Inequalities in Health and Health Care Provision UK

National Inequalities in Health www.statistics.gov.uk

Death Rates and Infant Mortality Rates per 1,000, per country (2003) per 1000 population Infant Mortality Rate per 1000 population England 10.1 5.3 Wales 11.5 4.1 Scotland 11.6 5.1 Northern Ireland 8.5 United Kingdom 10.3 General Register Office for Scotland

Main Points In all causes of mortality: rates are higher in Scotland than anywhere else in the UK. rates are higher for both males and females in Scotland than anywhere else in the UK. only in road traffic accidents do males in Northern Ireland fare worse than in Scotland.

Main Points In terms of rates of mortality: Scotland has the highest death rate per 1000 population and the level is 1.3/1000 above the national average. Infant mortality rates, however in Scotland are lower than the national average of 5.3/1000, and those for England and Northern Ireland.

Causes of death by gender, 2003, UK www.statistics.gov.uk

NHS Expenditure by country in the UK {2002-3 (bmj NHS Expenditure by country in the UK {2002-3 (bmj.com 2005) and 2004-5} Per capita (£) 2002-3 2004-5 England £1085 £1249 Wales £1186 £1287 Scotland £1262 £1533 Northern Ireland £1214 £1371

Per capita public spend on health Percentage population and per capita spend on health in countries in the UK (2004-5) % of total UK population Per capita public spend on health England 83.7% £1249 Wales 4.9% £1287 Scotland 8.5% £1533 Northern Ireland 2.9% £1371 www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,dhsspsni.gov.uk/ www.isdscotland.org

Relative level of health care spend on a per capita basis per country (2004-5) The UK average = 100 England 97% - 3% Wales 104% + 4% Scotland 114% + 14% Northern Ireland 107% +7% www,dhsspsni.gov.uk/

Number of Health Service Staff per 10000 people per country (2003-4) England 259 Wales 231 Scotland 294 Northern Ireland 276 www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,dhsspsni.gov.uk/ www.isdscotland.org

Availability of hospital beds and health staff in UK countries (2003) Hospital beds per 1000 population Staff per 1000 population Medical & dental Nursing GPs England 3.8 1.4 5.6 0.57 Wales 5 6.4 0.61 Scotland 6 1.8 7.4 0.76 Northern Ireland 4.9 1.6 7 0.63 www.ic.nhs.uk/ www.statswales.wales.gov.uk/ www,dhsspsni.gov.uk/ www.isdscotland.org

Findings Statistics on mortality rates and morbidity rates confirm that: There is a clear north-south divide in the health of the British public Death rates are higher in Scotland than in England and Wales Death rates are highest in Scotland for both male and females. More money is spent on health care provision in Scotland than in England and Wales. But

Inverse Care Law Areas which experience the worst ill health – Scotland followed by Northern Ireland – receive the most money on health care provision and manpower. Areas which experience the least ill health – England and Wales – receive the least money on health care provision and manpower. This is called the ‘Inverse Care Law’.

But….. More money is spent on health care provision in Scotland than in England and Wales. In other words there is no correlation between the incidence of ill health and the allocation of financial and manpower resources put into health care.

Lack of Correlation Is this lack of correlation between the incidence of ill health and the allocation of financial and manpower resources in health care provision: a reflection of the disparity in where the resources and manpower are targeted? a reflection of the greater needs of people in Scotland? or

Inequalities in Health Care Provision Studies show that wide variations in health care provision do exist within the UK. Guardian Newspaper extract (October 1999) ‘’Rather than having a National Health Service, it is as if we have dozens of independent health services, all operating under different rules and using different criteria. In some parts of the country you’ll be booked into a specialist cancer hospital which will spend thousands on chemotherapy drugs even though the success rates for some drugs for cancer are miniscule; in others you’ll be told that your time is up even though there are plenty of well proven cures which might well succeed’’. Nigella Lawson

Geographic Imbalance (2004-5) The NHS spends about £1,533 each year on each person in Scotland. The NHS spends about £1249 each year on each person in England.

Inequalities in Health Care Provision (2001) Geographic imbalance in NHS provision. In Scotland there are: 51 consultants for every 100,000 75 GPs for every 100,000 808 nurses for every 100,000. In England there are: 39 consultants for every 100,000 56 GPs for every 100,000 620 nurses for every 100,000.

Comparison of NHS provision between Scotland and England (2001)

Regional Imbalance in Funding in England (2001) Average national rise in funding was 4.2%. Isle of Wight received a rise in funding after inflation of 3.6%. Yet it has the highest proportion of elderly and the lowest household income in England. London Authority of Kensington, Chelsea and Westminster received 5.9% after inflation.

NHS costs within England (2001) The cost of a hospital operation can vary by up to 20 times within England. A lung transplant can cost between £2,488 and £31,430. A hip replacement can cost between £354 and £7,784 depending on where you live.

The Anomaly? The variations in the allocation of financial and manpower resources throughout the UK are not the sole cause of inequalities in health. If that were the case then Scotland, which receives the highest level of spending and manpower, should be the healthiest part of the UK – but it is the worst. Also, there are areas in Scotland and Northern Ireland which compare favourably with the healthiest areas in England. There are parts of London that have levels of ill health as bad as the worst areas in Glasgow. Within Glasgow there are huge differences in health in areas barely one mile apart.

The Reasons? Scotland needs its extra healthcare expenditure to overcome unfavourable factors which work against delivering comparable health outcomes. Higher levels of deprivation which exist in Scotland. Higher levels of rurality and remoteness which make it more difficult to ensure adequate access to healthcare for people in remote areas of Scotland such as the Western Isles and more expensive than in urban and central belt areas.

The Evidence (2005) For example NHS spending per head of population in 2004-5 in Lothian was £1199 compared with £2076 for the Western Isles. This represents a difference of £877 per capita. The average cost per in-patient case in Shetland is £3759 whereas in Greater Glasgow it is £2806. www.isdscotland.org

Patients face geographical care lottery See BBC News PowerPoints for articles on inequalities in health care provision. Patients face geographical care lottery GPs under pressure Patients don’t listen to their doctors Millions ‘illiterate’ about health Courtesy of www.bbc.co.uk