Inequalities in Health and Health Care Provision UK

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Inequalities in Healthand Health Care
ProvisionUK
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National Inequalities in Health
www.statistics.gov.uk
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Death Rates and Infant Mortality Rates per 1,000,
per country (2003)
General Register Office for Scotland
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Main Points

• In all causes of mortality
• rates are higher in Scotland than anywhere else
  in the UK.
• rates are higher for both males and females in
  Scotland than anywhere else in the UK.
• only in road traffic accidents do males in
  Northern Ireland fare worse than in Scotland.

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Main Points

• In terms of rates of mortality
• Scotland has the highest death rate per 1000
  population and the level is 1.3/1000 above the
  national average.
• Infant mortality rates, however in Scotland are
  lower than the national average of 5.3/1000, and
  those for England and Northern Ireland.

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Causes of death by gender, 2003, UK
www.statistics.gov.uk
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NHS Expenditure by country in the UK 2002-3
(bmj.com 2005) and 2004-5
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Percentage population and per capita spend on
health in countries in the UK (2004-5)
www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,d
hsspsni.gov.uk/ www.isdscotland.org
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Relative level of health care spend on a per
capita basis per country (2004-5)
The UK average 100
www,dhsspsni.gov.uk/
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Number of Health Service Staff per 10000 people
per country (2003-4)
www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,d
hsspsni.gov.uk/ www.isdscotland.org
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Availability of hospital beds and health staff in
UK countries (2003)
www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,d
hsspsni.gov.uk/ www.isdscotland.org
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Findings

• Statistics on mortality rates and morbidity rates
  confirm that
• There is a clear north-south divide in the health
  of the British public
• Death rates are higher in Scotland than in
  England and Wales
• Death rates are highest in Scotland for both male
  and females.
• More money is spent on health care provision in
  Scotland than in England and Wales.

But
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Inverse Care Law

• Areas which experience the worst ill health
  Scotland followed by Northern Ireland receive
  the most money on health care provision and
  manpower.
• Areas which experience the least ill health
  England and Wales receive the least money on
  health care provision and manpower.
• This is called the Inverse Care Law.

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But..

• More money is spent on health care provision in
  Scotland than in England and Wales.
• In other words there is no correlation between
  the incidence of ill health and the allocation of
  financial and manpower resources put into health
  care.

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Lack of Correlation
Is this lack of correlation between the incidence
of ill health and the allocation of financial and
manpower resources in health care provision a
reflection of the disparity in where the
resources and manpower are targeted? a
reflection of the greater needs of people in
Scotland?
or
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Inequalities in Health Care Provision

• Studies show that wide variations in health care
  provision do exist within the UK.

Guardian Newspaper extract (October
1999) Rather than having a National Health
Service, it is as if we have dozens of
independent health services, all operating under
different rules and using different criteria. In
some parts of the country youll be booked into a
specialist cancer hospital which will spend
thousands on chemotherapy drugs even though the
success rates for some drugs for cancer are
miniscule in others youll be told that your
time is up even though there are plenty of well
proven cures which might well succeed. Nigella
Lawson
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Geographic Imbalance (2004-5)

• The NHS spends about 1,533 each year on each
  person in Scotland.
• The NHS spends about 1249 each year on each
  person in England.

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Inequalities in Health Care Provision
(2001)

• Geographic imbalance in NHS provision.
• In Scotland there are
• 51 consultants for every 100,000
• 75 GPs for every 100,000
• 808 nurses for every 100,000.
• In England there are
• 39 consultants for every 100,000
• 56 GPs for every 100,000
• 620 nurses for every 100,000.

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Comparison of NHS provisionbetween Scotland and
England (2001)
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Regional Imbalance in Funding in England (2001)

• Average national rise in funding was 4.2.
• Isle of Wight received a rise in funding after
  inflation of 3.6. Yet it has the highest
  proportion of elderly and the lowest household
  income in England.
• London Authority of Kensington, Chelsea and
  Westminster received 5.9 after inflation.

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NHS costs within England (2001)

• The cost of a hospital operation can vary by up
  to 20 times within England.
• A lung transplant can cost between 2,488 and
  31,430.
• A hip replacement can cost between 354 and
  7,784 depending on where you live.

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The Anomaly?

• The variations in the allocation of financial and
  manpower resources throughout the UK are not the
  sole cause of inequalities in health.
• If that were the case then Scotland, which
  receives the highest level of spending and
  manpower, should be the healthiest part of the UK
  but it is the worst.
• Also, there are areas in Scotland and Northern
  Ireland which compare favourably with the
  healthiest areas in England.
• There are parts of London that have levels of ill
  health as bad as the worst areas in Glasgow.
• Within Glasgow there are huge differences in
  health in areas barely one mile apart.

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The Reasons?

• Scotland needs its extra healthcare expenditure
  to overcome unfavourable factors which work
  against delivering comparable health outcomes.
• Higher levels of deprivation which exist in
  Scotland.
• Higher levels of rurality and remoteness which
  make it more difficult to ensure adequate access
  to healthcare for people in remote areas of
  Scotland such as the Western Isles and more
  expensive than in urban and central belt areas.

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The Evidence (2005)

• For example NHS spending per head of population
  in 2004-5 in Lothian was 1199 compared with
  2076 for the Western Isles. This represents a
  difference of 877 per capita.
• The average cost per in-patient case in Shetland
  is 3759 whereas in Greater Glasgow it is 2806.

www.isdscotland.org
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See BBC News PowerPoints for articles on
inequalities in health care provision.

• Patients face geographical care lottery

• GPs under pressure

• Patients dont listen to their doctors

• Millions illiterate about health

Courtesy of www.bbc.co.uk