THE POSTCODE LOTTERY

  • There have been concerns since the late 1990s about the notion of the postcode lottery, rising from differences in access to NHS treatment throughout the country, and concerns that where you live can define the quality and availability of NHS services you can expect.
  • The postcode lottery has become a big issue in the NHS, where the gap between the idea of a nationwide, comprehensive service and the reality of local decision making has been increasingly tense.
  • Services which have been affected by the postcode lottery have included access to certain cancer drugs, fertility treatments, hernia repair, hip and knee replacements, cataracts and varicose vein surgeries, as well as variations in waiting times, access to cancer screening programmes and availability of drugs for mental health conditions.
  • The postcode lottery came about largely from the practice of GP fundholding during the 1990s, a system which enabled GPs to receive a fixed budget from which to pay for primary care, drugs, and non-urgent hospital treatment for patients. The concept of a postcode lottery is also a by-product of patients and consumers becoming more aware: patient groups have become more adept at lobbying for their consumer "rights" to drugs and services.
  • In 2008, Gordon Brown vowed to end the NHS postcode lottery, to mark the 60th anniversary of the NHS, and the issue of the postcode lottery has continued to come under much scrutiny in the context of the 2012 Health and Social Care Act.
  • The increase in rationing within the NHS has led to an increase in the effects of the postcode lottery, in determining which patients have access to certain treatments. In April 2013, the NHS published generic commissioning policies, in order to ensure fair and consistent decision making across the board. with the aim of reducing the impact of the postcode lottery by making treatments available to all, regardless of where they live.

 

Some GP commissioners pay twice as much for IVF as others, review finds (BMJ: 11 September 2014)

Fertility Fairness is a multidisciplinary umbrella organisation that represents the major patient and professional bodies working in the field of infertility. It used freedom of information requests to map the fertility services offered by clinical commissioning groups (CCGs) in England. The audit found that the average prices paid for IVF ranged from £2900 to £6000. Fertility Fairness added that costs varied widely across the country because there was no national tariff for IVF treatment on the NHS—leaving it up to CCGs to negotiate locally with clinics on how much they should pay for each cycle.

The research also found that the number of commissioners offering the full three cycles of IVF that the National Institute for Health and Care Excellence recommends had fallen from 27% in 2011 to 18% (38 of 208 CCGs) in 2014. More than half of CCGs (110; 53%) offered just one cycle of IVF, up from 39% in 2011, and nearly a third (29%) offered two cycles (up from 26% in 2011). One CCG—Vale of York—offered no funding for fertility treatment.

The research also found that CCGs continued to restrict access to fertility treatment by using arbitrary age criteria that did not reflect NICE’s recommendation that treatment should be offered to couples where the female is under 42. For example, CCGs in Hampshire and the Isle of Wight continued to restrict access for couples where the female was 35 or over.

Last year an investigation by The BMJ found that only four of 195 CCGs had altered their IVF policy to reflect NICE guidelines published in February 2013, which advised that the age limit for women undergoing IVF should be raised from 40 to 42 and that IVF should also be offered to single women and same sex couples.

 

No NHS funding for fertility treatment in York (BBC News: 7 August 2014)

NHS bosses in York have decided to continue a policy of not funding fertility treatment.

The NHS Vale of York Clinical Commissioning Group (CCG) is currently the only area in England not to support IVF treatment. Funding was suspended in 2010 by the former primary care trust as part of a bid to save money.

Dr Tim Hughes, a GP member at the CCG, said the decision had been made "with a heavy heart."

Dr Hughes said the governing body had "voted to temporarily defer the commissioning of IVF services" but hoped to provide fertility treatment sometime in the future.

Criticism over NHS Down's syndrome test availability (BBC News: 14 July 2014)

A new screening test for Down's syndrome is still not available across the Welsh NHS, six years after guidelines said it should be.

In 2008 the National Institute for Health and Care Excellence (NICE) said all pregnant women should be offered the ultrasound scan and blood test. But currently only patients in north Wales are offered screening.

The Welsh government said introducing the test across Wales had been "challenging".

The guidelines recommended that all pregnant women are offered a combined ultrasound and blood test which identifies the risk of having a baby with a genetic condition caused by abnormal chromosomes, including Down's syndrome

 

Royal College of General Practitioners raises concerns over funding levels and postcode lottery for patient appointments (RCGP, 1 June 2014)

The Royal College of General Practitioners (RCGP) has voiced its concerns over the level of funding for general practice and the postcode lottery facing patients wanting to visit their local GP.

Up to four times as many people are reporting that they cannot get an appointment at their local surgery in places where access to a GP is worst, compared to the best performing areas. The RCGP analysis, based on the GP Patient Survey, also highlights that those patients who experience the most difficulty in getting to see a GP tend to live in the most deprived areas.

This survey data was allied to warnings over the proportion of health spending going to GPs, which is now at a historic low of 8.5% of the overall health budget; the RCGP argues that the increasingly stretched resources available to the general practice sector will lead to 34 million requests for consultations not being met this year amid increasing demand from the public for GP appointments.

 

 

NHS trusts told to end postcode lottery of IVF treatment. (The Telegraph: 15 May 2014)

Most couples who have not conceived after a year should be given three full cycles of IVF treatment on the NHS for free, the National Institute for Health and Care Excellence has said.

The first guidance on the issue was delivered ten years ago but NHS trusts have never fully implemented it across all areas meaning patients faced a postcode lottery. Gosport MP Caroline Dinenage told the Commons last week that women in her area are only being offered one cycle of IVF treatment up to the age of 35.

Earlier this year, campaign group Infertility network UK said three quarters of NHS organisations were not offering three full cycles as the Nice guidance intended.

 

Lottery of NHS drugs punishes the dying (The Telegraph: 21 January 2014)

Thousands of patients suffering from cancer and other serious illnesses are being denied the drugs they need from the NHS, according to a report. Even though the treatments have been approved by the health service rationing body, at least 14,000 patients a year are not receiving them. As many as one in three of those suffering from some types of cancer are going without medication that could extend their lives, the figures show. Experts said the report, from the Health and Social Care Information Centre, a government quango that provides NHS statistics and analysis of trends in health and social care, exposed an “endemic and disastrous postcode lottery” of care within the health service. Charities said the findings were “alarming” and meant patients were being condemned to an early death because local NHS bodies were failing to fund drugs even though they had been proven to work.

 

Surgeons criticise postcode lottery in weight loss services (The Guardian 9th January 2014)

A postcode lottery is denying obese people in some areas access to intensive weight loss programmes, which are a prerequisite for bariatric surgery, the Royal College of Surgeons has said. NHS England's clinical commissioning policy requires individuals to have tried and exhausted all non-invasive treatment options, including weight management services, prior to potentially higher-risk surgical approaches. But based on evidence from its surgeons, the RCS says such weight loss services are not being made available to some people, putting their health at risk. It says north Cumbria stopped seeing patients for such programmes in September, and no funding is now available for them. In November Channel 4's Dispatches reported that fewer than one in four NHS clinical commissioning groups were funding weight management (tier 3) services.

 

 

 

 

 

End postcode lottery of cancer care, say MPs (The Telegraph: 10 December 2013)
 
Cancer care in the UK is a postcode lottery with regional divides leaving many people facing lengthy waits to be diagnosed and unable to access treatment, a new report has warned. Figures show that people’s chances of being diagnosed early and surviving various forms of cancer differ significantly across the country, with a gulf between affluent parts of London and the Home Counties and the rest of Britain. Premature cancer mortality rates are more than twice as high in Liverpool – 157 deaths per 100,000 people below the age of 75 – as they are in Kensington and Chelsea, west London, where fewer than 78 people die early. People living in the North East have more than double the chance of being sent for a targeted form of radiotherapy than those living the South West. There was a wide regional variation in urgent referral rates between, ranging from under 800 referrals per 100,000 in areas of London to nearly 3,500 per 100,000 population in the North East and East Anglia.
 

 

NHS struggle to meet £20bn savings target hits elderly hardest (The Guardian: 6 December 2013)
 
Patients are being denied knee replacements and cataract removals as the NHS struggles to meet its £20bn savings target, official data has revealed. The number of those operations, as well as hip replacements, has fallen to its lowest level for five years, despite England's elderly population – which has most need for those procedures – having risen over the same period. Surgeons, charities and Labour claimed declining access to three of the most common surgical procedures was leaving patients in pain and discomfort and was evidence of a widening "postcode lottery" in the availability of treatment. NHS data contained in the healthcare information firm Dr Foster's annual Hospital Guide, published Friday, shows that 24% of England's population, more than 12 million people, live in an area where the number of these hip, knee and eye operations fell between 2009-10 and 2012-13.

 

Hips, knees and cataract operations: Postcode search (BBC News: 5 December 2013)
 
The number of vital, non-emergency procedures carried out by the NHS in England has started to be rationed, analysis by research group Dr Foster suggests. But the picture varies from area to area. Hip and knee replacements and cataract operations - recognised as some of the most effective procedures - have dropped significantly in some Clinical Commissioning Group (CCG) areas in the last two years, while they have risen in others. GP-led CCGs have replaced primary care trusts in England and now commission healthcare on behalf of patients. Enter your postcode to find out about hips, knees and cataracts in your area.
 

 

Postcode lottery over dementia care exposed (The Yorkshire Post: 30 November 2013)
 
Dementia diagnosis rates vary widely across Yorkshire according to new figures that map out a worrying postcode lottery of care. Some of the best and worst performances in the country are to be found in different corners of the region, a report by the Department of Health reveals. Sheffield leads the way with 68% of people who have the condition given a diagnosis – the third best rate in England. But diagnosis rates are almost half that in the East Riding, which languishes near the bottom of the national league table with just 38 per cent of patients diagnosed. The overall rate of diagnosis across all the region’s clinical commissioning groups (CCGs) was 51.8%, beating the 48 per cent national average. Yorkshire’s figure was bolstered by Sheffield’s high rate along with those in Bradford Districts (65.3%) and Bradford City (62.5%). Rotherham; Leeds South and East; Leeds West; Wakefield; and North Kirklees also all scored above the regional average, while diagnosis rates in Greater Huddersfield; Leeds North; Harrogate and Rural District; Airedale, Wharfedale and Craven; Calderdale; and Barnsley were above the national average.
 

 

Hip operation patients face 'postcode lottery' of care (The Telegraph: 17 November 2013)
 
Thousands of elderly people admitted to hospital with broken hips are dying due to a “postcode lottery” which sees the death rate six times higher in some units than others, a report claims. Hip operation death rates have reached 13 per cent in some hospitals compared to just two per cent at the most successful ones. The huge inequalities in care lead to the deaths of 5000 pensioners who break a hip each year, according to the National Hip Fracture Audit for 2013. It concluded that some hospitals were failing to meet the required standards necessary to meet the needs of the 70,000 pensioners who break a hip each year.

 

Some NHS trusts spending four times as much on meals as others (Daily Mail: 16 October 2013)
 
Budgets per patient vary wildly between £4.15 per day to £15.22. Campaigner calls the disparities a 'postcode lottery'. Some hospital trusts spend as little as £4.15 per day feeding patients - less than half the national average, new figures reveal. Barnet and Chase Farm Hospitals NHS Trust in London spent £4.15 per inpatient per day in 2012/13, compared to a national average spend of £9.87. The data, released by the Health and Social Care Information Centre (HSCIC), showed some NHS trusts spend over three times as much per inpatient per day as other trusts.

 

Lives of elderly at mercy of postcode lottery in 'ageist' NHS, figures suggest (The Telegraph: 2 September 2013)
 
Age discrimination is rife in the NHS with elderly people routinely being denied potentially life-saving treatment simply because of where they live, stark new figures suggest. Treatment statistics obtained by the former health minister Paul Burstow show dramatic variations between the availability of surgery for people over 75 in different parts of England. It amounts to alarming evidence that older people’s lives are being placed at the mercy of an unfair postcode lottery in the health service, Mr Burstow said. Patients over the age of 75 are six times as likely to be allowed cancer surgery in some areas as in others, according to the figures obtained in response to a Parliamentary question tabled by Mr Burstow.

 

'Stark variation in NHS surgery due to rationing' (BBC News: 8 March 2013)
 
The number of patients undergoing common surgical procedures varies widely across England because of funding restrictions, figures show. Local NHS rationing of  has led to a "postcode lottery", say researchers. The Department of Health said access to services should not be decided on cost, but rather on suitability for surgery, which should be judged by clinical experts on the basis of individual need.
 
A comparison of hospital data with primary care trust (PCT) policies on rationing of surgery showed a significant difference in the number of operations being done depending on local rules. For example for cataract surgery, PCTs with rationing in place were admitting about 48% fewer patients than those with no such policy in the first year restrictions were introduced, the figures showed. Significant variations had been seen in access for almost every year looked at since rationing The type and number of procedures rationed by PCTs varied considerably and only 17 of 119 respondents had no policy for all five of the procedures looked at. 

 

NHS England publishes generic commissioning policies(NHS England: 4 April 2013)
 
NHS England has published a number of interim generic policies, aimed at ensuring fair and consistent decision-making across its direct commissioning function. The 14 policies cover all aspects of NHS England’s direct commissioning responsibilities including specialised services, primary care, screening, military and offender health.The policies, agreed by the Clinical Priorities Advisory Group (CPAG), set out NHS England’s approach on a variety of funding issues including Individual Funding Requests; access to treatments for patients moving between different sets of commissioners and services providers, and the process that NHS England will adopt for implementing guidance produced by the National Institute of Clinical Excellence (NICE).

 

Patients with rare conditions face postcode lottery (The Guardian: 20 October 2012)
 
Research shows that patients with rare conditions have less chance of accessing 'orphan' medication if they live in England. Figures contained in a new report by the think-tank 20:20 Health, claims the NHS is providing an unequal service. Seriously ill patients with life-threatening rare diseases are being denied vital drugs because of a postcode lottery across the NHS that campaigners say is frustrating and unfair. New research reveals that patients with a rare condition have much less chance of accessing "orphan" medication if they live in England rather than Scotland or Wales. "Orphan" drugs treat patients with a condition affecting fewer than five in 10,000 people.

 

NHS care for elderly is a ‘postcode lottery’ (ITV.com: 23 March 2012)
 
An alarming postcode lottery has been uncovered by ITV News in the levels of NHS care available to people who fall ill in their old age. ITV News has examined Dept of Health data which shows how many people get NHS Continuing Care within each Primary Care Trust (or NHS Trust). And the results are staggering: for example, if you live somewhere like Barking and Dagenham, you’re almost ten times more likely to receive the funding than if you live somewhere like West Berkshire. The figures revealed that 158.4 people out of 50,000 received Continuing Care in the best performing areas while only 16.4 people received it in the worst.

 

Weight surgery 'a postcode lottery' (The Uttoxeter News: 10 March 2012)
 
Thousands of patients who want weight-loss surgery are facing a postcode lottery on the NHS, data suggests. Some people who should meet the criteria for surgery are forced by their local hospitals to wait until they become even more obese. Around one million people in the UK are thought meet the criteria for bariatric surgery, with around a quarter of these wishing to have it. Guidelines from the National Institute for Health and Clinical Excellence (Nice) say people are eligible if they have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 with other significant disease such as diabetes or high blood pressure. (...) NHS Stockton-on-Tees carried out the most procedures per population, with 5.9 operations per 10,000 people. Meanwhile, NHS Rotherham funded just one operation among its 244,000 population, the investigation found.

 

Dementia patients' 'postcode lottery' of care (The Telegraph: 07 March 2012)
 
Dementia patients across England are receiving a "postcode lottery" of care, with health authority spending per patient varying 21-fold. Freedom of information requests to 134 primary care trusts (PCTs) have found the amount spent per dementia patient varies from £38 at NHS Nottinghamshire County to £802 at NHS Barnsley. The average for the 54 which provided information to GP magazine, which submitted the FOI requests, was £160. Four in 10 spent less than £100. (...) Dr Ian Walton, a West Midlands GP with a special interest in mental health, told the magazine: "GPs are blamed for not picking up dementia. But they haven’t got support from services. It’s why GPs are not inclined to refer." 
 

 

NHS postcode lottery survey reveals wide UK disparities (The Guardian: 9 December 2011)
 
NHS Atlas of Variation, a government analysis of regional treatment, shows huge inequalities in quality, quantity and costs. The government survey of healthcare, the NHS Atlas of Variation, reveals huge variations in treatment and costs around the UK. The postcode lottery of treatment in the NHS has been exposed by the largest government analysis of healthcare in England, which reveals wide regional disparities in patient treatment. The NHS Atlas of Variation, a copy of which has been obtained by the Guardian, lays bare the tension between the health secretary's vision of a "localised" health service and the need to impose basic minimum standards of acceptable care. While ministers accept that "some variation is warranted because different populations have different levels of need", the differences in cost, quality and patients outcome mean that "unwarranted" inequalities need to be ironed out.

 

MP Hugh Bayley calls for more NHS funding to end ‘postcode lottery’ (The York Press: 2 December 2011)
 
Calls for NHS funding to be increased so a “postcode lottery” surrounding health services in York is ended have been made by one of the city’s MPs. (...) Mr Bayley said figures he obtained from the Commons library showed that, in the first year of the current Government, the budget for local primary care trusts increased by 2.2 per cent, but actually fell by 1.8 per cent once the Retail Price Index, a measure of inflation, was taken into account. Mr Bayley said: 'York is back to a postcode lottery where patients are being denied a growing range of treatments for obesity, infertility, back pain and minor surgery which are available to NHS patients in neighbouring areas and other parts of the country'.
 

 

‘Postcode lottery’ for knee and hip surgery (Age UK, 6th November 2013)

People needing a knee or hip replacement face significantly different waiting time lengths depending on where they live and when they begin their wait, a new report suggests. Researchers from the Medical Technology Group have reported a 'pronounced postcode lottery'; with patients in some areas waiting up to a month longer for operations than others elsewhere.

Patients in London typically waited 121 days for surgery last year, compared to the 91 or 93 days people in the East Midlands waited for a hip or knee replacement respectively.The last decade has seen a 92% increase in the number of NHS-conducted hip and knee replacement operations, the report found, with 140,000 carried out last year alone. This makes them among the most common medical interventions now seen in the UK. However, the report also found that over the last 10 years 49,351 knee replacements have been performed in March - 13% more than the 42,944 undertaken in April. It suggests health trusts forecasting an end-of-year under-spend are 'incentivised' to spend up to their delegated limit and carry out additional procedures in March.

It adds: 'This financial-calendar led allocation of procedures is highly unlikely to be the best model through which to fund equitable and consistent healthcare.'

 

Elderly at mercy of postcode lottery in 'ageist' NHS (The Telegraph: 02 September 2013)

Treatment statistics obtained by the former health minister Paul Burstow show dramatic variations between the availability of surgery for people over 75 in different parts of England. It amounts to alarming evidence that older people’s lives are being placed at the mercy of an unfair postcode lottery in the health service, Mr Burstow said. Patients over the age of 75 are six times as likely to be allowed cancer surgery in some areas as in others, according to the figures obtained in response to a Parliamentary question tabled by Mr Burstow. Michelle Mitchell, director general of Age UK, said: "The clear implication of these figures is that many older people, particularly in certain areas of the country, still face unfair, discriminatory and potentially illegal practice in the NHS. Everyone deserves fair access to medical care, yet older people's health and even their lives are at risk if arbitrary decisions are being made about their care based on their age, rather than their individual clinical need."

 

Dementia stats down but postcode lottery drives uneven care (The Conversation: 18 July 2013)

Dementia has been described as a ticking time bomb, with the number of those affected predicted to double in the next two decades, however a new study suggests that the prevalence of people with dementia in the UK has actually fallen over the past 20 years.

The findings, based on data from participants aged over 65 and living in Cambridgeshire, Newcastle and Nottingham, appears to be in line with a much larger Europe-wide study published by Alzheimer Co-operative Valuation in Europe. The researchers in England looked at 7,000 people randomly chosen between 1989 and 1994 and asked them about their lifestyle, health and socio-economic status. Nearly 8,000 more were recruited again between 2008 and 2011. Around 1,500 were tested for dementia.

Based on the estimated prevalence of dementia 20 years ago, the researchers then estimated that some 880,000 within the UK would be expected to have dementia by now (about 8% of people aged over 65). But this local study suggests a national prevalence of around 670,000 people (6.5% of the over 65 population). Overall, this is a fall of nearly a quarter in the number of people expected to have dementia.

The statistics about dementia are arguably the same all across the UK, and we can compare how four sets of policy makers have responded in England, Scotland, Wales and Northern Ireland. Each of the four health departments has a different policy. Based on the same statistics on prevalence of dementia, each country made a different policy at a different time and got hugely different outcomes. In Northern Ireland, for example, you have a 63% chance of being diagnosed by the health system, but in England it’s 42%. This postcode lottery is a scandal but averaging out the figure for England, Wales and Northern Ireland easily buries such differences.

 

Report reveals postcode lottery for cataract surgery (Optometry Today: 17 July 2013)

The RNIB has launched a report which shows substantial regional variation in the rates of cataract operations across England, resulting in a postcode lottery. The report revealed that rates of cataract operations in North Lancashire were four times the number of those in South Reading. It also found that there were significant differences in waiting times and rates of second eye operations.
 
The RNIB commissioned the analysis to examine variation of access to cataract surgery across England. Data between 2007/08 and 2012/13 were analysed at both patient and Clinical Commissioning Group (CCG) level. The research showed that in 2012/13, the rate of operations varied from 1,147 per 100,000 in Fylde and Wyre CCG (North Lancashire) to 267 in South Reading CCG. Operation rates were also low for Ipswich and East Suffolk, Central Manchester and Tower Hamlets CCGs.
 
Commenting on the findings, Clara Eaglen RNIB’s manager of eye health campaigns, said: “Regional variation has created a postcode lottery which is simply unacceptable. NHS ‘efficiency savings’ achieved by cutting cataract operations are a false economy, as denying treatment leaves patients at risk of depression, social isolation and fall-related hip fractures which are more costly to treat.
 
 

NHS England publishes generic commissioning policies (NHS England: 04 April 2013)

NHS England has published a number of interim generic policies ensuring fair and consistent decision-making across its direct commissioning function. The 14 policies cover all aspects of NHS England’s direct commissioning responsibilities including specialised services, primary care, screening, military and offender health.

The policies, agreed by the Clinical Priorities Advisory Group (CPAG), set out NHS England’s approach on a variety of funding issues including Individual Funding Requests; access to treatments for patients moving between different sets of commissioners and services providers, and the process that NHS England will adopt for implementing guidance produced by the National Institute of Clinical Excellence (NICE). Other policies include the Ethical Framework for Priority Setting and Resource Allocation which sets out a fair and consistent approach to decision-making.

The policies are being adopted on an interim basis to enable NHS England to carry out further engagement with patients, carers and the public over the next 6-12 months in refining and agreeing final versions. NHS England plans to bring together a steering group which will lead development of the policies, working in partnership with a range of stakeholders. This group will test the principles on which the policies are based and will revise them, where appropriate, in order to make them more accessible.

 

'Stark variation in NHS surgery due to rationing' (BBC News: 08 March 2013)

Local NHS rationing has led to a "postcode lottery", say researchers: the number of patients undergoing common surgical procedures varies widely across England because of funding restrictions, figures show.  The Department of Health said access to services should not be decided on cost, but rather on suitability for surgery, which should be judged by clinical experts on the basis of individual need.

A comparison of hospital data with primary care trust (PCT) policies on rationing of surgery showed a significant difference in the number of operations being done depending on local rules. For example for cataract surgery, PCTs with rationing in place were admitting about 48% fewer patients than those with no such policy in the first year restrictions were introduced, the figures showed.

Significant variations had been seen in access for almost every year looked at since rationing. The type and number of procedures rationed by PCTs varied considerably and only 17 of 119 respondents had no policy for all five of the procedures looked at.

 

Hospitals in new cancer drugs postcode lottery amid fears some doctors prefer to stick with tried and trusted treatments (The Daily Mail: 24 January 2013)


Hospitals are denying patients the latest cancer drugs, a report reveals today: many are refusing to give patients life-extending new treatments approved by NHS rationing body NICE. Research has uncovered a 40-fold variation between hospitals offering the highest numbers of drugs and those providing the least.

Charities warn that patients are at the mercy of an ‘unjustifiable postcode lottery’, with their chance dependent on where they live. There is also concern that hospitals are deliberately holding back highly effective treatments because they are more expensive than ones they already use. The stark variation may also be partly due to doctors in some hospitals preferring to give patients drugs they have used for years, rather than trying new treatments.

Research by the Rarer Cancers Foundation analysed NHS figures showing how often hospitals were prescribing new cancer drugs approved by NICE. The charity looked at 25 treatments recommended by the watchdog within the last ten years to treat cancers including breast, bowel, stomach, pancreatic,  prostate, kidney and leukaemia. Some of these drugs have been shown to boost survival rates by as much a quarter while others can extend the lives of terminal patients by a year.

Andrew Wilson, chief executive of the Rarer Cancers Foundation, said: ‘For the first time these figures expose the highest and lowest users of cancer drugs. ‘Patients have a right to know. Some variation may be explained on clinical grounds, but others could reveal an unjustifiable postcode lottery: the NHS owes it to patients to investigate these variations and account for why they occur.’  

 

IVF 'postcode lottery' to worsen, Lord Winston warns (The Telegraph: 02 January 2013)

IVF treatment will be down to a “postcode lottery” this spring when doctors take control of NHS spending, Lord Winston has warned. The fertility expert said the availability of in vitro fertilisation treatment was already unfair, with many Primary Care Trusts (PCTs) denying women the recommended three cycles of treatment.

The introduction of Clinical Commissioning Groups in April will widen the regional disparity as panels of doctors gain control of local budgets and target spending towards the most pressing needs in their area, he said. While women in some areas may see the availability of IVF increase, others living in regions with different priorities — such as those with more elderly patients — could find treatment harder to come by, Lord Winston said. This could force more women to seek private fertility treatment, driving up the cost of the procedure, he said.

The change in how NHS services are commissioned was dictated by the Health and Social Care Bill, which put spending in the hands of smaller, localised groups of doctors rather than PCTs.

 

Patients with rare conditions face postcode lottery (Guardian: 20 October 2012)

Research shows that patients with rare conditions have less chance of accessing 'orphan' medication if they live in England. "Orphan" drugs treat patients with a condition affecting fewer than five in 10,000 people. Figures contained in a new report by the think-tank 20:20 Health, claims the NHS is providing an unequal service. Seriously ill patients with life-threatening rare diseases are being denied vital drugs because of a postcode lottery across the NHS that campaigners say is frustrating and unfair.

New research reveals that patients with a rare condition have much less chance of accessing "orphan" medication if they live in England rather than Scotland or Wales.  While the European Medicines Agency (EMA) has approved 68 drugs for use with patients with rare conditions such as unusual forms of cancer and epilepsy since 2000, the National Institute for Health and Clinical Excellence (NICE) has assessed only 18 of them, recommending that seven become available on the NHS in England and Wales, and another five under certain restrictions. In contrast NICE's equivalents in Scotland and Wales have made 28 and 21 respectively available in some way.The Scottish Medicines Consortium (SMC), has examined 56 of the 68 drugs and made 14 fully available and 14 more in some circumstances. Similarly, the All Wales Medicine Strategy Group (AWMSG) has looked at 51 and made 12 available and nine others in some cases.

The figures are contained in a new report by the think-tank 20:20 Health, which claims the disparity between the Celtic countries and England shows the NHS is providing an unequal service.

 

Mother attacks NHS 'postcode lottery' on pupil's hearing aid (This is Cornwall: 27 May 2012)

Ellie Sanders, four, was born with a rare condition called hemifacial microsomia which affects the development of the lower half of the face, and is being denied a hearing aid because of where she lives. Ellie has just one ear and desperately needs a special device so she can hear teachers and follow lessons on her first day of school in September.

Her mother Kelly, 31, applied for the bone anchored hearing aid (Baha) implant which transmits sound directly through the skull and reaches the inner ear, but she says Ellie is the victim of a "postcode lottery" with two NHS trusts arguing about who should pay the £3,000 bill. And while other children elsewhere in Britain get the aid little Ellie, from Truro, Cornwall, faces starting school without one.

Kelly said: "Other families in the same situation elsewhere in the UK have been offered a Baha. They don't have to go crawling around to other trusts. Kelly first tried unsuccessfully to get a Baha from the former Cornwall and Isles of Scilly Primary Care Trust which later became NHS Kernow. When she asked NHS Kernow for the device she was told she couldn't have one and was instead directed to NHS England, which has also failed to deliver: a spokesman for NHS Kernow said: "This particular type of equipment is funded by NHS England. We have written to the consultant caring for Ellie to advise him of this".

NHS England refused to comment on individual cases but a spokesman said: "From April 1, 2013, there was a new national commissioning policy in place providing guidance on bone anchored hearing aids for hearing loss: "This now ensures patients have the same access to treatment irrespective of where they live in the country".

 

NHS postcode lottery survey reveals wide UK disparities (The Guardian: 09 December 2011)

The NHS Atlas of Variation, a government analysis of regional healthcare treatment which shows assesses data on quality, quantity and costs, reveals huge variations in treatment and costs around the UK. The Atlas exposes what is a 'postcode lottery of treatment' in the NHS by revealing wide regional disparities in patient treatment.

The NHS Atlas of Variation, a copy of which has been obtained by the Guardian, lays bare the tension between the health secretary's vision of a "localised" health service and the need to impose basic minimum standards of acceptable care. While ministers accept that "some variation is warranted because different populations have different levels of need", the differences in cost, quality and patients outcome mean that "unwarranted" inequalities need to be ironed out.

The most stark contrast shows up in the rate of prescribing anti-dementia drugs, with patients in some parts of the country – such as North Lancashire – prescribed 25 times as many treatments and tablets to help "temporarily improve or stabilise symptoms" than in Kent. There is also concern that some women suffering with breast cancer are staying too long in hospital in certain parts of the country. In parts of south Wales, patients can stay for days whereas in Hertfordshire the same surgery warrants an overnight stay. The report states that most patients undergoing breast cancer surgery can be "safely managed as day cases or with a single overnight stay" but it adds: "At present, over 20 primary care trusts (PCTSs) have (average) lengths of stay in excess of three days".

Covering 71 key indicators – including hospital admission rates, what treatments health trusts choose to fund and how children are managed in NHS – the atlas attempts to map the "utilisation of healthcare services that cannot be explained by variation in patient illness or patient preferences". The government is aware that its plans are being tarred as increasing health inequalities and last week Andrew Lansley, the health secretary, told GPs that "the degree of variation is considerable, and unexplained by simple differences in population".

Our use of cookies / millipedia :: ethical digital