18 May 2012

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?

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.