Cost of living - a black lady stands against a doorframe looking stressed

Cost of living

Cost of living – a barrier to healthcare for the most vulnerable

The cost of living is having a detrimental impact on people’s decisions about their healthcare.

If you are disabled, on means-tested benefits or aged 18-24, research shows you’re more likely to avoid vital health services due to the fear of extra costs. Healthwatch England has set out immediate actions for the government and the NHS.

Over the last year, many charities and campaign groups have warned that millions of people are struggling with the cost-of-living crisis.

To understand the scale of this impact, especially on people’s health and their use of health and care services, Healthwatch England commissioned a poll of people in England.

Findings from waves 1 and 2 were reported on earlier this year.

Key trends

The poll of 2000 adults in England, conducted four times between October 2022 and March 2023, suggests that people are increasingly avoiding vital health and care services due to the fear of extra costs. These include:

  • going to a dentist because of the cost of checks ups or treatment
  • booking an NHS appointment because they couldn’t afford the associated costs, such as accessing the internet or the cost of a phone call
  • buying over the counter medication they normally rely on
  • taking up one or more NHS prescriptions because of the cost.

Rising costs further exacerbate health inequalities

The research also highlighted that the financial burden of healthcare is weighing heavily on specific groups:

  • people on disability benefits
  • people on means-tested benefits
  • and younger people, aged 18-24.

People from these groups are more likely to be making tough decisions to avoid essential services. Examples include:

  • People on disability benefits are over twice as likely to have avoided their usual over-the-counter medication than the general public, 15% compared to seven per cent.
  • 20% of people on means-tested benefits have avoided booking an NHS appointment due to the associated costs, including the internet or phone call, compared to six per cent of the general public.
  • People aged 18 to 24 are twice as likely to have avoided an NHS appointment due to travel costs compared to the general public, 14% to six per cent.
  • On average, one in five people from each group avoided the dentist because of the related costs.

The cost of living should never be a barrier to care

As a patient champion, we are worried that vital health and care services are out of reach for many people.

We know that people living with ill health and disability are already much more likely than others to be pulled into poverty because of spiralling costs.  Making decisions between eating, medications and keeping medical devices running, can further impact their physical and mental health, putting them in danger.

The cost of living should never be a barrier to healthcare.


While we welcome the support already in place, social tariffs and schemes must be better communicated to the people who need it.

This includes ensuring that:

  • Communication providers communicate about and signpost to social tariffs
  • Primary care teams make people who need medication aware of pre-payment options
  • Dentistry teams offer check-ups based on individual need, to free up more NHS slots
  • More people are aware of the Healthcare Travel Cost Scheme (HTCS).

The government working with health and care services must also go further to support people in the cost-of-living crisis.

Tangible actions

Healthwatch England has set out immediate tangible actions:


Guidance should encourage GPs to offer people over-the-counter medications on prescription based on socioeconomic grounds.


NHS England should re-open its review of the HTCS, and introduce reimbursement for journeys to people’s GP, dentist and pharmacy teams.

NHS freephone 

NHS England should work with Ofcom and telecommunications companies to ensure that hospital and GP phone numbers are part of the freephone service, so cost is never a barrier to phoning a health service.

Benefits system 

Government should ensure benefits, including Statutory Sick Pay (SSP), keep pace with inflation in real terms.

Government should also extend the amount of time SSP can be paid to people who can no longer work due to long waits for NHS treatment. One in ten people wait over four months for a GP referral, and 92% of people on waiting lists are currently waiting up to 46 weeks for a hospital appointment. This means that the current 28-week access cannot support those who need it.


Health leaders and regulators should look at what more can be done to ensure telecommunications providers introduce and raise awareness of social tariffs to eligible households, as the uptake of this support remains low.

Recent research by Citizens Advice suggests that up to one million people have cancelled their broadband in the last year because they couldn’t afford it.

As we increasingly move to more remote ways of communicating, tracking, managing and attending NHS appointments, we must ensure that everyone can access the support they need.


If you would like to tell us about your experience of the cost of living and how it has affected health and social care services you have used please get in touch.

Mother and baby next to a window

Postnatal checks failing many

Thank you to everyone who told us about their experiences of maternal mental health care. Healthwatch England has analysed the responses shared by 2,693 new mothers and birthing parents since April 2020 and you can read the findings below.

The analysis suggests that not all GP practices comply with the requirement to provide six to eight-week postnatal checks. And where those checks take place, it is not clear that GP practices are aware of NICE guidance which tells them in detail how to spot mental health problems and provide help.

Key findings

  • Over one in 10 (16%) of new mothers and birthing parents who shared their experiences said they hadn’t received the six to eight-week check.
  • Of those who said they had been offered the postanal check, only one in five, 22%, were satisfied with the time their GP spent talking to them about their mental health.
  • Nearly half, 44%, of respondents felt that the GP did not spend enough time talking to them about their mental health, while a third, 30%, said that their GP didn’t mention this during the check.
  • One in seven, 15%, said they had had their six-week check over the phone, with many new parents finding it hard to verbalise their mental health struggles and discuss physical issues. In the worst cases, respondents felt the way their mental health issues were discussed was inappropriate and potentially harmful.

Six-week postnatal checks

In April 2020, the Government introduced the six to eight-week postnatal check after Healthwatch England shared the experiences of almost 1,800 women on mental health during their journey to parenthood.

General practitioners in England have since been contractually obliged and paid to assess new mothers’ mental health and wellbeing, providing an opportunity for referral to specialist services and additional support. Crucially, the checks must take place separately from a postnatal check focused on the health of the baby.

The latest research took place between October and December of 2022 to find out to what extent mental health support has improved during and after pregnancy.

Experiences of mental health support during and post-pregnancy

  • Two-thirds, 1800, of the women and birthing parents who shared their experiences had struggled with their mental health during and after pregnancy.
  • Nearly half of those, 41%, received no support to help with their mental health during and post-pregnancy.
  • Delays in accessing mental health support can have a devastating impact on new parents, with some reporting they had struggled to leave the house, bond with their child and maintain relationships.
  • First-time mothers are particularly vulnerable to developing mental health problems and are less likely to access timely care.

Louise Ansari, National Director at Healthwatch England said: “With mental ill health affecting up to a third of new and expectant mums, six-week postnatal checks are key to assessing their wellbeing after the birth. If left untreated, poor mental health can have a devastating impact on new parents and their families.

“Unfortunately, our findings show that although most new mothers and birthing parents are likely to be invited to a postnatal consultation, these are frequently carried out as a tick-box exercise, where mental health is not treated as a priority or not assessed at all.

“Monitoring the delivery of six-week checks should be the first step to ensuring there’s a consistent approach to offering quality mental health support to all new mothers. NHS England should consider what additional support and guidance it can provide to GPs so that the help new parents get is of the best quality.

“We also need to ensure that maternal mental health and peri-natal services continue to remain on the government’s agenda and a priority in workforce planning and funding budgets.”


Healthwatch England has made five recommendations to help ensure every new mother and birthing parent receives the six-week check, and that it is of the highest quality:

  1. Integrated Care Systems (ICSs) should monitor the delivery of six to eight-week postnatal consultations as part of their primary care commissioning responsibilities.
  2. The Medical Licensing Assessment being introduced from 2024 should check understanding of the importance of postnatal mental health and the mental health element of postnatal checks.
  3. The section of the GP contract on delivery of postnatal consultations should be updated to include mention of signposting to specialist and community mental health services and point to best practice guidance around carrying out open-ended discussions.
  4. As part of its Maternity Transformation Programme, NHS England should consider what additional support and guidance it can provide for GPs to have quality conversations about mental health at the six to eight-week postnatal consultation.
  5. Deliver the Long-Term Plan commitments on improving access to specialist community perinatal mental health services.


Find maternity and parenting information and support

Get in touch to tell us about your experiences

Are you struggling to access health services this winter?

With the NHS under extra pressure this winter, we need to hear your experiences of care to help services understand what is working and spot issues affecting support for you and your loved ones.

The NHS is facing added pressures this winter. This means that it can be more challenging for people to receive the care they need.

Feedback from the public can play a vital role in helping health and social care services understand what is working and spot issues affecting the care of local people.

This is why we have launched a campaign to get more people to share their experiences of care this winter.

If you or a loved one have used GPs, hospitals, pharmacies, care homes or other support services this winter, we want to hear about your experience.

Every experience matters

Have you faced challenges or delays accessing health and care services this winter? If you have, we want to know how this has affected your health and wellbeing.

Have you found accessing NHS services easy? Are there any aspects of the care you got that you really valued?

Your positive or negative feedback can help services hear what is working and spot issues affecting care for you and your loved ones.

Have your say

Please share your experience and help us make NHS decision-makers aware of what needs to change to improve access to care.

We’re completely independent and impartial, and anything you say is confidential.

Share your story

You can also provide feedback on care by giving us a call on: 03332 408 468

NHS stay well this winter

How to stay well this winter

Winter conditions present an increased risk to our health, especially if you are older or have a long-term health condition such as heart or kidney disease, asthma or diabetes.

Being cold can raise the risk of increased blood pressure, heart attacks and strokes. The cold, damp weather can aggravate existing health problems, making you more vulnerable to respiratory winter illnesses. Here are some tips to help you stay well this winter.

Top tips to stay well from the NHS

  • Make sure you get your COVID-19 booster and flu vaccination if you are eligible.
  • Keep warm by wrapping up, wearing lots of layers of thin clothes.
  • Stay active by moving around indoors, avoid sitting for more than one hour. Keeping active can also support your mental health.
  • Keep the heat in by drawing your curtains at dusk and keeping doors closed to block draughts. Try and heat rooms you regularly use to at least 18°C and keep your windows closed at night. Make sure you’re getting the help you’re entitled to with heating costs.
  • Use a hot water bottle or an electric blanket to keep warm in bed – but don’t use both at the same time.
  • Have at least one hot meal a day. Eating regular meals and drinking hot beverages can help you keep warm.
  • Look after your mental health by speaking to someone – a friend, family member or healthcare professional, like your doctor – if you are feeling down. Check out the NHS website for support on where to get urgent mental health support.
  • Make sure you have the right medicines at home in case you get poorly. Ask your pharmacist if you are unsure.
  • Wash your hands with soap and water:
    • When you get home or into work;
    • After you blow your nose, sneeze or cough; and
    • Before you eat.
  • If you get ill, rest and keep warm, drink lots of liquids, have at least one hot meal each day and take the tablets you have been recommended by a healthcare professional.

If you get ill

  • If you think you need medical help right now, call 111 by phone or use NHS 111 online.
  • If it is a real emergency and life-threatening, then you can call 999.
  • If it’s less urgent contact your doctor or pharmacist.

Look out for others

  • Keep in touch with your friends, neighbours and family and ask if they need any practical help, or if they’re feeling under the weather.
  • Make sure they’re stocked up with enough food supplies for a few days, in case they can’t go out.
  • If they do need to go out in the cold, encourage them to wear shoes with a good grip and a scarf around the mouth to protect them from the cold air, and to reduce their risk of chest infections.
  • Make sure they get any prescription medicines before the holiday period starts and if bad weather is forecast.
  • If you’re concerned about someone’s health or safety, call NHS 111 for health advice, or 999 in an emergency.

Download the NHS stay well this winter leaflet

Download the NHS stay well this winter easy read leaflet

Need more advice?

Read more tips on keeping well this winter at the NHS website.


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Pregnant lady and her partner

Tell us about maternal mental health care

Pregnancy is a major life event for any family. It can be joyful and fulfilling but also challenging. Healthwatch England is launching a national survey to understand if care works for new mothers and birthing parents and what needs improving for people who develop mental health difficulties relating to their maternity experience.

With one in four women experiencing mental health problems during pregnancy and in the first year following the birth of a child, support from maternity services can significantly impact their mental health and wellbeing.

Who do we want to hear from?

  • We want to hear from you if you have been pregnant in the last two years and have experienced mental health difficulties before, during or after giving birth.
  • We are interested in the experiences of women from ethnic minority communities and LGBTQ+ birthing parents.

Everything you share is confidential and will help us and the NHS understand what they need to put in place to better support people using maternity services.

Share your story

Find out more about Healthwatch England’s research

This piece of work has now finished.


Share your experiences of GP referrals

Have you been referred by your GP practice to a specialist for tests, diagnosis or treatment? Or have you expected or requested a referral but didn’t get one? We’d like to hear about your experiences to help the NHS understand what is working and what could be better.

The survey will only take a few minutes of your time and any information you share will be anonymised.

What is a GP referral?

It’s when a GP or other medical professional at a GP practice sends you to a specialist at a hospital or community clinic for further tests, diagnosis or treatment. Your GP could make a referral for many reasons, such as a hip replacement, MRI scan, physio, mental health services, endoscopy and more. A referral can happen during a phone or face-to-face appointment.

Tell us about your experiences

Share your views about GP referrals

Have you or your loved one struggled to get a GP referral for tests or treatment?

Healthwatch England has been hearing from the public about how hard it can be to get a GP practice referral to another NHS service, and they would like to hear about your experiences.

GPs are the first point of call for many health issues and the gateway to specialist support. But with many GP surgeries stretched thin and under pressure, NHS decision-makers need to understand if people are finding it difficult to get the right help.

Examples of services your GP can refer you to include:

  • Scans or tests for a diagnosis of a condition or health issue
  • Mental health support
  • Surgery for knees, hips and eyes
  • Support like physiotherapy for back pain or arthritis
  • Non-urgent heart problems
  • Wellbeing services, like smoking cessation or diabetes management.

The impact of delayed referrals

GP referrals affect people of every age group, every background, and every region across the country. Some of the things patients have said include:

  • People feel like their symptoms are dismissed
  • They have to try multiple times before they’re successful
  • They are left in the dark about how serious their condition is.

Share your views

As the independent champion of health and social care services, we want to hear your experiences of trying to get specialist NHS support, like physiotherapy, talking therapies, hospital scans and consultations.

By sharing your story, we can use your feedback to help the NHS better understand your challenges and improve how people access the care they need.

Find out more about GP referrals

This piece of work has now ended.

Your Care, Your Way – what you said

Healthwatch England has published new findings, which show services are failing in their legal duty to provide accessible information for people with physical and learning disabilities.

As part of the Your Care, Your Way campaign, between March and May 2022, an online survey was carried out which heard from 605 people affected by communications challenges.

People being refused communication support

One in four respondents (28%) – including deaf, blind and people with learning disabilities – said they had been refused help when requesting support to understand information about their healthcare. This included information being provided in formats such as Braille, British Sign Language and Easy Read.

Not being given information in the right format affected people’s mental health and wellbeing (38%), meant they missed out on important information about their health (29%) or meant that they could not contact a service they needed (27%).

Respondents also reported that the quality of communication from NHS and social care services had worsened over the last two years. Two-thirds (67%) felt that the way health and care services communicate with them had gotten worse or slightly worse over the course of the pandemic.

Impact on people who have mental health conditions

It is not just people with sensory impairments or learning disabilities who are affected by this issue.

A fifth (22%) of those who reached out to Healthwatch to share their experiences identified themselves as having a mental health condition, such as depression or anxiety.

Of these people, 35% reported they rarely or never get the support they need to understand healthcare information or communicate with staff. The majority of them (70%) also said that the lack of information in a format they could understand further impacted their mental health and wellbeing.

Why we need better Accessible Information Standard

The findings come as NHS England (NHSE) is conducting a review of the Accessible Information Standard (AIS). The Government created this legal requirement in 2016 to ensure all publicly funded health and social care providers meet the information and communication needs of people who are deaf, blind or have a learning disability. Publication of this review is expected later in the year, with updates to be implemented by April 2023.

Earlier this year, Healthwatch England uncovered that many health and social care providers significantly failed their duty to ask about people’s communication needs and then act on this information.

They joined forces with leading disability organisations, including RNIB, RNID, Mencap and SignHealth, to inform the long-awaited review of the AIS. The coalition called on NHSE to take on board their recommendations, including stronger accountability across services to protect people’s rights to accessible information.

Louise Ansari, national director at Healthwatch England said:

“Our findings are a stark reminder that some of the most vulnerable people in our society are still excluded from access to healthcare because they communicate in British Sign Language or they need information in visual formats. And this is despite the fact that their rights to accessible information are protected in law.

“People’s right to accessible information should be based on their communication needs, not just on a diagnosed disability. For instance, people who have a mental health condition or are waiting for a diagnosis should have a right to request communication support in the same way as people who have a sensory loss or a learning disability.

“If people cannot get information about their healthcare they understand, this can have a significant impact on their mental health and can lead to them missing doctor’s appointments or taking the wrong medication, putting them in danger.

“As we are waiting for the review of the Accessible Information Standard, we strongly advise that NHSE and the newly created 42 integrated care systems ensure equitable access to healthcare for everyone.”

Find out more about the results of the accessible information survey

Get in touch

If you would like to tell us about your experience of accessing health and social care services in the last 12 months please get in touch.

Because We All Care

‘Because We All Care’ – tell us what you think about services

Healthwatch England has launched #BecauseWeAllCare with the Care Quality Commission to help improve care by encouraging everyone to share their experiences of health and social care services.

Public feedback helps spot what is working well and what could be better. With services working to respond to the COVID-19 pandemic and deal with a backlog of care, people’s views have never been more important.

New research from the Care Quality Commission highlights the impact lockdown measures have had on the wellbeing of people who use care services:

  • Nearly three-quarters of carers (73%) say that the COVID-19 lockdown restrictions have impacted on the mental health of the person they care for.
  • Over half (56%) of carers say that the COVID-19 lockdown restrictions have impacted on the dignity and independence of the person they care for.

The research also found that throughout the pandemic, care was most commonly impacted by:

  • Increased waiting times for appointments and procedures (49%)
  • A lack of resources and equipment (24%)

With just 17% of people in England expecting services to improve in the next 12 months, we are calling for you to feedback on the services you use as a crucial way to improve their quality.

Sir Robert Francis QC, Chair of Healthwatch England, said:

“Since the outbreak of the COVID-19 pandemic, public feedback has played an important part in helping the NHS and social care services spot and respond to issues caused by the virus.

“As we continue to live with the pandemic, the NHS continues to face huge pressures across the whole system. NHS staff are grappling with many difficulties, including increased COVID demands, while trying to tackle the backlog in elective care and diagnostics that the pandemic had made so much worse.

“It is important that this is managed as well as possible, to make sure that the risks and distress to patients are minimised. That’s why it is vital people have the opportunity to share their views and experiences of care whether they have needed treatment for COVID-19 or other illnesses. Their feedback will help services understand both key national and local issues and the steps they can take to serve patients better.”

So, if you’ve recently used a GP, dentist, hospital or other care service, let us know your experience and help improve care for everyone.

Share your story

adult social care Northumberland

What is Adult Social Care?

Do you or a loved one need help with social care? Healthwatch England has put together a useful guide about who can access adult social care and how to pay for it.

Social care can be very different from the health care you receive from the NHS. Although it can include medical help, social care offers more practical support to enable people to live independently. These services are usually provided in people’s homes, care homes or elsewhere in the community, rather than at a GP practice or hospital.

If you or someone you live with needs social care, it’s important to understand what types of care and support are available, where to find the correct information, and how services are paid for.

Read What is Adult Social Care?

If you would like to tell us about your experiences of adult social care services get in touch.