BBK Manifesto 2026: Stop the healthcare postcode lottery

Where you live can still determine the standard of medical treatment you receive, despite the NHS’s founding principle of equal access to healthcare. Variations in funding, service provision, local priorities and care pathways mean too many patients continue to face a postcode lottery. 

Since our 2025 Manifesto for Injured People, we have seen some positive steps forward. In January 2026, the Government announced measures to tackle the postcode lottery in cancer care, including increasing the number of cancer specialists in underserved communities, ending regional disparities in access to diagnostic technology and raising standards of care across England. A particular focus will be on rural, coastal and deprived areas, where patients often face longer waits for diagnosis and treatment due to workforce shortages.  

But much more still needs to be done, so we are urging the Government to set national minimum standards for specialist services and access to equipment. Through the 2026 BBK Manifesto, we are shining a spotlight on areas where postcode-driven disparities remain particularly stark and setting out the changes needed to create a fairer, more consistent healthcare system for all. 

Concerns from the SCI community  

The postcode lottery for people with spinal cord injuries could worsen under plans to move responsibility for specialist services from national NHS oversight to 36 local Integrated Care Boards from April 2027, MPs have warned. 

The All-Party Parliamentary Group (APPG) on Spinal Cord Injury found there were already persistent variations in access to specialist rehabilitation, coordinated support and long-term care, with patients often experiencing different outcomes depending on where they live.  

Given the highly complex nature of spinal cord injury, the APPG argues that stronger national coordination and consistent standards are needed to ensure equitable care across the country. The concern is that further localisation could leave patients and families navigating a fragmented system, with access to vital services dependent on geography rather than clinical need. 

Wheelchair access

Another example impacting our clients is the inconsistent access to mobility aids, in particular wheelchairs. There are widespread delays across NHS wheelchair services.  

In December 2025, a light was shone on this issue when the House of Lords held a debate examining the UK Government’s plans to publish a strategy for wheelchair provision through NHS and social care services. The debate highlighted widespread concern about the inconsistent and uneven provision of wheelchairs and mobility equipment across England. Lord Hunt described services as under-resourced and subject to a postcode lottery, while Lord Kamall pointed to significant regional variations in eligibility criteria, meaning patients can face very different requirements depending on their local authority or Integrated Care Board. 

For example, North Bristol defines regular use of a wheelchair as four times a week, in Oxford it is at least three days per week, and Wirral and West Cheshire defines it as “more often than not”. 

These disparities are causing widespread issues.  

Access to MRI machines

Limited access to MRI scanners also presents a huge challenge for the NHS, especially for those with a spinal cord injury. The UK has one of the lowest numbers of MRI scanners per capita in the developed world, with only 8.6 per million people. Germany has upwards of 34 to 35 units per million people – more than triple the UK rate. 

As a result of this lack of equipment, almost half (46%) of NHS acute trusts in England are failing to meet the interim target that no more than 20% of patients should wait longer than six weeks for a diagnostic test.  

Analysis by the Royal College of Radiologists found that, in September 2025, more than 386,000 people waited beyond the six-week standard, including more than 74,000 patients awaiting CT or MRI scans, which are critical for the timely diagnosis and treatment of conditions such as cancer. Overall, more than 1.7 million people were on diagnostic waiting lists, with patients in the East of England experiencing the longest delays.  

While NHS trusts have until 2027 to meet the national target, only around half are currently doing so. 

For people with Cauda Equina Syndrome (CES), this shortage can be particularly harmful, as timely diagnosis is essential to avoid permanent neurological damage. The national Getting It Right First Time (GIRFT) pathway recommends that patients with suspected CES receive an emergency MRI within four hours. However, a 2024 review by Bolt Burdon Kemp found 62% of NHS trusts had not implemented the GIRFT pathway, and nearly 40% cited a lack of 24-hour MRI access as a key barrier. 

Access to latest technologies

Analysis by the Royal College of Surgeons of England found significant regional variation in access to robotic-assisted surgery, raising concerns about a postcode lottery for patients across the NHS when it comes to access to the latest technological advances in healthcare.  

The review, based on Freedom of Information data from NHS trusts, revealed major differences in how robotic surgery technology is funded, distributed and used, despite national guidance from NHS England. It also highlighted that some hospitals have had to rely on charitable donations to purchase robotic surgical systems, with Royal United Hospitals Bath NHS Foundation Trust reporting that more than £2 million was raised through donations.  

Similarly, the Royal College of Radiologists (RCR) and Radiotherapy UK have warned of a “deadly postcode lottery” regarding access to two innovative forms of radiotherapy that are known to be effective against cancer. 

While progress has been made in tackling some healthcare inequalities, access to care, equipment, diagnostics and innovative treatments remains too dependent on where a person lives. Patients with the same condition should be able to expect the same standard of care, regardless of postcode.  

This is why we’re calling for national minimum standards for specialist services and equipment, ensuring consistent access to rehabilitation, wheelchairs, diagnostics and treatment across every Integrated Care Board. Healthcare shouldn’t be a lottery based on location.  

This blog is part of our 2026/27 Manifesto for Injured People. At Bolt Burdon Kemp, we support injured people not only by winning their cases but by driving positive change. Guided by our clients’ experiences and partnerships with charities across the UK, we are raising awareness of the changes needed to better support injured people. We will continue working with politicians from all parties to ensure injured people’s needs are not overlooked in Westminster or beyond. You can read our full manifesto here.