Category Archives: North East

Last week I handed in my badge.  No, I was not playing a disgraced sheriff in a western.  It was my NHS badge and my term of office was up.

I carry some treasured memories away with me.  The first thing I have to say is that everyone I encountered was very dedicated and extremely professional about how they did their job.  Secondly I am convinced that the NHS needs fundamental reform and that will not be easy.

It needs more resources.  Even Theresa May thinks that. But that is not all.

We need to think about what we are actually trying to do, and the best way of achieving it.  As Professor McKeown pointed out the big advances in health were achieved through better public health – that is better food, hygiene, housing and sanitation. Hospitals, perhaps it is stating the obvious, deal with the sick and injured.  Long term conditions need care, and that has to be provided in a community setting.

Since the NHS began medical science has developed fantastically and the number of specialist consultants has increased far more than the number of GPs. The main killers in 1948 were circulatory disorders, in particular rheumatic heart disease, respiratory disease and infection. Today the picture is different and the main killers are heart disease, in particular coronary artery disease, and cancer. The incidence of these diseases can be reduced if we can tackle lack of exercise, unhealthy eating and smoking

Publicity focusses on the problems of the hospitals.  Over half of them are in financial difficulties,and need funding

But long term we need to prevent people becoming ill if we can,and to  look after those who have conditions which cannot be cured. Neither of those last two can be done in hospital.

People live now longer, which is a good thing, but it means that we have many more things wrong with us as we get older. The majority of NHS patients are elderly. Many have conditions, rather than illnesses, such as mobility problems, which cannot be cured but have to be cared for. The obvious need is for more to be spent on social care and public health, which encourages healthy living. In fact the budgets for both are being reduced. The total NHS budget is over £120 billion. Public health gets £2.5 and Adult Social Care £17 billion. Both got less this year than last year.

The people who see most patients are the Family Health Services, that is GPs, Pharmacists, Opticians and Dentists. They get 22% of the budget whereas hospitals receive 43%.

The obvious answer is we have to get our act together so fewer people end up in hospitals which are at breaking point. If more could be done outside hospital our system would run better and would be more patient friendly as more people could be treated locally and stay at home.  Durham Council and the NHS are showing how to effectively cooperate.

Unfortunately the infamous 2012 Health and Social Care Act works totally contrary to this idea.  The then Coalition Government thought the answer lay in more efficiency. They believed, with scant evidence, that many public sector employees in the NHS were living a protected life and needed to be exposed to a competition. Hospitals were to compete like supermarkets and the private sector could bid for  NHS work. This goes totally against the idea of a cooperative model where GPs,Hospitals and Local Authorities, who run public health and social care, all talk to each other to provide the best for each patient.  Private providers are reluctant to fit into such a model, and there is little evidence that privatising services improves them. The present Government admitted it did not work in their last manifesto,but are in such a mess they are unable to do anything about it.  Meanwhile the NHS was to work round the rules as best it can.

A future Labour Government needs to do two things quickly.  Repeal the 2012 Act and restore the NHS as “preferred provider” when contracts are awarded.The private sector should only be used if the NHS cannot do something. Moving to a cooperative model means building trust between different organisations. This will be difficult enough without people fearing it is a recipe for privatisation by the back door.

The NHS is a fine example of where cooperation and mutual help works. Let us keep it that way.

This was first published in the Newcastle Journal

2 Comments

It is a pleasure to be speaking with you about something that I know all of us in the room are passionate about changing in this country – health inequality.

It comes as no surprise that the Office for National Statistics found earlier this month that the least deprived men at birth in 2014 to 2016 could expect to live almost a decade longer than the most deprived. This decade has seen a slowdown in improvements in life expectancy, an appalling consequence of this Government’s failure to improve the chances of the worst-off, as years of underfunding in health and social care take their toll.

Similarly, the north south divide remains as relevant as ever. For both males and females, the healthy life expectancy at birth is the highest in the South East, at 65.9 years for men and 66.6 for women. I am sure you can guess which region is the lowest!

Here in the North East healthy life expectancy for men is 59.7 years and for women it is 59.8 years – significantly lower than the England average. That means that inequality gap in healthy life expectancy at birth for the South East and North East is 6.2 years for men and 6.8 years for women.

There are lots of factors that play into these figures, and life expectancy here is increasing faster than anywhere else in the country, but it is simply not good enough that those from deprived areas are having their life expectancy shortened. That is why we all need to make a pledge to change this.

Today I’m going to speak about three public health epidemics that affect, not just the North East but the whole country: smoking, obesity and malnutrition. If we are able to tackle these epidemics, then we will be a step closer to achieving the goal of the UK having some of the healthiest people in the world.

Smoking

Smoking continues to be the leading cause of preventable deaths – in 2015, 16% of all deaths in people aged 35 or over in England were estimated as being attributable to smoking. It is estimated that 474,000 hospital admissions a year in England are directly attributable to smoking, which represents 4% of all hospital admissions. Smoking causes around 80% of deaths from lung cancer, around 80% of deaths from bronchitis and emphysema, and about 14% of deaths from heart disease. Therefore, smoking and its related health problems leave a heavy burden on our already financially strapped NHS, costing more than £2.5 billion each year.  Addressing smoking in our society could therefore help reduce that high financial cost and money could be directed towards improving our NHS and ensuring that we have a healthy society.

Smoking prevalence is decreasing across the country, and I’m pleased to say that smoking rates in the North East is declining faster than the national average. This is due to great support from programmes such as Fresh North East, which since 2005 has been tackling high smoking rates here. They have clearly been doing an excellent job, as since 2005, the North East has seen a fall of nearly a third with around 165,000 fewer smokers. However, the North East still has the highest lung cancer rates in the country and smoking rates still remain high, especially among those who are unemployed or members of lower socioeconomic groups and it is deeply concerning that those groups, for whom poverty is rife, are not being sufficiently helped to quit smoking.

I welcome the Government’s Tobacco Control Plan – even though it was delayed by 18 months – but the Government must move away from warm words and empty promises and commit to the right funding for smoking cessation services so that smoking rates can decline across the country.

Obesity and malnutrition

I have also been calling on the Government to go further in their commitment to reduce obesity levels.  The UK has one of the worst obesity rates in Western Europe, with almost two in every three people being either overweight or obese. I am one of those two, but I am back on a strict diet now to try and become the one, I hope that there will soon be a lot less of me! It is hard though, if it was so easy no one would be overweight.

However, I was a skinny kid and a slim teenager and proud to say a size 10 when I got married and I still ended up overweight as time went by. So therefore I worry greatly when I see all the stats for this country’s children when a pattern now emerges at a very early age. In 2016/17 almost a quarter of reception children, aged between 3 and 4, were overweight or obese. In the same year, for pupils in year 6, it was over a third. An obese child is also over five times more likely to grow up into an obese adult, so the Government should be doing all that it can to ensure that child obesity rates are reduced as a matter of urgency.

The Government’s Child Obesity Strategy to tackle this was welcome, but left much to be desired. I am sure some of you will know that it was published in the middle of summer recess, during the Olympics and on A- Level results day. At first, I thought the strategy must have been missing some pages. But it turned out, this world-first strategy really was just thirteen pages long. For whatever reason, many of the commitments David Cameron had promised and desired as his legacy had been taken out by Theresa May and her staff. We now know that May’s former joint chief of staff, Fiona Hill, is said to have boasted about “Saving Tony the Tiger”, the Frosties Mascot. Now that Fiona is out of the picture, we are expecting a second Childhood Obesity Strategy this summer, so I hope that there will be more than thirteen pages!

Of course, there is no silver bullet to tackling childhood obesity. As I said, if staying slim and losing weight was easy then we wouldn’t have the problem we have now.  However, there are two policy suggestions that I have been championing recently: restricting junk food advertising until the 9pm watershed on all channels not just on children’s channels and restricting the sale of energy drinks to young people.

Advertising is so much more powerful than we all think. There is a reason they spend many millions on it!  According to a University of Liverpool report, 59% of food and drink adverts shown during family viewing time were for foods high in fat, salt and sugar and would have been banned from Children’s TV.  The same report also found that, in the worst case, children were bombarded with nine junk food adverts in just a 30- minute period, and that adverts for fruit and vegetables made up just over 1% of food and drink adverts shown during family viewing time. It is therefore no wonder that there are so many children in this country who are overweight or obese. That is why I’ve been calling for restrictions on junk food advertising on TV, but I know that other modes of advertising need to be investigated more widely too like advergames and food brands which are high in fat, salt and sugar sponsoring sporting events that are popular with children.

This leads me to my next point of energy drinks, because to pin point just one brand, Red Bull who sponsor several extreme sports competitions which are not necessarily marketed to children, but are watched by children. When my son was a teenager, I would go so far as to say that he was addicted to energy drinks. And it was a huge problem for me, especially as he could legally buy them as he told me every day in his defence, in his eyes I was being ridiculous! He and his friends would buy and drink bottles and cans of them every day and it would completely change his personality. I’m pleased to say that ten years on he is older and much more sensible now, thanks to me warning him of the health dangers of energy drinks.

Although that was a decade ago, the trend still remains that children, as young as ten, are buying energy drinks for as little as 25p. The UK has the second highest consumption of energy drinks per head in the world.  You might expect America to have the highest consumption, but it is actually Austria, home to Red Bull headquarters. A 500ml can of energy drink contains 12 teaspoons of sugar and the same amount of caffeine as a double espresso.  You wouldn’t give a child have 12 teaspoons of sugar or a double espresso, so why are we allowing them to drink it in an energy drink?

If we want our children to be the healthiest in the world, we cannot sit idly on this any longer. Thankfully, many supermarkets and some retailers have now taken the step to restrict the sale of energy drinks to children. Supermarkets such as: Waitrose, Aldi, Asda, Sainsburys, Morrisons, Tesco, Lidl have restricted the sale. Boots lead the way in being the first non-food retailer to restrict the sale of energy drinks to children a few weeks ago, and just this week they were joined by Shell Petrol Stations and WH Smith. I am still calling on all supermarkets and retailers to take steps to do this.

The Government have got to do better if our children are going to be encouraged to live a healthy lifestyle and eat a healthy diet.

However, there are millions of people up and down the country who do not have access to healthy and affordable fresh food or the skills to cook up tasty meals or even the cooking equipment or the energy such as gas or electric especially when poor and on key meters, which leads us to another issue which certainly does not get the attention it deserves: malnutrition. Malnutrition affects over three million people in the UK, 1.3 million of which are over the age of 65.  Like obesity, malnutrition is a Public Health epidemic, but because it is literally less visible, it does not receive the attention or outcry that you would expect. On this Government’s watch, we have seen a 54% increase in children admitted to hospital with malnutrition and in the last decade, we have seen the number of deaths from malnutrition rise by 30%.  It should be at the forefront of this Government’s conscience that in one of the 6th richest economies in the world in 2018, malnutrition is increasing instead of being eradicated.  I’m proud to say that Labour will make it a priority to invest in our health services and ensure people don’t die from malnutrition in 21st century Britain.

Both obesity and malnutrition are costly to our NHS, estimated at £5.1 billion a year for obesity and £13 billion a year for malnutrition. That is why prevention is so important and why I am a key campaigner for Universal Free School Meals, because it gives all children access to a hot and healthy meal, encourages a healthy relationship with food and is beneficial to their mental and physical development. Healthy food needs to be both affordable and accessible, and individuals need the skills to prepare and cook a fresh and healthy meal.

NHS funding

Finally, we all know that the NHS lacks the funding and the time it needs to do all of the things I have just mentioned. Since local authorities became responsible for public health budgets in 2015, it is estimated by the Kings Fund that, on a like-for-like basis, public health spending will actually fall by 5.2%. This follows a £200 million in-year cut to public health spending in 2015/16 and further real-term cuts to come, averaging 3.9% each year between 2016/17 and 2020/21. On the ground this means cuts to spending on sexual health services by £30 million compared to last year, tackling drug misuse in adults cut by more than £22 million and smoking cessation services cut by almost £16 million. Spending to tackle obesity has also fallen by 18.5% between 2015/16 and 2016/17, again with further cuts still in the pipeline in the years to come.

The North East Commission for Health and Social Care Integration area spends £5.2bn on health and care each year. Over 60% of this is spent on tackling the consequences of ill health through hospital and specialist care, compared to the 3% devoted to public health. That is over twenty times more spent on consequences rather than prevention. So if the UK is going to be one of the healthiest countries in the world, then the Government really does need to recognise the importance of prevention and public health.  If we invest in our NHS and public health services, then we invest in the health of everyone in this country and that is why public health is so important.

I look forward to working with you all now and in the future to ensure that one day we can proudly say that people in the UK are some of the healthiest in the world.

Tagged | Leave a comment

 

There is wide agreement that it would be beneficial to integrate social services and local NHS community services.  This could provide “wrap around care” and look after elderly and vulnerable people in a community setting. Such a system could reduce hospital admissions, but the reason for doing it is to improve the welfare of patients. Such scheme are already working well in Durham and other parts of the country.

Where there is not agreement is when such a system could be constrained within a strict financial envelope . A possible consequence could then be the outsourcing of management and the reconfiguration of hospital services.

The SHA does not believe in outsourcing or relying on the private sector unless absolutely necessary. Privatisation of particular parts of an integrated system could undermine the very integration which is desired. Compulsory tendering as prescribed in the 2012 act wastes a considerable amount of NHS time, and can leave the NHS open to legal challenge by a private provider with large pockets which will involve considerable unnecessary expense. Nor is the motive for integration to constrain costs but to improve the welfare of patients.

At present the average patient receives half their total expenditure in the final year of their life.  There needs to be a rebalancing. The elderly and frail should be properly cared for  but some clinical intervention is unnecessary.  More should be spent on the young. This would help reduce health inequalities.

The present system puts too much power in the hands of the acute trusts. There should be  a transfer to community and public health (as recommended by the Selbie Report for the North East)

The national NHS needs to ensure proper standards but organisation of a local integrated system should be jointly in the hands of local authorities and NHS organisations. Possibly a not for profit trust or social enterprise. The management of such a system should give equal weight to the NHS and local authorities, with a neutral chair, perhaps along the lines of an elected commissioner.

GPs should be integrated into a local system.The present  private contract system could be replaced by salaried GPs, Many now prefer this way of working.

There are serious concerns about the state of some care homes.  The provision and management of care homes should be integrated into the system set out above. This would lead to much closer relations between GPs, hospitals and care homes.

Research and innovation is very important.  Hospitals in the North of England are very good at innovation, but undersell themselves.  Universities should work closely with the NHS as is now promoted by the North Health Science Alliance. Funding tends to focus on the South.  Funding for research needs to be rebalanced regionally. The regions outside London also need to promote their research and innovation more loudly.

Devolution proposals could lead to an integration of health and local government as in Manchester.  This development needs to be evaluated as it progresses.

Conclusion

We envisage a situation where local authority social care, NHS hospitals and community care systems, GPs and Care homes are integrated into one system, run as a not for profit trust or cooperative.  Such a system would need representation from the NHS, Local Authority and independent members on the Board, with possibly a neutral chair who could be elected.

Regional networks are necessary for the effective management of hospitals. A specialist hospital in one part of a region would obviously serve the whole region.  Nevertheless the health and care trusts envisaged here should not be too big. In the North East for example Durham would be a good example, or the proposed North of Tyne authority.

 

 

 

David Taylor-Gooby

Feb 14th 2018

Leave a comment

In Easington we held a seminar on January 16th 2016 jointly between Easington Constituency, The Socialist Health Association and Unite and invited the public to come. There was a great turnout, including people who were willing to admit they suffered, or had suffered, mental health issues. There were almost 50 people there.

We had some good speakers too, who were willing to give up their time on a Saturday, Dr Paul Williams from Teesside and Dr Kamal Sidhu from Easington, joined by Anna Lynch, Director of Public Health for Durham. I am very grateful to all of them, as well as the people who made an effort to come.

The following points emerged from the discussion

  1. The Marmot Report on Health Inequalities addresses the issue of how we are to achieve greater equality in health and advocates concentrating more resources on young children People who suffer from mental health problems often live in communities which do not function well, and are likely to suffer from lack of work and money. Giving children a better start in life will help.

  1. By contrast many thought we should spend less on end of life care. Many frail older people end their days in hospital rather than in their own homes with the support of friends and family, which is where they would usually much rather be. But caring for the frail elderly in the community sounds very rosy, and even the most dedicated families need support, and at the moment that support often simply isn’t there. It is provided from the social care budget which is funded by local authorities. One response from the government is to transfer money from the NHS, and although the Better Care Fund, which is what the joint working with local authorities is called, works well in this part of the world, it means less money for the NHS. There other response is to say local authorities can levy a higher business rate to pay for social care, but the business rate is likely to be lower in the north than in the more prosperous south. So to ensure that pressure is taken off the NHS, and families receive the end of life care they want, more has to be given to local government, particularly in the North.

  1. The group agreed with the speaker who had said that priority needs to be given to provision in the early years. The first few years of life are crucially important in providing a foundation for good mental health. The closure of Children’s Centres was certainly not helpful.
  1. Anna Lynch, Director of Public Health, stressed the bad effects of social isolation and loneliness on not just the old, but everyone, and how this contributed to mental health problems. 18 to 34 year olds surveyed were more likely to worry about feeling alone and to feel depressed due to loneliness than the over 55s according to work done in Durham. Voluntary and community organisations do a wonderful job in helping combat loneliness, but they do need support, particularly in a less well-off area like the North East.

  1. Dr Sidhu, a GP in Easington, described the initiatives currently taking place in the area, particularly with “Talking Therapies” as an alternative to prescriptions. But concerns were raised about IAPT. It’s too often delivered by phone, when people want 1 to 1 face-to-face attention. 25% of prescriptions are not used as intended in any case. GPs would like to spend longer with their patients to investigate mental health issues. There is a funding issue, as always. It has been calculated that the needs of 100 patients in Easington are equivalent to 123 in more prosperous parts of the country. What doctors call the “inverse care law”. The most money goes to those who need it least.

  1. Much can be done by the voluntary/community sector (VCS), but it needs proper support. This is not an excuse to save money, or some romantic “Big Society” idea, but a practical way of mobilising community resources and empowering people and communities. The cooperation between the NHS, other agencies such as housing, the local authority, and the VCS as demonstrated by the Area Action Partnerships in County Durham is a good example to follow. Awareness of mental health issues should be part of the school curriculum, and even things like “mental health first aid”, training people to spot symptoms and help, rather like “First Responders”.

  1. Regarding funding proper funding of Social Care would reduce pressure on the NHS and allow people to be supported in their own homes, and support for the VCS reduces pressure on both families and social care. Organised trips to take older people out reduces loneliness, and activities as varied as fishing and mountaineering allow young people to interact with others and reduce isolation. (There are examples where the NHS and local authorities have funded such things) The important point is to reach those in need. There is a difficult balance to ensure that the better off do not dominate such activities, but that they are not simply reserved for those deemed to be in need. What is needed is a comprehensive social mixture.

  1. Funding is always a difficult issue when discussing the NHS, and there is no doubt that more funding will need to be made available for the NHS, and that people will have to contribute more, albeit in a fair and progressive way. But the distribution of funding is also important and recent changes in the funding formula have clearly benefitted more prosperous areas, and mental health issues tend to be concentrated in areas of deprivation.

  1. Regarding the care of the elderly, there is a crisis in the funding of nursing homes. Better trained staff are required, and better links with the NHS. Carehomes could be built in hospital grounds and publicly funded.

  1. Better information is needed about what services are available. The group liked the idea of Stockton’s ‘Navigators’—people who help others to find their way round the system and get to the right services for them. Better information via social media seems to be needed; that’s especially relevant for younger people. GPs need to put in more effort into finding out what services are available in the community. But it was recognised that things do change–directories of services are soon out of date etc.
  1. Employers need to be better at supporting employees with mental health difficulties. It was suggested that there could be a mental health occupational health service that employers (especially smaller employers) could link into to support their employees.
  1. Community development is an essential aspect of good mental health. The group talked about the need for communities to be caring, knowledgeable and prepared to help people with mental health difficulties. Isolation is lessened when a community is really operating as a community. Bear in mind that loneliness is experienced by the young as well as the old.
  1. Service integration is needed. Still too many people are ‘bounced around’ the system and their issues are not properly addressed. Some left on medication for years. And still too much fragmentation. Why is social care means-tested while health services are free? This points to the need for integration of health and social care which the Labour Party was the first to champion.
  1. There’s strength in numbers. Everyone needs to realise that the best way to make complaints about inadequacies in the system is by collective action.
  1. Much care for people with mental health issues is delivered at home, and in the family context. Parents struggle with isolation and stigma. This can often make the condition worse and could lead to self-harm. Proper support is needed, and as pointed out above can be delivered through the VCS and a community development approach so that those who really need it are contacted.
  1. Responding to mental health issues is something where everyone can play a role. Government has to support and facilitate. That means funding, and ensuring it is distributed fairly.

North East Socialist Health Association Report, March 2016

Leave a comment

Whatever you think about the new regime in the Labour Party, one of the good things about it is a willingness to discuss policies openly, and to invite other people to join in. In Easington we held a seminar jointly between the Constituency, The Socialist Health Association and Unite and invited the public to come. There was a great turnout, including people who were willing to admit they suffered, or had suffered, mental health issues.

We had some good speakers too, who were willing to give up their time on a Saturday, Dr Paul Williams from Teesside and Dr Kamal Sidhu from Easington, joined by Anna Lynch, Director of Public Health for Durham. I am very grateful to all of them, as well as the people who made an effort to come.

Dr Williams mentioned the Marmot Report on Health Inequalities (an excellent read if you are interested in the subject) which addresses the issue of how we are to achieve greater equality in health. Concentrating more resources on young children is the answer, according to Professor Marmot. People who suffer from mental health problems often live in communities which do not function well, and are likely to suffer from lack of work and money. Giving children a better start in life will help.

By contrast many thought we should spend less on end of life care. Many frail older people end their days in hospital rather than in their own homes with the support of friends and family, which is where they would usually much rather be. But, and there is always a but, caring for the frail elderly in the community sounds very rosy, but even the most well-meaning families need support, and at the moment that support often simply isn’t there. It is provided from the social care budget which is funded by local authorities. Now we all know the budgets of local authorities are being squeezed, and local authorities are in the north have been hit worst because they received extra help from the previous government. The government’s response has been first to transfer money from the NHS budget, and although the Better Care Fund, which is what the joint working with local authorities is called, works well in this part of the world, it means less money for the NHS. There other response is to say local authorities can levy a higher business rate to pay for social care, but you don’t have to be a genius to realise that the business rate is likely to be lower in the north than in the more prosperous south. So to ensure that pressure is taken off the NHS, and families receive the end of life care they want, more has to be given to local government.

Anna Lynch stressed the bad effects of social isolation and loneliness on not just the old, but everyone, and how this contributed to mental health problems. 18 to 34 year olds surveyed were more likely to worry about feeling alone and to feel depressed due to loneliness than the over 55s. according to work done in Durham. Voluntary and community organisations do a wonderful job in helping combat loneliness, but they do need support, particularly in a less well-off area like the North East.

Dr Sidhu described the initiatives currently taking place in Easington, particularly with “Talking Therapies” as an alternative to prescriptions. 25% of prescriptions are not used as intended in any case. GPs would like to spend longer with their patients to investigate mental health issues. There is a funding issue, as always. It has been calculated that the needs of 100 patients in Easington are equivalent to 123 in more prosperous parts of the country. What doctors call the “inverse care law”. The most money goes to those who need it least.

So there is a clear message. Dealing with mental health is a challenge for all of us, and we can all help, even in small ways such as befriending lonely people. But we cannot escape the fact that the Government needs to distribute resources for both health and social care more fairly and in accordance with need.

Leave a comment

By Clare Bambra, Durham University and Alison Copeland, Durham University

The north-south divide is a powerful trope within popular English culture and it’s also evident within the country’s health. A recent report by Public Health England showed that between 2009 and 2011, people in Manchester were more than twice as likely to die early (455 deaths per 100,000) compared to people living in Wokingham (200 deaths per 100,000).

This sort of finding isn’t new; for the past four decades, the north of England has persistently had higher death rates than the south, and the gap has widened over time. People in the north are also consistently found to be less healthy than those in the south across all social classes and among men and women. For example, average male life expectancy in 2008-10 in the north-west was 77 years, compared to 80 in the south-east.

A large amount of this geographical health divide can be explained by social and economic differences with the north being poorer than the south. Certainly, over the past 20 years the north has consistently had lower employment rates (for example this is 70% in the north-east compared to 80% in the south-east).

This is of course associated with the lasting effects of de-industrialisation (with the closure of large scale industry such as mining, ship building and steel) and the lack of any replacement jobs or a strong regional economic policy.

While the NHS clearly cannot address all the issues that cause the north-south divide, there have been attempts to increase NHS funding in areas that have the worst health – and many of these are in the north. The current NHS funding formula considers factors such as deprivation and ill-health indicators by area, so places with worse health and higher deprivation have higher NHS budgets.

However, NHS England has a new funding formula out for consultation which fundamentally changes the way money is allocated to General Practitioners for the care of patients, and it appears that the north will lose out.

In our BMJ letter, we mapped the new NHS funding data and this showed clearly that the more affluent and healthier south-east will benefit at the expense of the poorer and less healthy north. For example, in areas like south-eastern Hampshire, where average life expectancy is 81 years for men and 84 years for women, and healthy life expectancy is 67 years for men and 68 years for women, NHS funding will increase by £164 per person (+14%).

This is at the expense of places such as Sunderland, where average life expectancy is 77 years for men and 81 years for women and healthy life expectancy is 57 years for men and 58 years for women, and where NHS funding will decrease by £146 per person (-11%). More deprived parts of London will also lose out with Camden receiving £273 less per head (-27%) under the proposed formula.

While the objective of the new formula is to provide “equal opportunity of access for equal need”, these geographical shifts are because it has defined “need” largely in terms of age and gender, with a reduced focus on deprivation.

It also uses individual-level, not area-level need, GP-registered populations rather than higher wider population estimates, and secondary care (use of hospitals and A&E) not primary or community care use. This means that areas with older populations have higher health care usage so they are getting money transferred to them from areas with fewer old people.

However, areas with more old people are also areas that have healthier populations who live longer – hence there are more old people. These healthy old people are largely in the south-east so, within a fixed NHS budget, the new NHS formula can only shift money to them by taking it from others.

The new formula appears to shift NHS funds from some unhealthy to healthy areas, from north to south, from urban to rural and from young to old.

Many of the areas that will lose NHS funding if the new formula is implemented are the same areas that have also lost out from above average cuts to local authority budgets. The scale of the potential NHS funding shifts will add further stress onto these local health and social care systems and potentially widen the north-south health divide by reducing access to NHS services where they are needed most.

The authors do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.

The Conversation

This article was originally published at The Conversation.
Read the original article.

Tagged , | 1 Comment
%d bloggers like this: