Huge regional variations in NHS spending revealed
pharmafile | August 11, 2006 | News story | |Â Â Â
A new report has revealed large differences in how NHS money is spent across England, with some PCTs spending much greater amounts of money on heart disease and cancer than others.
The analysis of NHS spending data by the independent think-tank, the King's Fund, takes into account differences in the health needs of local populations and other relevant factors, exposing for virtually the first time ever the variation in how diseases are prioritised in the health service.
The exercise has been made possible by the Department of Health releasing budget data as part of its National Programme Budget Project, one of the aims of which is to make NHS spending more transparent.
In one of the most extreme cases, Islington PCT is spending four times more on mental health than Bracknell Forest PCT after accounting for needs and other factors. But even excluding these examples, the figures showed a two-fold difference in mental health spending between neighbouring PCTs was common.
There are similar variations for other diseases, with the proportion spent on cancer care ranging from 3% to over 10% of PCTs' budgets. Daventry and South Northamptonshire PCT is an example of one authority spending four times more than Heart of Birmingham Teaching PCT, with needs and other factors once again taken into account.
King' Fund Chief Economist Professor John Appleby said: "This new data is very revealing, and raises serious questions about the consistency of decisions PCTs make about how much they spend on different diseases.
"However, a proportion of the variation in PCT spending will not be a result of deliberate choices by PCTs. Variations in clinical decisions about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, contribute to the variations in PCT spending."
Appelby concluded by saying that the Department of Health's National Programme Budget Project was an extremely important initiative which would help answer vital questions about where NHS money goes, what taxpayers get for their investment in the NHS and how value for money can be improved.
The briefing also shows the clinical areas in which the extra NHS money is being spent. The largest share of 2004/5 spending (over 7 billion pounds – 11%) was devoted to mental health services – twice as much as that spent on cancer care.
The figures also show spending is reaching the government's three clinical priorities of mental health, coronary heart disease and cancer. The areas received the highest share of the total increase in PCT spending between 2003/4 and 2004/5.
Responding to the report, Nigel Edwards Director of Policy at the NHS Confederation said: "The problems highlighted in this report are common across the health systems of most developed countries – variations in spending are not exclusive to the NHS."
He said the Programme Budgeting Initiative was one of the first times that this data has been made available, and that PCTs needed to investigate it further before they decide on what the appropriate action would be,
"Changing the pattern of spending is difficult and it takes time to allow services to adjust. Patients and the public with an interest in a particular condition are likely to see above average spending as a good thing and attempts to bring it in line with other areas as undesirable."
He continued: "Variation in the delivery of health services, or the 'postcode lottery' as its often called, is frequently seen as a problem by politicians and the public. Yet at the same time they say that they want less central control in health and more decisions to be taken locally – there is a direct trade-off between them."
The NHS Confederation has also revealed that a recent poll of 201 NHS chief executives conducted found 70% believed that strengthening local commissioning will lead to increased variation.
"The healthcare priorities of the people of Brighton will be different to the priorities of those living in Bradford," said Edwards. "It is right that local health services meet the needs of local patients and therefore important to understand that a consequence of this will always be variations in spending."
Edwards says politicians, the public and the NHS urgently need to engage in an honest discussion about the reality of so-called post-code prescribing in the NHS, with the Confederation hosting a debate in October to discuss the issue.
