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".

Christopher Hitchens Talks About Cancer

Christopher Hitchens talks candidly and wittily about his esophageal cancer in this Vanity Fair article, and to Jeffrey Goldberg in this video (with an appearence by Martin Amis)...



Although he says the prognosis isn't great for him, let's hope his treatment is successful and he doesn't get to not meet his maker (as he doesn't really exist) any time soon.

Fear and Dishonesty Emerge As Labour's Main Tactics

We have been warned that this General Election campaign could turn nasty and at the end of the first week it has. The Times reports that the Labour party has targeted 250,000 women with leaflets suggesting that treatment for breast cancer will be inferior under a Conservative government. As if that is not appalling enough there is a question around exactly how these tawdry leaflets were distributed. And there have been widespread calls from leaflet recepients, the Tories, Lib Dems and SNP for Labour to apologise.

What we need to know is, who authorised this campaign? Was it Andy Burnham the Health Secretary who today defended the leadlets and did Gordon Brown know about it?

Even if Labour didn't illegally use private medical data to select their victims audience, as they claim, Labour sources confirm to The Times that they did use "socio-demographic research". They also have access to the Mosaic database from Experian, which includes "anonymised hospital statistics, including postcodes and the diagnoses of patients, to identify the likely addresses of those with particular illnesses". Along with all this, they used Tangent Communications to distribute the leaflets. Tangent are said to specialise in “highly targeted marketing”. Tangent Communications clients include the Department of Health and Cancer Research UK.

Of course, even if you believe that they didn't target sufferers of, and those vulnerable to cancer directly, the prevalence of the disease means there are few people who have not been affected by it in one way of another. Labour knows the fear it strikes into the hearts of millions and this is what they seek to exploit.

Labour's objective is to focus on the Conservatives intention to drop micro management by government ministers using politically motivated targets. They paint this as some kind of lessening of a commitment to quality healthcare that would adversely affect cancer treatment. In order to maintain that impression they need to ignore that fact that the Tories intend to replace these targets with a system that judges health care providers by far more relevant, measures focussed on actual outcomes. This makes more sense to me. I don't care how long whatever phase of my treatment, a government minister decides is important, takes if I know that the overall care I will receive maximises my chance of survival with as little adverse impact to my quality of life as possible.

Far from reducing information available to patients about health care the Tories pledge to increase it, and that pledge it pretty much central to their vision of moving to a more patient focused system where we'd have a choice where we go for treatment. If you want more detail on their plans, the Conservatives will be publishing their Manifesto on Tuesday. However, the Draft Manifesto they published earlier in the year sets out their plans as well. I suggest skipping the blurb at the start and jumping straight to page 8.

Now, you may not agree with this approach. Fair enough, that's a matter of opinion. The best way to deliver health care is a big question and there will be many different theories and proposals. But to suggest that your political opponents are setting out to deliberately damage health care is wrong and to target the fears of women about breast cancer is utterly contemptible.