Deprivation differences…. especially across the UK – revisited

In 2010 Richard Ushiro-Lumb in the BMJ news reported:

Cancer incidence in England’s deprived areas is 16% higher than in rich areas

BMJ 2010; 340 doi:     (Published 14 June 2010)    

“As many as 14 000 cases of cancer could be prevented each year in England if everyone was as healthy as the richest 20% in the country, a study has found.

Between 2000 and 2004 there were 21% more diagnoses of cancer in men who live in the most deprived areas of England than in the least deprived. The gap for women was marginally lower at 11%, found the study by the National Cancer Intelligence Network.

Experts believe that the gap in cancer incidence between rich and poor people is caused by a higher prevalence of unhealthy habits such as smoking, late diagnosis, differences in treatment choices, and a lower uptake of screening in more deprived areas…..”

I am attaching a couple of interesting articles and letters on deprivation.

Deprived areas bm 102013j   Medicins du Monde in Tower Hamlers 2006

It is interesting that GPs in practices such as my own like to work in “teams”. The fostering of a team is much easier if everyone has the same boundaries and objectives. Richard Watton in the BMJ 19th October points out that “The idea was that geographically based working (for many practices) would be better than practice based teams. It was a failure and was abandoned after a few years.” This is not the case in Wales’ rural area where geographical teams abound… Multidisciplinary Teamsbmj.f5450.full. Working in teams in deprived areas is particularly effective.

There are several deprived areas of the UK, and these find it difficult to attract doctors. In some countries this is addressed by “locking the doctor in” to 5 years commitment to the region that trained them- or they can buy their way out.

BMJ 19th October 2013 Vol 347: Deprived areas will lose out with new capitation formula

NHS funding is allocated to areas on the principle of providing “equal opportunity of access for equal need.”1 To help achieve this, the current NHS allocation formula incorporates a deprivation related measure: the “health inequality weighting.”1 The relative roles of deprivation and age as determinants of health have been subject to political debate over the past years,2 3 4 and NHS England is consulting on a new “weighted capitation formula.”1 5 This removes any health inequalities style weighting in favour of a person based allocation model of previous health utilisation.1

Using the data provided by NHS England,1 we mapped the difference in funding per person between the current formula and the new formula for clinical commissioning groups (CCGs) and NHS area teams (figure). This showed that the more affluent, healthier south east will benefit most and the poorer, less healthy north will lose out substantially. For example, in CCGs like South Eastern Hampshire, where healthy life expectancy is 68 years for women, NHS funding will increase by £164 (€193; $261) per person (+14%). This is at the expense of CCGs such as Sunderland, where healthy life expectancy is 58 years for women, and where NHS funding will decrease by £146 per person (−11%). More deprived parts of London will also lose out, with Camden receiving £273 less per head (−27%).

Regions deprivation

Change in spending (£/head) between new and old resource allocation funding formulas by clinical commissioning group (left) and NHS area teams (right)

Although these changes are not on the scale that a purely “age only” allocation formula would produce,3 they are still sufficient to undermine the principle of “equal opportunity of access for equal need.” They are also potentially a first step towards an age only allocation, and they could widen the north-south health divide by reducing NHS services in the north. The new capitation formula is out for consultation and worried BMJ readers should respond.

Reply in correspondence

Deprived areas will lose out with proposed new capitation formula

The authors seem to be unaware of the history of problems with NHS resource allocations based on weighted capitation. Since 1976, attempts have been made to use increasingly sophisticated formula to take account of deprivation, while ignoring the inescapable and undisputed connection between need and old age. The demographic time bomb has exploded, as people born in huge numbers after the First World War become increasingly frail. The current difficulties in A&E departments are attributable at least in part, to this effect, felt most keenly in what was once called, pejoratively, the Costa Geriatrica. Coastal West Sussex illustrates the situation dramatically, and is long overdue some extra money to help cope with the demand.

John G Gooderham, locum lollipop lady

None, Billingshurst RH14 9TJ

I need hardly point out that Northern Ireland, Scotland and Wales are not included in the graphic, and comparators are not available. Much of these three areas is deprived relative to England. It is hard to recruit and there is often little competition for posts. There is a net 20% loss of graduates to Wales… and their plans and goals are not necessarily within the region they were trained in. Matthew Paris commented on Jan 3rd about Wales’ poverty in “My Week” in The Times.

Grad Plans2

In the Books page I have added

The Great Escape: Health, Wealth, and the Origins of Inequality. By Angus Deaton. Princeton University Press

Here is an extract from the Economist review:

…..”Mr Deaton argues that the main barrier to progress in poor countries is not lack of resources but bad governments. Yet it is these governments that receive the aid either directly or indirectly. The flow of foreign money undermines governments’ incentives to raise money from their own taxpayers, which in turn requires growth-friendly policies and reformed institutions. Instead it shores up ill-functioning governments, the very misfortune holding back poor countries.”……

Read the whole review here: The Great Escape – Economic inequality – Angus Deaton

Update 21st October 2013 based on BBC News 17th October:

Poorest pupils in Wales fail to match English at school

Doctors want good education for their children….. Has any of the readers any idea of how to make recruitment easier to our deprived areas?

The Welsh economy is good evidence that the inverse care law still applies.

Update 28th October 2013: See posting on GVA and GDP

I appreciate these map diagrams are from 2010 and 2007/8 and that the report from Wales is from 2005. But they do imply that there may be a problem if Scotland leaves the United Kingdom. An area with higher than average GDP and 9m people may be leaving the mutual pool of 65m people. Assuming budgets are static, the subsidy for the poorer regions that remain in the UK would be proportionately higher from the remaining affluent areas. This might cause some resentment… It certainly needs discussion.



Report: Wales Government compares GDP with Europe April 2005. This reports claims Wales has 90.2% of the average GDP per capita of Europe.

Update 6th November 2014. Rosemary Bennett and Jill Sherman report: It’s even grimmer up north as the locals flee south (and this applies to Wales and Scotland as well to some extent..)

It’s official — it really is grim up north. Income, economic activity, life expectancy and even happiness are lower than anywhere else in England, and only Cheshire bucks the trend.

The latest problem facing the north is a rapidly declining population. The north has lost almost a quarter of its share of the English population in the past 100 years as London and the southeast draw those looking for well-paid jobs.

People living in the north account for only 28 per cent of the English population, a level that was last recorded in 1821 before Britain’s industrial heyday. The figures come in a study produced by the Office for National Statistics (ONS) in response to debate about how to revive the north.

George Osborne, the chancellor, has urged Manchester and other northern cities to help to boost the economic fortunes of the region and suggested that elected mayors would help.

The data suggests that this would be a considerable task. There are 794 businesses per 10,000 head of population in the north compared with 1,058 per 10,000 in the rest of England. Household income after tax is below the national average of £17,000 everywhere apart from North Yorkshire, where affluent Harrogate and York boost the numbers, and parts of Cheshire.

A baby born in the north will live one year and eight months less on average than one born anywhere else in England, and the official happiness rating is 7.3 out of ten, just below the 7.4 average.

One glimmer of hope is the popularity of northern universities. Last year 11,623 more 18 to 20-year-olds moved from south to north than from north to south. However, they do not stay; in the 21-30 age group, 23,831 more people moved southwards than northwards.

“This is likely to reflect less favourable labour market conditions and, in particular, fewer graduate opportunities in the north,” the ONS said.

This entry was posted in A Personal View on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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