Mental health funding cut by millions in five regions despite NHS England call for £1 billion to be spent by 2021 (The Independent: 25 April 2017)

Clinical commissioning groups in Sefton, Scarborough, the Isle of Wight, St Helens and Walsall are reducing spending on mental health by £4.5m

Spending on mental health services is being cut in five regions of England, new figures have revealed – despite Government pledges to “transform” the way mental health problems are dealt with.

Theresa May has promised to tackle the “stigma” around mental health and NHS England said in February last year an extra £1 billion a year should be invested in mental health services by 2021.

But clinical commissioning groups (CCGs) in Sefton, Scarborough, the Isle of Wight, St Helens and Walsall are set to reduce spending on mental health by £4.5m, according to Freedom of Information data obtained by Pulse magazine...read more

 

NHS delays leave thousands facing long wait for wheelchairs (The Guardian: 21 March 2017)

One in five children who need a wheelchair are being forced to wait beyond the supposed maximum 18 weeks, as are almost one in six adults. Campaigners say the figures reveal a “postcode lottery” in provision across England.

Some 7,200 people who received a wheelchair between October and December had waited at least 19 weeks, despite the NHS Constitution guaranteeing access to one within 18 weeks.

NHS England does not record how long over the 18-week threshold patients have waited for a wheelchair. But the charity Muscular Dystrophy UK says it knows of young adults who within the past year had waited more than eight months.

The NHS England figures obtained by the Health Service Journal (HSJ) show that those with the greatest need for the equipment can face the longest waits.

Nic Bungay, director of campaigns at Muscular Dystrophy UK, told HSJ that long waits for a wheelchair appropriate for their needs were stopping young people “going out independently … and accessing university, work and friends”.

An estimated one in 50 Britons is believed to use a wheelchair to go to work or school, get to the shops, look after their children or undertake other tasks. The Wheelchair Alliance, led by Paralympic champion Lady Grey-Thompson, claims “great variation in ability to access assessment and obtain service provision”, as well as delays in receiving equipment and having it repaired, were affecting too many people.

The campaign group is urging the NHS to ensure equality of access for everyone who needs a wheelchair, which “would prevent confusion and disadvantage when education needs mean a user moving to another area or changing their GP [and put] an end arbitrary age discrimination. This is especially the case where very young children may or may not be provided with chairs depending solely on where they live.”...read more

 

Smokers trying to quit hit by postcode lottery as GPs ration help (The Guardian: 19 February 2017)

Smokers in England wanting to quit face a postcode lottery as cash-strapped councils and GPs restrict access to services that can help them.

The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision.

Evidence obtained under the Freedom of Information Act shows that an increasing number of clinical commissioning groups – the 200 or so organisations that deliver NHS services in England – have been instructing GPs to stop providing the services. Many of the groups argue that it is no longer their responsibility.

In 2012, local authorities were made responsible for improving public health and given £2.8bn of ring-fenced grants to pay for it. But, as the grants have been pared back, councils have pulled their funding for stop smoking services.

This has led to a rationing of treatments – such as nicotine replacement therapies, bupropion (brand name Zyban) or varenicline (Champix) – in many areas. When used in conjunction with counselling, studies suggest the chances of a smoker quitting can be substantial.

Almost a quarter of a million people stopped smoking in the 12 months to April 2015 as a result of using the services, a quit rate of 51%. The services are said to have a high success rate in helping smokers in poorer communities stop.

“We are increasingly concerned that cuts in council spending, NHS cost pressures and a lack of joined-up thinking by central government are combining to block progress on cutting smoking, still the No 1 public health challenge facing the country,” said Deborah Arnott, chief executive of Action on Smoking and Health (Ash)....read more

 

Plan to force councils to raise more money to pay for elderly care 'could spark a postcode lottery' (Independent: 29 November 2015)

George Osborne has given councils new powers to levy council tax bills to directly fund social care

George Osborne’s plan to force local councils to raise more of their own money to pay for elderly care could spark a “postcode lottery” that determines much help the vulnerable can expect to receive at home, Town Hall leaders have warned.

In the Spending Review on 25 November, the Chancellor gave councils new powers to levy an extra 2 per cent on council tax bills to directly fund social care.

However, local government chiefs have warned that the change could widen the gap in care standards. The LGA calculated that, even where the 2 per cent surcharge was applied, it would be worth more in wealthier areas with more expensive homes – adding 15 per cent to those councils’ budgets by 2020 compared with just 5 per cent in disadvantaged towns.

LGA deputy chair David Simmonds, the Tory leader of Hillingdon,  said that depending on individual circumstances,  “you are not going to get any help at all” in some areas.

 

GP funding withdrawn as direct result of Government public health cuts, says local council (Pulse: 21 September 2015)

Public health commissioners were forced to cap funding of GP-run NHS Health Checks as a direct result of the Government’s mid-year cuts in funding, a local authority has said. Hertfordshire County Council told Pulse it needed to make savings as a result of the cuts – and hoped GPs would come to an agreement with them over how to achieve this. The Government introduced a £200m cut in the public health budget in June as part of a raft of measures to ‘bring down public debt’ – although it insisted this was on projected underspends and would not affect frontline services. As revealed by Pulse, public health commissioners in Hertfordshire recently wrote to GP practices to request the change to their contracts – meaning they will be paid only for the health checks they have already completed so far this year. Local GP leaders have vowed to fight the contract change, warning that it will force practices to lay off staff and cut other GP-run services, but say they have been accused of putting GPs’ ‘personal interests’ ahead of the need to sustain other public health services such as those for drug and alcohol misuse...read more

 

Revealed: Shocking NHS postcode lottery for elderly care (The Telegraph: 18 September 2015)

Elderly people in some parts of the country are nine times more likely than in others to be admitted to hospital as emergency cases - for lack of the right care in their local communities. Charities said the new official figures are a “troubling” insight into a growing crisis in care of the elderly, with hundreds of thousands of pensioners being admitted to hospitals via casualty in cases which could have been avoided with the right help earlier. The statistics also reveal a three-fold difference in the chance of cancer sufferers being diagnosed early enough to have a good chance of successful treatment, depending where they live. The figures, published by Public Health England, are among more than 100 measures assessed today in an “NHS atlas” exposing enormous variations in NHS care. They also show major disparities in dementia care, the chance of receiving stroke treatment quickly, or receiving treatment at all for a host of common health complaints such as cataracts. Over 75s living in Canterbury were the most likely to be admitted to hospital as an emergency for a stay of less than 24 hours, with 11,000 cases per 100,000 population.

 

English people with rare eye condition may be forced to move to Scotland to 'save their sight', says charity (The Independent: 25 July 2015)

English people living with a rare eye condition may be forced to move to Scotland or Wales to “save their sight”, the country’s leading charity for the blind has said, after the NHS refused to fund routine access to treatments.

The Royal National Institute of Blind People (RNIB) said it was considering legal action over NHS England’s decision not to recommended routine use of the drugs Humira and Remicade for patients with a severe form of the inflammatory eye condition, uveitis.

Both drugs are routinely available in Scotland and Wales and their use is standard practice in many other countries. A trial of Humira for one group of paediatric uveitis patients, taking place in the UK, was stopped early because overwhelming evidence of the drugs’ benefit meant it was deemed unethical to continue giving some children placebo.

However, NHS England concluded there was “not sufficient evidence” to recommend routine use.

 

Slashed budgets and STIs: The painful truth about birth control services in Britain today (The Independent: 16 June 2015)

‘Very worrying for sexual health, as well as other services: Government announces £200m cuts to public health budget.’

So tweeted the All-Party Parliamentary Group on Sexual and Reproductive Health last week, after George Osborne’s announcement that the Department of Health must make £200 million pounds worth of savings from public health budgets.

The news was met with alarm from the UK’s sexual and reproductive health (SRH) services.

Already a ‘Cinderella service’, SRH care has historically been less well funded or supported than other areas of health, and often finds it hard to attract and retain staff.

The proposed cuts could make huge differences to whether you can get an appointment when you need it or even the contraceptive you want.

 

NHS treatment cuts 'lack consistency' (Laboratory Talk: 2 March 2015)

During 2011, England’s NHS was tasked with finding £20 billion of efficiency savings over four years, in part by reducing the use of ineffective, overused or inappropriate procedures.

However, a report published today by researchers at Imperial College London (ICL) has found that an absence of clear national guidance about which procedures to perform less has caused inconsistency among NHS commissioning groups.

“Our research revealed a lack of consistency between commissioning organisations regarding which procedures were cut,” said Sophie Coronini-Cronberg, from the School of Public Health at ICL, who led the study.

“With little national guidance about which procedures to remove or restrict funding for and under which circumstances, commissioners may be turning to locally developed, unofficial lists and criteria of low-value treatments,” Coronini-Cronberg said.

“This urgently needs to be addressed to avoid local variations. Arbitrary decision-making needs to be replaced with objective, consistent, evidence-based policies.”

 

Cancer victims face postcode lottery for NHS care (Daily Mirror: 15 January 2015)

Thousands of cancer patients are dying needlessly every year because of an “unacceptable” postcode lottery of care, MPs warn.

A damning National Audit Office report warns almost 20,000 deaths a year could be avoided if patients from deprived areas fared as well as the richest in society.

Elderly cancer patients are also suffering from outcomes in particular.

The House of Commons Public Accounts Committee - which ordered the report - slammed the “astounding” survival rate differences within England and “shocking disparities” with other countries in Europe.

 

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.

 

Cancer patients dying early because of postcode lottery (The Guardian: 15 August 2014)

Thousands of people are dying early of cancer every year because of an "inexcusable postcode lottery" in how quickly the NHS diagnoses and treats the disease, a leading charity warns.

Delays mean that cancer patients in some areas of England have up to a 61% higher risk of dying within a year of their diagnosis than those in other places, simply because of where they live.

While one in four (24%) of newly diagnosed cancer sufferers in north-east Hampshire and Farnham in Surrey die within a year, 38% of those in the London borough of Barking and Dagenham do so, according to a new Macmillan analysis of data from the Office for National Statistics.

[...]

About 6,000 more people a year would still be alive 12 months after being diagnosed if average survival across England could be made as good as that already achieved by the top 10% of England's 211 local CCGs, the charity says.

"This analysis shows an inexcusable postcode lottery, which is responsible for 6,000 patients dying needlessly every year within 12 months of being diagnosed with cancer," said Juliet Bouverie of Macmillan.

 

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.

 

Patients denied vital operations by NHS bodies, surgeons report (The Guardian: 15 July 2015)

Patients are being denied access to vital surgery by NHS bodies, which are ignoring guidelines and choosing to ration some operations, according to an investigation by the Royal College of Surgeons.

The surgeon's report said that 73% of Clinical Commissioning Groups (CCGs) –the GP-led organisations involved in the delivery of a range of NHS services – do not follow rules set down by the National Institute for Health and Care Excellence and clinical guidance on referral for hip replacements, or have no policy in place for this procedure.

It also found that more than a third of CCGs (44%) require patients to be in various degrees of pain and immobility – with no consistency applied across the country – or to lose weight before surgery.

 

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: 9 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.
 
 

See also:

Patients facing hip and knee op 'lottery' (Crosby Herald: 6 November 2013)
 
 
‘Postcode lottery’ for knee and hip surgery (Age UK: 6 November 2013) 
 
Elderly at mercy of postcode lottery in 'ageist' NHS (The Telegraph: 2 September 2013)
 
Dementia stats down but postcode lottery drives uneven care (The Conversation: 18 July 2013)
 
Report reveals postcode lottery for cataract surgery (Optometry Today: 17 July 2013) 

NHS England publishes generic commissioning policies (NHS England: 4 April 2013)

'Stark variation in NHS surgery due to rationing' (BBC News: 8 March 2013)

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)

IVF 'postcode lottery' to worsen, Lord Winston warns (The Telegraph: 2 January 2013)

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

NHS care for elderly is a ‘postcode lottery’ (ITV.com: 23 March 2012)

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

NHS postcode lottery survey reveals wide UK disparities (The Guardian: 9 December 2011)

 

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