NHS to drop poverty as yardstick for local funding: NHS commissioning board will discontinue funding system using a formula involving age, poverty and regional variations
The new independent quango at the heart of the coalition's health reforms has said it will stop using income to determine health spending levels around in the country next year as part of a set of reforms designed to promote "patient choice" in the NHS.
The NHS commissioning board, which will take over £95bn of health spending for patients from next year, said it would discontinue the current funding arrangements, which use a complex formula involving age, poverty and regional price differences to work out how much an average patient in each part of the country should get from the taxpayer.
Traditionally, this system led to charges that the NHS was taking cash from affluent rural areas and handing it to inner-city ones. However, the board announced that clinical commissioning groups – clusters of GPs who will buy care for patients – would each receive a flat real-terms increase of 2.3% next year.
The board argued that to have continued with the old formula would have given "higher growth [in funding] to areas that already have the best health outcomes compared to those with the worst. On the face of it, this appears inconsistent with the [board's] public purpose to improve health outcomes for all patients and citizens and reduce health inequalities."
Earlier this year, the then health secretary, Andrew Lansley, told a conference that "age is the principal determinant of health need": the older the population, the more likely that patients will be spending NHS cash. This notion caused outrage because it was a repudiation of the health service's historic view that the foremost link is that between poverty and health.
This thinking has led to income levels playing a large part in determining health funding. Last year, Manchester received 17% more per head than Devon, a wealthier area with a large elderly population. This is justified, experts say, if one considers that males in Manchester live 6.5 years less, on average, than those in Devon.
However, Sheena Asthana, professor of health policy at Plymouth University, pointed out that on some measures Dorset, the area with the most over-75s, had higher "rates of illness and death" than Tower Hamlets, in east London, but received £500 less per patient.
In an interview, Sir David Nicholson, chief executive of the board, said there was a real problem with "unmet need" in the NHS. He said: "The current formula will calculate how many people, for example, lived with colorectal cancer in an area but not tell you about the utilisation of services [or] whether there was little or high demand [for the NHS]. That's where the current formula floundered."
Alan Maynard, professor of health economics at the University of York, said rewarding those that "used health services most would end up with a policy that benefitted richer, Tory-voting areas".
Maynard said: "Poor people tend not to use the health service as much as the rich, because they are poorly educated, often without work. Those that do use the NHS are older and richer. So tying the money to patients' pattern of use will benefit Tory areas … not, perhaps, by design.
"That might be fine, if welfare spending on education and housing and employment was increased: those are the social determinants of whether people, especially the poor, are healthy or not."
Sir David said that there would be an "urgent, fundamental review of the approach to allocations".
"We want to be offering equal access for equal needs … in time for 2014," he said.
The career civil servant would become the public face of the NHS, replacing the secretary of state. Sir David admitted the interview "was unusual … ministers usually do this sort of thing".Labour pointed out that money would be set aside again to pay for the coalition's shake up. Andy Burnham MP, Labour's Shadow Health Secretary, said: "Yet again, the NHS is being instructed to set aside much-needed funds to pay for the costs of a back-office re-organisation. That is simply unjustifiable when the NHS front-line is taking a battering and nurses jobs are being lost in their thousands.
"In addition, the NHS is being mandated to make a 1% surplus. This, coupled with the on-going costs of re-organisation, will translate into yet more real-terms cuts on the NHS front-line at a time when hospitals are already 'full to bursting'.
"The fact is that David Cameron cut NHS spending over his first two years in office and it is now reeling from a reckless re-organisation that nobody wants." The Guardian
The new independent quango at the heart of the coalition's health reforms has said it will stop using income to determine health spending levels around in the country next year as part of a set of reforms designed to promote "patient choice" in the NHS.
The NHS commissioning board, which will take over £95bn of health spending for patients from next year, said it would discontinue the current funding arrangements, which use a complex formula involving age, poverty and regional price differences to work out how much an average patient in each part of the country should get from the taxpayer.
Traditionally, this system led to charges that the NHS was taking cash from affluent rural areas and handing it to inner-city ones. However, the board announced that clinical commissioning groups – clusters of GPs who will buy care for patients – would each receive a flat real-terms increase of 2.3% next year.
The board argued that to have continued with the old formula would have given "higher growth [in funding] to areas that already have the best health outcomes compared to those with the worst. On the face of it, this appears inconsistent with the [board's] public purpose to improve health outcomes for all patients and citizens and reduce health inequalities."
Earlier this year, the then health secretary, Andrew Lansley, told a conference that "age is the principal determinant of health need": the older the population, the more likely that patients will be spending NHS cash. This notion caused outrage because it was a repudiation of the health service's historic view that the foremost link is that between poverty and health.
This thinking has led to income levels playing a large part in determining health funding. Last year, Manchester received 17% more per head than Devon, a wealthier area with a large elderly population. This is justified, experts say, if one considers that males in Manchester live 6.5 years less, on average, than those in Devon.
However, Sheena Asthana, professor of health policy at Plymouth University, pointed out that on some measures Dorset, the area with the most over-75s, had higher "rates of illness and death" than Tower Hamlets, in east London, but received £500 less per patient.
In an interview, Sir David Nicholson, chief executive of the board, said there was a real problem with "unmet need" in the NHS. He said: "The current formula will calculate how many people, for example, lived with colorectal cancer in an area but not tell you about the utilisation of services [or] whether there was little or high demand [for the NHS]. That's where the current formula floundered."
Alan Maynard, professor of health economics at the University of York, said rewarding those that "used health services most would end up with a policy that benefitted richer, Tory-voting areas".
Maynard said: "Poor people tend not to use the health service as much as the rich, because they are poorly educated, often without work. Those that do use the NHS are older and richer. So tying the money to patients' pattern of use will benefit Tory areas … not, perhaps, by design.
"That might be fine, if welfare spending on education and housing and employment was increased: those are the social determinants of whether people, especially the poor, are healthy or not."
Sir David said that there would be an "urgent, fundamental review of the approach to allocations".
"We want to be offering equal access for equal needs … in time for 2014," he said.
The career civil servant would become the public face of the NHS, replacing the secretary of state. Sir David admitted the interview "was unusual … ministers usually do this sort of thing".Labour pointed out that money would be set aside again to pay for the coalition's shake up. Andy Burnham MP, Labour's Shadow Health Secretary, said: "Yet again, the NHS is being instructed to set aside much-needed funds to pay for the costs of a back-office re-organisation. That is simply unjustifiable when the NHS front-line is taking a battering and nurses jobs are being lost in their thousands.
"In addition, the NHS is being mandated to make a 1% surplus. This, coupled with the on-going costs of re-organisation, will translate into yet more real-terms cuts on the NHS front-line at a time when hospitals are already 'full to bursting'.
"The fact is that David Cameron cut NHS spending over his first two years in office and it is now reeling from a reckless re-organisation that nobody wants." The Guardian
No comments:
Post a Comment