Postcode lottery of care persists in England
pharmafile | September 11, 2008 | News story | Sales and Marketing |Â Â parÂ
A new report identifies widespread variations in how much the NHS spends locally on different diseases.
The King's Fund says some PCTs appear to spend much more than others on particular therapy areas even when the different needs of local communities are taken into account.
Spending varies from 8.7% to 25% of PCTs' budgets on mental health, 3.6% to more than 9% on cancer and 5.7% to nearly 11% on circulatory diseases such as heart disease.
The report, NHS Spending: Local Variations in Priorities: An Update, used Department of Health figures from 2004-07 in its analysis and showed that the NHS received an extra £9 billion (a 16% increase) over that period.
It found at the extremes that:
* Islington PCT spends £332 per head of population on mental health compared with £114 by East Riding of Yorkshire PCT (a 2.9-fold gap in spending)
* Knowsley PCT spends £118 per head on cancer compared with £47 by Ealing PCT (a 2.5-fold gap)
* Middlesbrough PCT spends £167 per head on circulatory diseases compared with £76 by Southwark PCT (a 2.2-fold gap)
Across the board the government's priority disease areas – mental health (which represented 12% of PCT spending), coronary heart disease (9%) and cancer (6%) – take the largest financial shares.
At £8.4 billion, mental health services represents an investment of twice that spent on cancer care.
The report carries the caveat that there may also be some problems with data quality and accuracy in places, but it does take into account local differences in population and other legitimate variations.
King's Fund's chief executive Niall Dickson admitted that the report raised questions rather providing answers.
"It does not mean that any one PCT's spending is necessarily wrong but it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations – some of these are almost certainly not justified," he said.
"This latest analysis reveals that the widespread variations in PCT spending on different diseases have remained relatively unchanged over the past three years," says Professor John Appleby, the King's Fund's chief economist. "Even when local need and other legitimate reasons for variations in spending are taken into account, PCTs continue to spend varying amounts on cancer, coronary heart disease, mental health and a range of other diseases."
Not all variations will be due to deliberate choices by PCTs, he added.
Factors such as variations in decisions by clinicians about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, will also contribute to the differences.
The King's Fund says more work is needed to understand why these variations occur and persist, and warns that Department of Health data – used in part to determine the size of PCT budgets each year – may be insensitive to some dimensions of need, by disease and by area.
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