funding fairness, what does it all mean?

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Before Christmas I read with some dismay the news about NHS funding for next year.  Flat growth for all CCGS and a further review of the new funding formula.  Let me say right up front that I completely agree that deprived areas need money to be spent on improving health. But  am I alone in thinking there is a big difference between improving health and funding health care? To influence the determinants of health we need as a society to invest in education, housing, job creation. Absolutely.  We need also to fund public health so they can invest in programmes that improve health: smoking cessation,   promotion of healthy life styles, sexual health initiatives. Completely agree. So we need to target that money to places where the evidence shows us it will have the most impact. Investing in health treatment services in deprived areas has less impact on improving health than investing in education, housing etc. Most health care spending treats illness once it has happened . It doesn’t stop people getting sick.

When it comes to health CARE spend though we also need to go back to the evidence. This shows us that the biggest determinant for spend on health care is age. The older you are the more illness you have, the more money is spent on your care. Therefore it follows that areas of the country that have very elderly populations spend more on health care that areas with younger populations.  The difficult bit is that in areas of the greatest social deprivation people die early so have fewer elderly people. We need to change that. So in some ways it feels uncomfortable for all of us to invest more in seemingly “affluent areas” but that is only measuring one variable. We could say we are investing more in areas with the oldest populations where health care spend is the greatest. To  go back to the previous point, to help people live longer we need to improve their overall health. As they become healthier they will live longer and will then need more investment in their health care. So they can live long healthier lives.

No formula works absolutely and there are always winners and losers. I have a personal  interest in all of this of course. As a CCG in a relatively affluent area with high levels of elderly we have a low funding per capita compared with the national average and have a long term problem with living within our allocations. We are a health economy in long term financial deficit. We get £1474 per person per year compared with Barnsley, a much more deprived area,  who get £1900 per year. A small change of £50 per person per year would sort out or long term funding issues. So we don’t need to formula to turn things up side down , just one to be slightly more in our favour. On top of this we read and hear every week about health economies with lots of money desperately trying to find  ways to spend the money they have in year, who try all sort of new and untried schemes whilst we are asked to consider draconian measures  like short term closures of community hospital beds to meet our financial targets .A very small shift in the formula towards a more age related model would significantly improve our situation. We are told that our problems are of our making: bad management, lack of will to change. But the evidence doesn’t support that. Countless changes in management have failed to sort out the issues. We, as a health community, put in many of the measures to improve efficiency in the system years ago that most areas are just beginning to consider now.. We don’t moan about it we just got on with it. Running an efficient health system is the right thing to do. But being efficient isn’t enough!

An eminent group of people were tasked to look at the formula and come up with a new one that more closely modelled health care spend. They have taken years to come up with this and my understanding was that is increased the weighting for age. Changed slightly the balance between deprivation and age. It didn’t turn it upside down but it did change things a bit and it did move money into health econmies with very high percentages of older people. So I hope any review undertaken now doesn’t fundamentally undo all that work. I have talked to our public in Hambleton Richmondshire and Whitby very openly about the funding challenges we face. To maintain a safe health system in a rural area is expensive . There is no weighting in any formula for rurality.. I believe our public  will understand the reasons for any changes if we can explain them openly and honestly.