 to coincide with the deadline for …
Response status not verified
#2 —
Recommendation: While recruitment has stabilised and the arrival of new entrants through the pipeline has increased, significant and persistent gaps remain in public sector roles, geographically isolated practices and other “deficit areas”. High attrition rates and a “constant churn” in some …
Response status not verified
#13 —
Recommendation: The Catholic Education Service wrote to tell us that families in remote, isolated communities struggled to find an appropriate shop from which to purchase food, due to the limited number of supermarket chains taking part in the scheme.23 In its …
Response attribution not verified
#3 —
Recommendation: Huge local variation strongly suggests that GPs were inconsistent when judging who was clinically extremely vulnerable and should therefore be advised to shield and be eligible for support. As well as NHS Digital using national data to identify clinically vulnerable …
Response attribution not verified
#124 —
Recommendation: Other criticisms of UKRI funding brought to our attention included, from Dr Vicky Johnson, University of the Highlands, that its “money tends to go to the older universities, and not the post-1992s or the very new universities”.290 Also, from Professor …
Response attribution not verified
#123 —
Recommendation: On the subject of regional disparities in UKRI funding, Iain Stewart MP said to us “I don’t think there is a problem there to be solved. I don’t think we should get into the position of allocating money purely on …
Response attribution not verified
#11 —
Recommendation: We need a better solution to geographic disparities in education. The Government must acknowledge the diversity of challenges facing disadvantaged White communities and develop better ways to target support. We understand that Opportunity Areas are a relatively recent policy and …
Response attribution not verified
#14 —
Recommendation: The Government and UKRI should, in response to this report, and on an annual basis thereafter, set out how the R&D budget will be allocated by sector, region and cluster. The Government should also, in its response to this report, …
Response attribution not verified
#13 —
Recommendation: Future disclosures of departmental R&D spending should include breakdowns by region and cluster. The Government and UKRI should also develop a framework for tracking impact and publish annual regionally disaggregated reports that set out how public R&D funding supports innovation …
Response attribution not verified
#6 —
Recommendation: It is unacceptable that access to 24/7 palliative and end of life care services remains patchy throughout England. Individuals nearing the end of life should be able to access the right care, advice and medication, wherever they are and regardless …
Response attribution not verified
#39 —
Recommendation: We strongly disagree with the Minister’s argument that further ringfenced funding to support NHS Integrated Care Boards to maintain and develop women’s health hubs is unnecessary. The implementation of women’s health hubs is not complete. There are inconsistencies in provision, …
Response attribution not verified
#17 — Variations in local drug treatment funding and services hinder access for many in need.
Recommendation: DHSC has allocated strategy funding for drug treatment and recovery to local authorities on a phased basis over three years, with the areas suffering greatest harm receiving priority.52 Mr Trace told us there is no national system, with variations in …
Response attribution not verified
#1 — Place of residence significantly impacts health, driving preventable health inequalities in disadvantaged areas.
Recommendation: The places where people live—homes, communities and neighbourhoods—affect their health and wellbeing substantially. Place, health inequalities and the likelihood of developing preventable health conditions are inextricably linked. People from less well-off groups, and those who live in less well-off neighbourhoods, …
Response attribution not verified
#4 —
Recommendation: The Department did not do enough to assess how far families had to travel to supermarkets in the scheme and whether coverage was adequate to meet needs. The Department worked with the Department for Environment, Food & Rural Affairs to …
Response attribution not verified
#22 —
Recommendation: Cancer Alliances have had a positive impact on transforming cancer services and sharing best practice, and enjoy strong support from the sector. However, it is clear that while they are having some success, there is still significant unwarranted variation across …
Response attribution not verified
#3 —
Recommendation: It is unacceptable that there are parts of the country where women cannot access the specialist menopause services they need. By 2024, there should be a menopause specialist or specialist service in every Clinical Commissioning Group area. The Menopause Taskforce, …
Response attribution not verified
#22 —
Recommendation: We recommend that the Government moves towards sustainable and predictable models of funding for hospices, financing their running as well as investment costs, which reflects the increasingly central role they will play in delivering end of life care. This funding …
Response attribution not verified
Health investigations(1)
Independent reviews(1)
PHSO casework decisions(6)
P-004486 — Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board
Miss P complained the ICB declined funding for her sterilisation, arguing its policy creates health inequalities for women and lacks proper evidence. She also cited poor complaint handling.
NHS in England
Upheld
Dec 2025
P-003237 — A practice in the North Yorkshire area
Miss O complained the Practice provided insufficient information for her IVF funding application, causing delays that impacted her chances of becoming a mother due to her age.
NHS in England
Dec 2024
P-002043 — Cambridgeshire and Peterborough Integrated Care System
Miss T complained the ICS denied her IVF treatment, ignoring its own policy by considering her partner's medical history, and handled her complaint poorly.
NHS in England
Jun 2023
P-003161 — Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Mrs I complained Trust staff refused to remove her coil, giving conflicting reasons, which caused her extreme distress and fears about unintended pregnancy.
NHS in England
Nov 2024
P-001877 — Hampshire and Isle of Wight Integrated Care Board
Mrs T complained the ICB unfairly withdrew funding for fertility treatment after a private round, causing financial strain, distress, and delaying further pregnancies.
NHS in England
Mar 2023
P-004285 — South West London Integrated Care Board
Complaint alleged an Integrated Care Board (ICB) unjustly denied her funding request for IVF, causing significant emotional distress and mental health impact.
NHS in England
Nov 2025