Report Finds ‘Stark’ Evidence of Healthcare Postcode Lottery
Healthcare spending is subject to a postcode lottery, with some areas paying out more on cancer, heart disease or mental health than others, a new report says. Primary care trusts are charged with buying healthcare to suit the priorities of their populations, but data from the King’s Fund, the independent health foundation, finds that even taking into account varying needs, there are large and sometimes surprising differences.
For example, the biggest spender on cancer is Daventry and South Northamptonshire PCT, which spent £132 a head, compared with £35 a head by the bottom-of-the-league Heart of Birmingham PCT.
The report says there are unanswered questions about why PCTs reach different decisions about spending priorities and whether the variations have adverse effects on the treatment of patients.
For every disease there are similar variations. “Spending on cancer varies four-fold, on circulatory diseases three-fold, and on musculoskeletal problems eight-fold,” the report says.
More money is spent on mental health than any other category – more than £7bn, or 11% of the total spending by PCTs and twice as much as is spent on cancer care. Derbyshire Dales and South Derbyshire PCT spent the highest amount a head, at £265, while its neighbour, North Eastern Derbyshire PCT, spent the least, £66 – as did Bracknell Forest and Watford and Three Rivers PCTs.
The next biggest spend was on circulatory problems, including coronary heart disease, and then cancer.
The report says issues of access to Herceptin and other drugs have caught attention and led to widespread use of the phrase “postcode lottery”. But “there has been growing awareness of more fundamental variations in spending”. A “significant degree” of the variation in spend can be accounted for by factors such as the age and needs of the population and the cost of services, the report says. “However, once the effects of these are taken into account, some stark differences remain.”
Health minister Lord Warner said: “This is not about a postcode lottery because money is allocated to primary care trusts on the basis of health need. Some variations in spending across the country are to be expected as people respond to the different needs of local communities.”