IntroductionHospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.MethodsWe conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.ResultsBetween March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.ConclusionsEven in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.

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Health Education England and NHS England/Improvement for helpful discussions throughout the course of the project, and the Policy Research Unit's patient and public involvement and advisory group for helpful comments on the emerging findings of this study and reading a near final version of the report. This subject clearly matters to patients, as one of our patient advisers noted: 'Security of staffing levels is obviously critical to maintaining a good service, but also in giving confidence to patients using the service. Nobody wants to feel that they might be on the receiving end of an under-resourced medical team.'The views expressed are those of the authors and not necessarily those of the NIHR, the DHSC, or the ESRC. Factors associated with staff retention in the NHS acute sector  The Institute for Fiscal Studies, August 2022 Key findings1 Average monthly leaving rates differ substantially between NHS staff groups, but have remained stable over time. On average, 0.4% of consultants left the NHS acute sector each month between April 2012 and May 2021. The average leaving rate was 0.8% for nurses and midwives over the same period, and 1.2% for HCAs.

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