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.

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.