13 July 2007
Elderly people in some areas of England are 160 times more likely to receive NHS continuing care than others, startling figures published on July 13 reveal.
The extent of the 'postcode lottery' in access to NHS continuing care services – where the NHS funds
non-hospital care for those deemed by doctors as priorities, such as the severely infirm or dementia sufferers – is exposed by figures obtained by the charity Age Concern and seen by Public Finance.
Derby City Primary Care Trust, for example, offers free care to the lowest number of people nationally – just seven individuals in total – 0.26 per 10,000 of its population. In stark contrast, Harrow Primary Care Trust in northwest London provides services to 826 people or 42 per 10,000 of its population, despite having a younger demographic.
People in some PCTs are also 15 times more likely to receive free care than those in neighbouring trusts within the same strategic health authority. North East Essex PCT, for example, treats 1.75 people per 10,000 (a total of 54 people), while neighbouring Mid-Essex PCT funds treatments for 26 people per 10,000 (918 individuals).
Age Concern described the figures, obtained from the Department of Health, as 'unbelievable' and called for immediate government action to improve provision across the worst-performing trusts.
Gordon Lishman, Age Concern's director general, said: 'These new figures beggar belief. Individuals face a postcode lottery in getting NHS continuing care. There can be no justification for such huge variations in access.'
Health minister Ivan Lewis recently described problems in accessing social care as the 'running sore' of the health service.
His remarks followed criticism that the NHS was shunting costs on to councils by forcing all residents deemed as non-priority patients to use local, means-tested and often costly services.
But the Department of Health this week attempted to play down the impact and accuracy of variations in access to care. A spokeswoman said: 'There is certainly substantial variation and we have never denied that. However… ultimately assessments [of priorities] are carried out and decisions are made at a local level, and there are substantial demographic differences between PCTs.
'We also believe that there are currently differences in the way that PCTs record and report their data. We are working with SHAs to address this.' The department expects to see 'significantly decreased variations' over time, she said.
Former Local Government Association chair Sandy Bruce Lockhart recently warned that government cash set aside to tackle the problem was a 'drop in the ocean' and that Britain's ageing population would put further pressure on tightening budgets.
Age Concern this week called for billions of pounds of extra investment. It also estimated that more than 60,000 people who should qualify for free care would still be denied access to services – despite government plans to force PCTs to apply clearer, less subjective eligibility criteria from October.
Many NHS trusts face severe financial restraints. SHAs set the eligibility criteria for continuing care, which are then interpreted by PCTs. Critics claim that this loose arrangement fuels the postcode lottery.
Around 31,000 people nationally receive NHS continuing care and the new government guidelines are expected to raise that figure to around 37,000, with the additional capacity funded by £220m in existing national and local cash. However, Age Concern estimates that 100,000 people should qualify for NHS-funded care.
Lishman warned: 'The new framework is welcome but we want to see it monitored carefully to assess its impact in stamping out this unfair practice altogether, and greater pressure put on SHAs and local authorities to ensure that there is a seismic shift in attitudes in those PCTs that give low numbers of people continuing care.'
However, the DoH dismissed Lishman's call for a further 60,000 people to be offered free services. 'If we were to change the system so that an additional 60,000 received all care free of charge, it would be completely unaffordable and would lead to less resources being available for those most in need,' the spokeswoman said.
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