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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    it is to attribute outcomes to choices, inequality in utilisation tends to be used as a proxy for inequalities in access, and different studies pitch for different qualifications of need based on a combination of detailed information about patients and carefully justified “value judgements”.’*' Ultimately, a slew of studies has shown that “lower socio-economic groups use services less in relation to need than higher ones”.”*? This was acknowledged by Tony Blair in 2003 when he said the NHS does not provide equitable access to services.’*? HORIZONTAL INEQUITY 3.1 One test of the horizontal equity of healthcare provision in the NHS is hip replacement, since it is a common, effective, low risk and long established health technology. In 2006 the York University Centre for Health Economics reported that studies of elective total hip replacement in the NHS between 1991 and 2001 have yielded striking examples of the unequal delivery of specialist health services across socio-economic groups. Survey data for people living in deprived areas suggests that they may be more likely to need hip replacements.’*4 By setting this against administrative data which show that people living in deprived areas are less likely to receive hip replacement,’** the York study was able to conclude that there is substantial socio-economic inequity in the use and delivery of elective total hip replacement.’*° There is evidence that this is a widespread phenomenon. Also in 2006, an article in the journal Rheumatology found that while need for hip and knee joint replacements was three times as high in the poorest quintile of the population as the wealthiest quintile, the number of operations were no more common.’8” 3.2 Crucially—and this point cannot be emphasised enough—when the York team discussed their findings they observed that their study “did not include independent sector utilization”. About “a quarter of hip replacements in England are undertaken in the independent sector.” Relevantly, “[t]his non-NHS utilisation is concentrated among individuals and areas of high socio-economic status, particularly in the South East of England. Inequality in NHS utilisation therefore underestimates overall socio-economic inequality in utilisation”.’*® Not only is there inequity in the provision of healthcare within the NHS, but also even more extreme inequity in the provision of healthcare across private and public services: that is, across healthcare taken as a whole. We shall return to this shortly. GEOGRAPHICAL VARIATIONS ; 4.1 The NHS is patchy and there are signs that it is better in richer areas of the country. Recent statistics on meeting the 18-week target show that there are wide variations in performance across the country, with just 33 per cent of elective patients receiving treatment within 18 weeks in Hastings & Rother PCT against 82 per cent in Blackpool PCT.’8? Where diagnostics—MRI and CT scans—are concerned, there are massive variations in waiting times. Whereas patients in Wales can expect to wait only 47 days for an MRI scan, those in the North East can expect to wait 100 days. And while there are a small number of hospitals, such as South Warwickshire General Hospitals NHS Trust, where you can get a routine MRI scan in less than ten days, there are equally a small number where you have to wait more than 170 days, such as the Royal United Hospital Bath NHS Trust.”° Similarly, patients are waiting just three days at University College London to receive a CT scan—but 141 days at Norfolk and Norwich University Hospital NHS Trust.”! Where you live therefore determines how long you have to wait to access NHS services.’ 4.2 Recent studies have also uncovered geographical variations in spending. Take expenditure on cancer treatment per cancer patient, where there is for example wide disparity between Nottingham City PCT, at £17,028 per cancer patient, and Oxfordshire PCT, at £5,182 per cancer patient.””? Expenditure per heart disease death is more marked, ranging from £166,151 in Wakefield PCT to £17,241 in Calderdale PCT.” 781 Cookson, R., Dusheiko, M., and Hardman, G., Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001, CHE Discussion Paper 15, York: University of York, May 2006, p. 1. 782 Dixon, A., et al., Is the NHS equitable? A review of the evidence, p. 2. See also: Morris, S., et al., Inequity and inequality in the use of health care in England: an empirical investigation, p. 28. 783 “The 1945 model, for all its great strengths, was not the answer to inequality”, Tony Blair, speech to the Fabian Society conference, June 2003. 784 Cookson, R., et al., Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001, p. 2. 785 Cookson, R., et al., Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001, p. 1. 786 Cookson, R., et al., Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001, p. 1. 787 Steel, H., Melzer, D., Gardener, E., and McWilliams, B., “Need for and receipt of hip and knee replacements—a national population survey”, Rheumatology, 2006; 45; 1437-1441. 788 Cookson, R., et al., Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001, p. 8. 789 DH, “18 weeks referral to treatment—commissioner based”, 2008. Available at: http://www.performance.doh.gov.uk/rtt/ downloads/monthly/RTT_Admitted_Commissioner_Oct07.xls ™ Dr Foster, How healthy is your hospital? , London: Dr Foster, 2007, p. 15. 7! Dr Foster, How healthy is your hospital? , p. 15. 72 Bosanquet, N., de Zoete, H., Haldenby, A., NHS refom: the empire strikes back, London: Reform, 2007, p. 33. See also: Dr Foster, How healthy is your hospital? , p. 14. 73 http://www.hsj.co.uk/images/Conservatives%20cancer%20spend%20table%20261 107_tcm] 1-297712.doc 74 Gainsbury, S., “Heart disease rates show a nation of inequalities”, HSJ, 17/01/08.