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.
Midwives call for 'urgent' funding for mental health care for new mothers after postnatal depression death (18 July 2017)
There is an "urgent need" for more funding for mental health care for expectant and new mothers, leading midwives have said.
The comments from the Royal College of Midwives come after a report claimed services across the UK are "under resourced".
Researchers wrote the report following an online petition which gathered more than 55,000 signatures calling for the NHS to review how it treats and cares for women with postnatal depression.
The petition was set up by Lucie Holland, whose sister Emma Cadywould died following a battle with postnatal depression.
The report states that Ms Cadywould took her own life six months after giving birth to her first son - despite having been under NHS-led mental health care.
Her family urged health officials to look into the care of women with the condition, saying that if she had been referred for specialist care she would have recovered.
Dr Alain Gregoire, chairman of the Maternal Mental Health Alliance, added: "Emma's tragic death as a result of a severe perinatal mental illness offers us all an urgent wake-up call.
"We must act now to prevent more women from suffering or dying unnecessarily.
"Recovery through good support and care should be the norm if women and families everywhere have access to high quality specialist services, but it is still a postcode lottery. This has to change." ...read more
Almost 6,000 mental health patients sent out of area for care last year (The Guardian, 27 June 2017)
Almost 6,000 mental health patients had to be sent far out of their local area for treatment last year, with some travelling hundreds of miles, according to NHS figures.
Data obtained by the British Medical Association shows the number of patients with mental health problems travelling long distances for care in England has risen by 40% in two years.
In 2016-17, 5,876 travelled out of their area for treatment, compared with 4,213 in 2014-15.
Patients sent away for treatment could expect an average round-trip journey of seven and a half hours to see friends and family.
Dr Andrew Molodynski of the BMA’ consultants committee said it was an “endemic” issue, adding: “The government needs to get a handle on this situation because patients are being routinely failed by a system at breaking point, with tragic consequences.”.. Read more
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
The postcode lottery of new mothers' mental health services (The Guardian: 10 February 2017)
With one in 10 women developing a mental illness during or after pregnancy, including postpartum psychosis, not all are lucky enough to be cared for in a specialist mother and baby unit. The arrival of a baby is supposed to be one of the happiest times of a woman’s life. But for a sizeable minority, it takes a heavy toll on their mental health, posing a risk to the welfare of mother and baby alike.
More than one in 10 women develop a mental illness while expecting a child or in the first year after giving birth. For about 40,000 women it is severe and in extreme cases necessitates admitting mother and baby to a specialist unit.
Of the 40,000 who have antenatal or postnatal problems, or both, only a quarter get access to specialist perinatal mental health services. The costs of this postcode lottery are high, not only to the individuals and their families but to society. A study by the London School of Economics found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1bn for each one-year cohort of births in the UK, with three-quarters of the cost relating to the impact on the child.
Gregoire said it would take about £100 per birth – compared with the £2,800 he said was spent on physical maternity care – to bring mental healthcare up to National Institute for Health and Care Excellence standards...Read More
Pain-level rationing of hip and knee surgery due to cash crisis, admits NHS (The Guardian : 27 January 2017)
A senior NHS official has admitted that funding shortages mean hip and knee replacements will have to be rationed according to pain levels in some parts of the country.
Three clinical commissioning groups (CCGs) in the West Midlands have proposed reducing the number of people who qualify for hip replacements by 12%, and knee replacements by 19%. To qualify under the proposed rules, patients would need to have such severe levels of pain that they could not sleep or carry out daily tasks.
Julie Wood, the chief executive of the NHS Clinical Commissioners, said the proposal was a response to financial pressures.
“Clearly the NHS doesn’t have unlimited resources,” she told BBC Radio 4’s Today programe. “And it has to ensure that patients get the best possible care against a backdrop of spiralling demand and increasing financial pressures.”
She admitted that decisions on hip and knee replacements “will vary in different parts of the country”, amid reports that other areas were already using pain levels to ration such operations...read more
Talks begin on cutting NHS IVF funding in parts of Nottinghamshire (Notts Tv: 5 December 2016)
Health bosses are meeting the public today to discuss plans which could see NHS funding for IVF treatment scrapped in parts of Notts.
Members of NHS Mansfield and Ashfield and Newark and Sherwood Clinical Commissioning Groups (CCGs) are consulting on the proposals before a final decision is made in January.
Several options being reviewed include changing the eligibility criteria for access to IVF treatment funded by the NHS, and withdrawing it altogether.
The CCGs currently fund one cycle of IVF per person in both areas, although people sometimes pay privately for additional cycles if required.
Funding of IVF in Newark and Sherwood and Mansfield and Ashfield currently costs around £300,000 per year.
It was announced in August that the NHS needs to cover a shortfall of around £20m in the area.
Chief officer for NHS Newark and Sherwood and Mansfield and Ashfield CCGs, Dr Amanda Sullivan said: “The local NHS has been very successful in treating more conditions and in helping people to live longer.
“Additional funding has been made available to the NHS, but new treatments, growing levels of long-term conditions and increasing expectations mean that CCGs now have to re-prioritise how precious NHS resources are deployed…(read more)
Budget cuts hitting mental health patients, says UNISON survey (Union-news.co.uk: 21 November 2016)
More than four in five (83%) staff working in mental health surveyed said a postcode lottery exists in the level of care that patients receive. In some cases, people with severe conditions such as chronic anxiety and schizophrenia are unable to access help until they have reached crisis point.
The findings are based on a survey of more than 1,000 staff such as therapists, nurses and social workers employed by mental health care services including the NHS and councils across the UK.
The survey also highlights how increased patient demand for services, coupled with cuts in services have left those staff left behind facing intolerable pressures.
More than four in five (85%) surveyed said they had experienced cutbacks, and nearly nine in ten (88%) reported an increased workload. This has led to longer waiting times for patients before they can get help, according to more than half (52%) of staff, says UNISON.
UNISON head of health Christina McAnea said: “The government has pledged £1.25bn for mental health but services are still having budgets reduced. No-one should have to wait weeks to get the support they need, and staff shouldn’t be placed under such pressure that they risk using mental health services themselves.
“With fewer staff and more people seeking help, it’s no wonder that employees who dedicate their lives to helping others feel at breaking point. Funding for mental health services must reach those in need and not be diverted to plug gaps elsewhere in the NHS.”....read more
'Postcode lottery' revealed in NHS care (The Guardian: 8 September 2016)
Patients with dementia, diabetes and learning disabilities are being let down by their local health services in many parts of England, new figures show.
A postcode lottery of care across the country has been highlighted as new performance data shows that while some health bodies are performing well, neighbouring organisations are falling short.
More than half (57%) of local health bodies in England are not performing well enough on dementia, 71% are classed as “needs improvement” for diabetes care and 92% need to improve care for people with learning disabilities, the figures show.
NHS success in tackling health inequality varies hugely across England (The Guardian: 20 August 2016)
The social divide in hospital admissions – which means far more poor people end up in hospital for preventable conditions than richer people – varies dramatically across England, researchers have found.
Data compiled by the University of York for NHS England revealed that the performance of a clinical commissioning group (CCG) in tackling the social divide in these preventable hospital admissions is not always linked to how rich or poor the CCG’s patient population is.
Liverpool clinical commissioning group, which appears on the worst performers list, and Tower Hamlets and Portsmouth CCGs, which appear on the best performers list, each serve some of the most deprived neighbourhoods in the country.
At the wealthy end of the scale, South Cheshire performs badly on inequalities, while East Surrey CCG performs well, appearing in the top 10....read more
New 'dementia atlas' reveals disparity in care across England (The Guardian: 16 August 2016)
People with dementia are being let down by local services across the country, according to new government data that critics say has revealed a postcode lottery in care for the chronic and degenerative brain disease.
An interactive “dementia atlas”, published online on Tuesday by the Department of Health, shows that standards of care vary widely in different areas, with services failing to reach almost half the patients for check-ups even once a year in one area....read more
Charity nurses warn of ‘postcode lottery’ in specialist children's care (Nursing Times: 23 May 2016)
Expert children’s nurses have highlighted wide variations in services and standards for children with complex health needs as the ground-breaking charity nursing scheme celebrates its 10th anniversary.
Services provided by its nurses have made a dramatic difference to families including reducing distressing emergency hospital admissions and cutting lengthy stays in hospital.
However, nurses and managers involved in the scheme warn that many children with complex health conditions still face a “postcode lottery” when it comes to getting all-round support. Problems include reductions in children’s community nursing teams, huge variation in the types of services available and a lack of emotional support and training for parents caring for seriously ill children....read more
Jeremy Hunt urged to act against avoidable deaths from epilepsy (The Independent: 12 March 2016)
The Epilepsy Society has launched a new campaign calling on the Health Secretary Jeremy Hunt to act against avoidable deaths from the condition.
Although sufferers are at greater risk of premature death, almost four in 10 of those deaths are avoidable, according to the charity, which says better care, treatment and services are urgently needed. It has also launched an online campaign urging MPs to write to Mr Hunt requesting that a National Clinical Audit into the condition take place – for the first time since 2002.
The Epilepsy Society said the most worrying aspect is the postcode lottery for the 500,000 people in England living with the condition. Data from the Office for National Statistics shows that rates of premature death vary vastly: for example, someone with epilepsy is 49 per cent more likely to die prematurely in West Yorkshire than in Cheshire...read more
Prestigious teaching trust restricts access to heart service (HSJ: 1 March 2016)
A prestigious teaching hospital trust has temporarily restricted access to its outpatient cardiology service for out of area referrals, a leaked letter has revealed.
Cambridge University Hospitals Foundation Trust said the move was driven by its waiting list for routine cardiology outpatients rising by 50 patients a week and staff shortages. A leaked letter from the trust and its lead commissioner Cambridgeshire and Peterborough Clinical Commissioning Group said it made the move to avoid “potential safety concerns associated with excessively increased waiting times”.
The trust has told commissioners outside its main Cambridgeshire catchment area that their GP practices should send patients to “a different cardiology provider with immediate effect”...read more
The postcode lottery of new mothers' mental health services (The Guardian: 10 February 2016)
The arrival of a baby is supposed to be one of the happiest times of a woman’s life. But for a sizeable minority, it takes a heavy toll on their mental health, posing a risk to the welfare of mother and baby alike.
More than one in 10 women develop a mental illness while expecting a child or in the first year after giving birth. For about 40,000 women it is severe and in extreme cases necessitates admitting mother and baby to a specialist unit...read more
Diabetes care 'varies hugely' across England (Independent: 22 January 2016)
The Department of Health and NHS England paint an “unduly healthy picture” of the state of diabetes services in England, MPs have said.
The Public Accounts Committee said weaknesses in the approach of both organisations - and a lack of focus on preventing long-term complications from the condition - mean “the costs of diabetes to the NHS will continue to rise”.
MPs found that while evidence suggests the UK performs well compared to other countries, there are still “unacceptable variations” in how people with diabetes are able to access education about their condition. Furthermore, only 60 per cent receive the annual checks recommended to keep them healthy and prevent long-term complications.
The report said diabetes specialist staffing levels in hospitals “are not keeping pace” with the increasing percentage of beds occupied by diabetes patients.
It said: “The percentage of beds in acute hospitals in England occupied by people with diabetes continues to rise, from 14.8 per cent in 2010 to 15.7 per cent in 2013.
“However, the level of diabetic specialists has not significantly changed over this period. In 2013, nearly one-third of hospitals in England taking part in the audit had no diabetes inpatient specialist nurse and 6 per cent did not have any consultant time for diabetes inpatient care. “NHS England told us that an increase in nursing numbers isn't likely in the next year or two.” ... read more