Watchdog criticises unequal distribution of NHS funding
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《英国医生杂志》
A report by independent NHS inspectors has highlighted glaring inequalities in health between rich and poor areas in England and Wales and criticises the low numbers of GPs in deprived areas, which might be expected to need doctors most.
The Healthcare Commission, which has taken over the inspection role of the Commission for Health Improvement, said that the most deprived communities were still not being funded in line with their needs, despite a government formula designed to do just that.
Inspectors found that the 2002 formula for assessing health needs—the PCT revenue resource limits—was not being phased in quickly enough because the government feared the reaction from affluent areas as funds were withdrawn and redistributed to poorer districts.
For historical reasons, Easington Primary Care Trust, County Durham, was getting a fifth less than it should under the formula, a shortfall of ?6.5m ($49.3m; �39.8m). By contrast, Westminster Primary Care Trust in London received 31% over target. Such discrepancies have resulted in those most needing health advice having access to fewer doctors, the report said.
"These primary care trusts that are undertarget tend to have fewer GPs. Given that the under-target PCTs serve more deprived populations with more ill health, they might be expected to need more, rather than fewer, GPs when compared to less deprived areas," the report said.
The report detailed the 10 most overfunded trusts, which had on average one more GP per 10 000 residents than the 10 most underfunded trusts. The 10 most overfunded trusts were: Westminster, Richmond and Twickenham, Cambridge City, Kensington and Chelsea, Wandsworth, Oxford City, Trafford South, Rushcliffe, St Albans and Harpenden, Sheffield South West. The 10 most underfunded were: Easington ,Tendring, Knowsley, Barking and Dagenham, Ashfield, North Liverpool, Central Liverpool, Heart of Birmingham, Tower Hamlets, Basildon.
The disclosure came in the commission抯 first annual report on the state of health care in England and Wales. The watchdog was created in April to regulate standards in the NHS and private hospitals.
Commenting on the report, the chairman of the Healthcare Commission, Professor Ian Kennedy, said, "The NHS must serve the whole nation not just those who live in certain areas or those best able to demand health care of good quality."
The BMA抯 chairman, Mr James Johnson, said that government plans to narrow the health gap between the rich and poor depended on a sustained increase in staffing: "Most worrying in this report is the fact that primary care trusts in some of the most deprived areas are not being funded in line with their needs . . . some of the most vulnerable patients—those who most rely on the NHS—are losing out because of a local shortage of GPs.
"With challenges ahead, like the European Working Time Directive and the trend towards part time and flexible working, the government must make it clear how the NHS will get the numbers of doctors it needs."
The report also identified differences in death rate between poorer and affluent areas: the death rate from cancer is 60% higher in Tower Hamlets (east London) and Liverpool than in east Dorset. For coronary heart disease, death rates in affluent areas, such as Guildford, Kensington, and Chelsea, are half those in Liverpool, Tameside, and Manchester.
Older people in the 10 most deprived primary care trusts—those in big cities with deprivation and large ethnic minority communities—were far less likely to get immunised against influenza. More than 70% of older people received a flu jab in the most affluent trusts, compared with 50% in the most deprived.
There was some good news in the report. In March, fewer than 50 people had been waiting more than nine months for an operation in England. But in Wales at the end of the same month, 8457 patients had been waiting longer than a year.(London Rebecca Coombes)
The Healthcare Commission, which has taken over the inspection role of the Commission for Health Improvement, said that the most deprived communities were still not being funded in line with their needs, despite a government formula designed to do just that.
Inspectors found that the 2002 formula for assessing health needs—the PCT revenue resource limits—was not being phased in quickly enough because the government feared the reaction from affluent areas as funds were withdrawn and redistributed to poorer districts.
For historical reasons, Easington Primary Care Trust, County Durham, was getting a fifth less than it should under the formula, a shortfall of ?6.5m ($49.3m; �39.8m). By contrast, Westminster Primary Care Trust in London received 31% over target. Such discrepancies have resulted in those most needing health advice having access to fewer doctors, the report said.
"These primary care trusts that are undertarget tend to have fewer GPs. Given that the under-target PCTs serve more deprived populations with more ill health, they might be expected to need more, rather than fewer, GPs when compared to less deprived areas," the report said.
The report detailed the 10 most overfunded trusts, which had on average one more GP per 10 000 residents than the 10 most underfunded trusts. The 10 most overfunded trusts were: Westminster, Richmond and Twickenham, Cambridge City, Kensington and Chelsea, Wandsworth, Oxford City, Trafford South, Rushcliffe, St Albans and Harpenden, Sheffield South West. The 10 most underfunded were: Easington ,Tendring, Knowsley, Barking and Dagenham, Ashfield, North Liverpool, Central Liverpool, Heart of Birmingham, Tower Hamlets, Basildon.
The disclosure came in the commission抯 first annual report on the state of health care in England and Wales. The watchdog was created in April to regulate standards in the NHS and private hospitals.
Commenting on the report, the chairman of the Healthcare Commission, Professor Ian Kennedy, said, "The NHS must serve the whole nation not just those who live in certain areas or those best able to demand health care of good quality."
The BMA抯 chairman, Mr James Johnson, said that government plans to narrow the health gap between the rich and poor depended on a sustained increase in staffing: "Most worrying in this report is the fact that primary care trusts in some of the most deprived areas are not being funded in line with their needs . . . some of the most vulnerable patients—those who most rely on the NHS—are losing out because of a local shortage of GPs.
"With challenges ahead, like the European Working Time Directive and the trend towards part time and flexible working, the government must make it clear how the NHS will get the numbers of doctors it needs."
The report also identified differences in death rate between poorer and affluent areas: the death rate from cancer is 60% higher in Tower Hamlets (east London) and Liverpool than in east Dorset. For coronary heart disease, death rates in affluent areas, such as Guildford, Kensington, and Chelsea, are half those in Liverpool, Tameside, and Manchester.
Older people in the 10 most deprived primary care trusts—those in big cities with deprivation and large ethnic minority communities—were far less likely to get immunised against influenza. More than 70% of older people received a flu jab in the most affluent trusts, compared with 50% in the most deprived.
There was some good news in the report. In March, fewer than 50 people had been waiting more than nine months for an operation in England. But in Wales at the end of the same month, 8457 patients had been waiting longer than a year.(London Rebecca Coombes)