Sunday, July 31, 2011

Health Inequality And NHS Funding

Labour claims that a small change in the way Primary Care Trusts are allocated funds is designed to transfer money from "Labour" to "Conservative" areas of the country.

Labour point to a report by Public Health Manchester. Unsurprisingly, Manchester comes out as a victim of this evil Tory conspiracy. Of course, their conclusions are totally unbiased and deserving of the weight Labour have given them. But even if you believe that, and the figures are true, is this method of allocating cash to areas of the country really that sensible?

The change being suggested is to reduce the amount of additional money allocated to areas of considered to suffer from "health depravation". On first look that sounds sensible. They'll have more issues so need more money. This money is intended to be spent in more preventative activities such as encouraging healthier lifestyles and sexual health etc. Again, that sounds like a sensible thing to spend money on in places with such issues. But there is something fundamentally wrong with that approach.

One sign that something is wrong is that the money is always targeted at the same areas. Year in year out. In other words, the money is not buying preventative services that are making any significant difference. No doubt there are the odd examples of success here and there, but no overall relative upward trend in general health in these communities is discernible.

There is no doubt that there is a serious problem with health inequality in Britain. It ends up costing the tax payer more and more as the issues go unaddressed. So there certainly is a case for spending money on it. But what is the best way of allocating funds?

We can easily turn Labour's claims round and point out that they originally ran a system that benefitted Labour areas at the expense of Tory ones. But this shouldn't be a party political issue. Instead we should think about the best way to fund activity that will improve health across the nation.

I would argue that funding for preventative health initiatives should be linked to outcomes. Where one initiative produces success it should be given funds to expand its activities to other areas etc. And it shouldn't matter if the initiative is state run, charity of private. The most successful provider should attract the most investment. But the current system just rewards failure. As long as an area keeps its "deprived" status its PCT can rely on some more money. The money fails to improve anything so they need more next year and such is the story of NHS spending over the decades.

The original idea behind setting up the NHS was a (typically deluded central planner's) view that it would cost less and less as the health of the nation improved. Instead we've spent more and more of our national income on it and have barely kept up with our international competitors in terms of overall national health. In some cases outcomes are woefully behind.

The NHS reforms go some way to at least lay the foundations for more effective funding of health care in Britain. But they have been watered down too much and much more is needed to transform the attitudes of NHS staff and users so that they are less resistant to change.

But a good first step would be to show real progress in addressing health inequalities by rewarding success in this area rather than failure and ignoring politicians who want "their" people funded more than the "other's".

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