In the post Health funding: new inequalities and Cornwall I discussed the Tory Libdem government’s idea to base NHS funding on the age of patients and to downplay deprivation. I said that I thought Cornwall might gain from the is shift in resources and now there is research from Clare Bambra showing this (Clare L BAMBRA Allocation of NHS resources: are some patients more equal than others? BMJ 17 May 2012).
In table 2 in her BMJ article Bambra shows the target allocation for 2011/12 on the present basis and on an age-only basis which omits weightings for health need, deprivation, and disability-free life expectancy, though I think includes market costs. Cornwall and Isles of Scilly primary care trust is shown to gain a modest 1.4 percent in funding on the age-only basis.
Contrast this increase in Cornwall’s age-only allocation with, for example, County Durham’s which is down 17.6 percent and Liverpool’s which is down 27 percent. The age-only perhead allocation for Cornwall would be higher than for either of those deprived areas, or several others.
Table 2 shows the funding shift starkly. Bambra points out that rejigging the funding formula by cutting the link with deprivation would lead to a shift of NHS funds from the deprived north and inner cities of England to the better off parts of the south – and from largely Labour voting to largely Conservative voting areas.
Bambra is thinking of Surrey and Richmond and Twickenham in the south not Cornwall but there is an ethical issue here for us in Cornwall: should we support a funding rearrangement from which Cornwall gains but which demonstrably penalises the more needy and poorer areas elsewhere in England?
I explained in my 27 April post that the formula shift “is likely in the long run to exacerbate health inequalities and deprivation; that would be unjust.” It will be interesting to see what Cornish nationalism says. If anything. Does fairness apply everywhere or is it merely a me-here-now-Cornwall cry? How far is the reach of social justice and the ironing out of health inequalities?
(Hat tip Green benches )
Addendum 23 May 2012
The department for health has said that what is being looked at is not age-only allocation, that deprivation would continue to be included but age would be the primary component.
HEALTH FUNDING: NEW INEQUALITIES AND CORNWALL
27 April 2012
Speaking the other day at a meeting of the new NHS clinical commissioning groups (the groups of GP doctors replacing the primary care trusts), the health secretary, Andrew Lansley, said that the funding formula for them would be changed. Presently both deprivation and the age profile of the population are among the criteria used in deciding how much each health authority in England gets. The proposal is to change the present disposition and give more emphasis to population age than deprivation. There is a brief note of this here (GPonline, 25 April 2012).
I explained here and here, when challenging the simplistic complaints about unfair funding for health in Cornwall, that the formula and the relativity of the components is complex. Age brings with it illnesses and more calls upon the health service; it is most certainly a valid criteria for funding. Deprivation brings with it serious health problems too and questions of social justice and is also a valid criteria. The more wealthy areas tend to have longer-living people. Deprivation is associated with ill-health and premature death and thus I think reducing funds for areas of deprivation with proportionately fewer elderly people will increase health inequalities further, a cycle of unfairness.
Of course lifestyle choices play a part in health but as Marx said, “Men make their own history, but they do not make it as they please; they do not make it under circumstances they choose, but under circumstances that are existing already, that are given and transmitted from the past” (The eighteenth brumaire of Louis Bonaparte). The circumstances of the poor include the prices for the healthier food and the distress from repeated adverse economic change and turmoil.
The shift to population age is likely to move funding to the southeast, southwest, and east of England and from the deprived northeast and northwest and Inner London boroughs like Hackney. What will happen to Cornwall’s health funding? We shall presumably gain as we have a significant long-lived elderly population though the market forces factor will reduce our funds (see those earlier health posts for its meaning). We shall probably though not certainly be in there as beneficiaries. See this map on the excellent Green benches blog.
The devil is in the details and I have not seen them yet but there is a question of social justice here. The proposed population age approach appears in effect to shift funds to the wealthy parts of England and to take funds from the more deprived parts in the north. This is likely in the long run to exacerbate health inequalities and deprivation; that would be unjust. Tory Libdem government’s proposals present an interesting question for us in Cornwall about the reach of social justice and the ironing out of health inequalities.
Hat tip: Green benches blog
NHS DEBATE: HOW CORNWALL LIBDEM MPs VOTED
15 March 2012
I accidentally deleted this post of 14 March so I am now restoring it.
On 13 March 2012 the House of Commons again debated the Tory Libdem NHS bill (the Health and social care bill). Labour put forward a motion acknowledging the 174 000 petition against the bill. A handful of Libdems, including Andrew George, Libdem MP for St Ives, put up an amendment which called for a pause for “an urgent summit of the Royal Colleges, professional bodies, patients’ organisations and the Government to plan health reforms based on the Coalition Agreement”.
Read the exact wording of the motion and amendment here (column 159) and here (column 182).
Both amendment and motion were lost.
Andrew George voted for both amendment and motion.
Stephen Gilbert (Libdem, St Austell and Newquay) and Dan Rogerson (Libdem, North Cornwall) voted against both amendment and motion (as did the three Tory MPs from Cornwall).
Libdem MPs voted against the motion by 42-6 and against the amendment by 43-7, including tellers.
CROSSING THE TAMAR
3 November 2011
The Cornwall/Devon border in the Lords the other day:
“In Plymouth there is another small integration pilot going on in the DGH [Derriford] whereby many patients from Cornwall go over the border to the acute hospital. Somewhere in the region of a quarter of Cornish patients do not go to Truro; they go to Plymouth.”
– Judith JOLLY Lords Hansard 2 November 2011 column 1325
DOING NUMBERS
26 September 2011
Andrew George, Libdem MP for St Ives, recently said that altogether “two thirds” of what he called “unfettered” Liberal Democrat MPs rebelled against the Health and social care bill (the health bill) in various votes on it.
Let me suggest another way of looking at this.
The official record of the make-your-mind-up final vote, the third reading vote, in the Commons reveals the shame of the Libdem party (Hansard 7 September 2011 column 497).
There are 57 Libdem MPs and 41 of them supported the health bill on third reading (40 votes for and a teller).
How many of the 57 voted against? Get your heavy duty calculator out. Are you ready for this? Okay? Four. Yes, that’s right, just four. Let me repeat that. How many Libdem MPs voted against the health bill at third reading? Four and only one of them from a Cornwall seat, namely Andrew George to his credit. There were also abstentions.
George has also now described what happened as “my almost sole rebellion against the health bill” which suggests the cold and cruel reality of four has trumped two thirds.
It’s been a joint Conservative Liberal Democrat bill from the start; indeed, the bill passed in the Commons only because Liberal Democrats voted for it; it would have failed had that forty one voted against. They’re up to their armpits in it.
None of this is a surprise. The coalition Liberal Democrats have supported every reactionary measure the Tories have introduced and only a progressive handful have dissented in vain. Truly the orange poodle party.
The extant and details of the rebellion by Libdem MPs on third reading is set out on the Public Whip and the Social Liberal Forum.
ABRACADABRA HEALTH FUNDING FOR CORNWALL
8 September 2011
We have been here before, but as many times as it takes …
On Tuesday Cornwall unitary council decided, unanimously Dick Cole’s MK blog tells us, to ask the secretary of state for health in England (health is a devolved matter for Scotland, Wales, and Northern Ireland) to “uplift Cornwall’s health funding by £20.6 million in this financial year”.
I wrote about this issue in some detail in the posts Progress on Cornwall health funding and Funding health in Cornwall, which give the funding figures, the shortfall, and the make up of the formula for distribution.
Briefly, the distribution of the relevant health funding is cursed by historical anomalies. Some health authorities get more than they need according to the formula, others, including but not only Cornwall, get less. In the jargon, measuring the distance from target, some are above target, others below. As the earlier posts show this 2011/12 financial year Cornwall’s shortfall is much less than in 2010/11, and there are authorities farther below target in percentage terms than Cornwall. As ever, the posts lead back to the source of the figures.
Successive governments are reducing the anomalies and trying to get everyone on target. It would not be responsible to put it right overnight: that would take millions from the overtarget authorities and destabilise their health services. It has to be done in a carefully managed way that maintains stability and the health services. In a time of austerity there is little chance of upping some while maintaining the overtargets of others. In fact Cornwall’s shortfall has been dramatically reduced since 2010/11.
Of course a reasonable case can be made that the pace of change to on-target could responsibly be faster. That was not what Cornwall Council chose to do. Nor did it challenge the make up of the distribution formula. It did not reckon the health authorities worse off in percentage distance from target than Cornwall and the fact that Cornwall’s £20 million is not the whole under target funding in England. Instead it voted for a simplistic and unrealistic motion – me, now – that I believe has no chance of success.
CORNWALL COMPARED: APHO HEALTH PROFILES 2011
30 June 2011
The Association of public health observatories (APHO) has published its health profiles for England 2011. These include comparative data for 351 local authorities, including Cornwall unitary authority, on numerous indicators associated with health and wellbeing such as deprivation and smoking in pregnancy.
The data is here in one spreadsheet and here by separate indicators. It’s a modern curate’s egg as one would expect, a mixture, and it deals with Cornwall as a whole (and there are variations within the county unnoted here but which should inform policies) but on many indicators Cornwall as a whole performs better than England as a whole.
LIBDEMS AND THE NHS BILL
15 June 2011
Nick Clegg and the Libdems are asking us to believe that they have taken the Tories by the scruff of the neck, shaken the nasty party hard, and rewritten the NHS bill (that is, the Health and social care bill) which they were against all along. This is brazenly rewriting history.
The original NHS bill was introduced with the total support of Nick Clegg who signed it off in the Tory Libdem cabinet. Not a single Libdem MP voted against the original bill at second reading (Hansard 31 January 2011 column 605 ff).
The Spectator of 6 April 2011 ran the wry item ‘Nick Clegg was claiming that the NHS reforms were the Lib Dems’ idea just three months ago,’ a reference to Clegg on the Andrew Marr program on 23 January 2011.
What changed?
The opposition and concern of many health professionals, the local elections, disastrous for the Libdems, and public opposition reflected in the vast NHS petition through the website 38 degrees, along with a fortuitously timed conference of Libdems from outside parliament which hammered the bill. The lemmings stopped at the cliff edge.
It makes sense to listen and change when there is such a confluence of events and people but trying to rewrite history is undignified and unpersuasive. However, the Libdems are desperate to find areas where they may safely and popularly disagree totemically with their Tory allies while remaining in government with them.
Is the Libdem party trying to save the NHS or trying to save its skin? But it is a famous victory … of Clegg over Clegg, of Libdems today over Libdems of 31 January.
Cornwall notes
Andrew George, Libdem MP for St Ives, said in the Commons debate on 31 January 2011 that he would not vote for the second reading of the bill; nor did he. However, he did not vote against it then either but he has been consistent and outspoken in his robust criticism of the bill from the start. Dan Rogerson (North Cornwall) voted for second reading. No vote is recorded for Stephen Gilbert (St Austell and Newquay).
It was a famous victory: a satirical refrain in the poem Battle of Blenheim by Robert Southey.
SCALPELLED
5 May 2011
Before the general election David Cameron promised that the NHS would be safe in Tory hands. Yes, I know, a politician’s promise is like snow in summer. Turn your back and it’s gone.
And gone this one has.
Along with the proposed Tory Libdem changes to the organisation of the NHS, are cuts – governments tend to call them efficiency savings but they usually turn out to be buying fewer paperclips, employing fewer workers, and ending or reducing services.
Last year the Tory Libdem government looked for annual cuts of 4 percent from hospitals in England. The other day Monitor, the foundation hospital regulator set up by the last Labour government, wrote to foundation and would-be foundation hospital trusts. The letter is here.
It has increased the suggested savings/cuts from 4 percent to 6-7 percent a year which compounded over five years total 37 percent; the letter explains why. I do not believe a hospital can make savings of that level without eating into jobs and patient services.
Additionally, this is the figure that Monitor will be using from May 1st when assessing an NHS hospital application to become a foundation trust. There are adverse changes to the tariff and readmission fines too.
What are the implications for the Royal Cornwall Hospitals Trust (RCHT) which aspires to foundation status? The RCHT should tell us now candidly how it sees its position and future in the light of these latest and large changes. Can it make these new savings/cuts? What will be the impact upon services, on paying off the debt, on investing in improvements, on securing foundation status?
I hope my gloom can be solidly confounded.
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UNITED KINGDOM
18 March 2011
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England £7.40 per item from April 2011
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