Health inequalities. Volume II, Written evidence / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee
Date:
c2008
Catalogue details

Licence: Open Government Licence

Credit: Health inequalities. Volume II, Written evidence / House of Commons, Health Committee. Source: Wellcome Collection.

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    87. The time lag between interventions and the achievement of results means that it is difficult to asses the short-term contribution of individual programmes towards the target. The Programme for Action observed that the impact of programmes is likely to be most visible towards the end of the decade. 88. A scientific reference group on health inequalities chaired by Professor Sir Michael Marmot of UCL and supported by leading academics and other experts oversees the development of the Status Report. CONCLUSION 89. Health inequalities are persistent, stubborn and difficult to change. Reducing them requires a balanced approach on a broad front between the role of the NHS on prevention and treatment of disease and local government, working in particular on the contribution of the wider social determinants of health. We have ramped up significantly the contribution of the NHS to the target, most recently through the reviews of both aspects of the target. The lessons from the reviews and the focus it provides have shaped the most recent CSR. The new PSA framework will help strengthen a cross government approach to health and well being, including on health inequalities. The common indicator base developed through the Operating Framework for the NHS and the National Indicator Set for local government will provide a focus for local action. 90. These efforts are being complemented by actions of the wider social determinants. This will be key in achieving a long-term sustainable reduction in health inequalities that modifies health status and the life chances of people living in disadvantaged groups and areas. Action is already in hand to break the cycle of poverty and deprivation across the generations. This challenge is being taken up across government in a range of programmes—on education, housing, and poverty—as part of wider action on poverty, inequality and social justice. January 2008 Memorandum by Imperial College of Science, Technology and Medicine (HI02) THE IMPACT OF THE QUALITY AND OUTCOMES FRAMEWORK (QOF) ON INEQUALITIES IN CHRONIC DISEASE MANAGEMENT IN PRIMARY CARE EXECUTIVE SUMMARY 1. The Quality and Outcomes Framework (QOF) introduced as part of the new general practitioner contract presents an important opportunity to reduce known inequalities in the management of chronic conditions. This submission provides a rapid appraisal of published research examining the impact of the QOF on inequalities in chronic disease management 2. Results from research studies which have used national contract data suggest that there were small differences in QOF performance between practices working in deprived and affluent areas in the first year of the contract. These differences appear to have narrowed in the second year of the contract. Studies using individual patient data suggest that there were marked age, gender and ethnic group inequalities in the quality of care being delivered before the introduction of QOF. Some of these inequalities have been partially attenuated afterwards. BACKGROUND 3. In addition to improving overall health care quality, the Quality and Outcomes framework (QOP) introduced as part of the new general practitioner contract presents an important opportunity to reduce known inequalities in the management of chronic conditions through an ongoing emphasis on improving the quality of care being delivered to all patients. However, concerns about the potential negative impacts of pay for performance programmes such as QOF on health inequalities have also been raised.' For example, lower QOF performance, resulting in reduced funding to a general practice, may perpetuate the inverse care law whereby the poorest communities with the highest health needs receive the lowest provision of primary health care. ' Casalino, L.P. and A. Elster, Will pay-for-performance and quality reporting affect health care disp: ities? H i 2007. 26(3); p. w405-14. q y rep g are disparities? Health Affairs,