THE NHS "LOTTERY"



Patients are being denied fair access to drugs and treatment because of wide variations in NHS spending, with some trusts providing nearly four times the amount of money for mental health and cancer care as others. A report published today by the King’s Fund, the independent think-tank, highlights “serious questions” about the postcode lottery of care across England, health economists said. Even when the socio- economic needs of local people are taken into account, there is still wide variation in primary care trust (PCT) spending on mental health, cancer and circulatory problems. After adjusting for such factors, Islington PCT spends 259 pounds a head on mental health — about four times the 66 pounds spent by Bracknell Forest PCT.

The proportion of PCT budgets spent on cancer also varies widely across England — from 3 per cent to more than 10 per cent of the overall budget.... But the report noted that higher spending PCTs would not necessarily offer the best quality of care, depending on how efficiently money is spent. PCTs are in charge of about 80 per cent of England’s NHS budget, about 58 billion a year.

The report, Local Variations in NHS Spending Priorities, said that the three government priority areas of heart disease, cancer and mental health consumed the largest share of PCT spending. The analysis focuses on data from 2003-04 to 2004-05 and highlighted a two-fold difference in spending on mental health a head across 90 per cent of PCTs. Mental health absorbed 7 billion — about 11 per cent of PCT spending — which was twice the amount spent on cancer care.

The report found differences in spending that appeared to be only partially explained by the different needs of their local populations, raising questions about why PCTs made different decisions about spending priorities, and whether spending variations had adverse effects on equity and efficiency. John Appleby, chief economist at the King’s Fund, said: “This new data is very revealing, and raises serious questions about the consistency of decisions PCTs make about how much they spend on different diseases. “However, a proportion of the variation in PCT spending will not be a result of deliberate choices by PCTs. “Variations in clinical decisions about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, contribute to the variations in PCT spending.”

Nigel Edwards, director of policy at the NHS Confederation, said that the problems highlighted were common across the health systems of most developed countries. “The Department of Health’s programme budgeting initiative is one of the first times that this data has been made available and primary care trusts will need to investigate it further before it is clear what the appropriate action is. “It is right that local health services meet the needs of local patients and, therefore, important to understand that a consequence of this will always be variations in spending.”

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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