NHS at 60- Labour no longer trusted on National Health Service

NHS at 60- On the eve of the NHS’s sixtieth aniversary a new poll shows that Labour is no longer the party trusted to bring in the health reforms that are needed to safeguard the NHS for future generations.

Despite the billions Labour has poured into health, the YouGov poll shows that public satisfaction with the NHS is dropping. Barely one in five people believe the Labour party will deliver a better health service over the next ten years, the You Gov poll shows.

It comes on the day Gordon Brown is to publish Lord Darzi’s package of reforms to overhaul the way the NHS is run.

The Prime Minister hopes the comprehensive review will transform Labour’s fortunes and restore the party’s reputation as guardians of the NHS on its 60th anniversary.

The results of the poll show he Tories have a clear lead on health policy with 31 per cent of people saying they would do a better job of running the health service, compared to 23 per cent who think Labour would deliver on the NHS.

The results of the latest poll confirm a shift in the political debate over health care, away from funding and towards improved management and organisation.

After years of above-inflation increases in health spending, most voters now believe the NHS has enough money. But they worry that the service has become bureaucratic and over-burdened with managers.

Sixty-nine per cent of people said reorganising the NHS is more important than spending more on it, up from 38 per cent in 1998. Only 24 per cent now want more spent on health, down from 59 per cent a decade ago.

Seventy-eight per cent of voters believe the NHS has too many managers.

And despite the billions Labour has poured into health, the new poll shows that public satisfaction with the NHS is dropping. In 1998, some 91 per cent of recent patients said they were happy with their treatment. That figure has now fallen to 81 per cent.

Some 44 per cent of people said they think “a great deal” of money is being wasted in the NHS. Another 38 per cent said a “fair amount” is wasted.

“David Cameron’s unambiguous commitment to the National Health Service means a great deal to the public. They know that the NHS needs reform and that Labour have failed them on this crucial issue,” said Andrew Lansley, the shadow health secretary.

“But they also know that Conservative reforms for healthcare will not threaten the security that comes with a health service available to all, based on need. This poll shows that the public, like staff across the NHS, are now willing and ready to trust the Conservatives with the stewardship of the NHS.”

In the foreword to the Darzi report, the Prime Minister hails the document as the blueprint for a “once-in-a-generation” shake-up in the NHS.

The report will usher in the creation of “polyclinics” with several doctors and nurses to replace hundreds of GP surgeries in the biggest cities, despite opposition from patients and the

British Medical Association.

It also says that hospitals should publish death rates for dozens of conditions, allowing patients to make “informed choices” about where to get treatment.

Hospitals should offer more home births for mothers, and old and terminally-ill will get the right to chose to die at home instead of in hospital.

And a new NHS constitution will enshrine rights to confidentiality, control of patient records and a second medical opinion.

Mr Brown writes: “Lord Darzi’s report is a tremendous opportunity to build an NHS which provides truly world-class services for all. It requires government to be serious about reform, committed to trusting front-line staff and ready to invest in new services and new ways of delivering services.”

But Norman Lamb, the Liberal Democrat health spokesman said he feared the Darzi package would be vague and impractical. He said: “What does all this mean? Will patients be able to enforce their rights?”

And despite Mr Brown’s bold claims for the review, there are doubts about whether Lord Darzi has been allowed to go far enough in drawing up his reform plans.

His report is not expect to deal with the controversial issue of “co-payment,” where patients can pay extra to top-up NHS care with private provision. That omission has drawn accusations that the review is too limited to prepare the health service for the demands of the next century.

A separate opinion poll for Reform, a think-tank, has suggested that most doctors believe top-up payments should be introduced to the NHS.

The ComRes poll showed that 79 per cent of GPs believe patients should be able to top-up their NHS care with private treatment.

• YouGov polled 2,163 adults across Great Britain between June 23 and 25.

From:
Labour-no-longer-trusted-on-NHS-reforms.html

NHS scandal of dying cancer victim was forced to pay

A woman who died of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian, O’Boyle’s husband, said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

Relapse for NPfIT white elephant records system

Just when the National Health Service’s mighty and troubled £12.7bn programme to provide every patient in England with an electronic record looked as though it might be about to turn an important corner, it has skidded off the road again.

The resulting accident is not yet terminal. But it does mean more dire headlines and it is hard to see how the news of Fujitsu’s departure from the Connecting for Health programme will not produce further delays to an electronic record that is already running more than four years late – even if some parts of the exercise, ironically, may speed up.

The bad news that the programme has parted company with another big supplier – Accenture having walked away in 2006 – comes as things were finally looking up. BT appeared to be cracking the installation of the new systems in London, the part of the country for which it holds the local service provider contract.

Preliminary installations that are critical to getting the electronic record to work have gone into most of London’s mental health trusts and two or three big acute hospitals – not without inevitable teething troubles, but without the sort of catastrophic disruption that hospitals in the south have at times seen as Fujitsu tried to do the same.

In the north, iSoft’s long-delayed Lorenzo patient-record software is about to go into three pathfinder trusts this summer. If that had gone well, the programme would have felt itself to be back on track. Now it is plunged into further doubt and condemnation from opposition politicians who were demanding yet again a review.

Fujitsu’s deal always looked questionable. It was the last, and in terms of scope, the biggest of the five regional installation contracts. It covered more than 12m people and 90 hospitals and NHS organisations.

But Fujitsu’s agreed price for it was only £896m, nearly £200m less to cover 25 per cent of the population than Accenture got from the NHS for covering 15 per cent. It looked badly underpriced.

A senior Fujitsu executive predicted that once one or two of the systems were in it would be “like shelling peas”. It proved to be anything but.

Hospital after hospital suffered crashes and troubled installations as what was still an interim system, without the full record, went in. As of March, new systems had gone into just nine out of 41 acute hospitals and they were working so badly that Fujitsu had not been paid for more than half of them, according to the National Audit Office.

Industry sources say both BT and Computer Services Corporation, which now holds the installation contract for almost everything north of London, have been more flexible about giving NHS trusts what they want, instead of insisting they have precisely what was specified in the original contract.

Negotiations with Fujitsu are understood to have broken down not on the price the NHS was prepared to pay for a more flexible deal but on the timing of upfront payments that the company wanted.

The NHS refused to depart from the principle that has kept the programme on budget to date – that it will not pay for services until they are delivered. One senior health department source said: “We have to protect the taxpayer.”

In a letter to NHS trusts, Gordon Hextall, the programme’s chief operating officer, said Fujitsu would support existing live sites and the industry expectation is that they will complete one or two that are about to go live in order to get paid.

Beyond that, rather than a complete takeover of Fujitsu’s contract by one provider, Connecting for Health may use the existing contracts to get both BT and CSC to take over different parts of Fujitsu’s uncompleted work: an approach that could give NHS trusts in the south more choice. Cerner, the key software supplier for the south may take a bigger role.

And Connecting for Health has also just signed a framework contract with a range of other, new, suppliers that could be brought into play.

All that will be the subject of fraught negotiation. For now, the programme feels as if it is on a knife-edge.

From:
http://www.ft.com/cms/s/0/7b9d569e-2db3-11dd-b92a-000077b07658.html

NHS pays up to 60pc higher prices to cut waiting lists

Private hospitals are once again being paid well above the standard National Health Service price in a drive to get waiting times down that has proved only partially successful.

Just months after the Department of Health cut back on a programme of independent sector centres to treat NHS patients at close to NHS prices – claiming that the NHS had sufficient capacity itself – private hospital providers say the service is once again “spot purchasing” significant numbers of operations at the last minute to get waiting times down.

Such last-minute purchases cost appreciably more than the standard NHS price, as the private hospitals are less able to plan and schedule their work.

One senior NHS manager said: “I know of examples where the NHS has recently paid the private sector 140 per cent, and even 160 per cent, of the NHS price to try to hit the waiting time target.”

The practice of spot purchasing had largely disappeared after the first independent treatment centres came in and the NHS introduced more structured contracts with the private sector.

The disclosure of its reemergence came as the DoH claimed to have hit a milestone in its drive to ensure that no one has to wait more than 18 weeks for treatment by the year end.

By the end of March, 85 per cent of patients who require admission were meant to have started treatment within 18 weeks, while 90 per cent of outpatients had started treatment within that period.

The health department said that a “milestone” had been achieved nationally. But closer examination shows that while some hospitals are reaching the 18-week target for almost all patients – pushing the average up – others are still way short of the March measure.

In London, fewer than 70 per cent of orthopaedic and neurology admissions were treated within 18 weeks, for example. In the south-east, fewer than 71 per cent of orthopaedic patients were operated on on time, and only just over 75 per cent in the south-west.

The east Midlands narrowly missed the milestone for cardiothoracic surgery, and the West Midlands missed it for orthopaedics, oral surgery and neurology.

However, David Worskett, director of the NHS Partners Network, which represents private providers, said some of the improvement had been due to a significant rise in spot purchasing in some parts of the country.

“It would have been better to bring more independent sector activity into the system,” he said, “because it is cheaper to have an agreed volume than to go in for last-minute purchases which are inevitably more expensive because the providers cannot plan.”

From:
http://www.ft.com/cms/s/0/27638a84-2daa-11dd-b92a-000077b07658.html

NHS NPfIT white elephant hit as Fujitsu fired from IT project

The NHS’s £12.7bn NPfIT programme to provide every patient in England with an electronic care record suffered a severe blow as the project fired one of its key suppliers after failing to resolve a dispute over the contract.

Ten months of renegotiations with Fujitsu, which holds the £896m 10-year contract for installing the record across the whole of the south and west of England, have broken down, according to both the company and the NHS.

The dispute centred on the NHS’s demand for more flexibility in delivery of the services – a request that would cost more. Fujitsu wanted either more money or a return to the original contract specifications.

Connecting for Health, the NHS IT programme, said it is now to issue a termination notice to Fujitsu in a move that could cost the Japanese-owned services company an estimated £300m.

It is the second time the programme has lost one of its big four suppliers after Accenture withdrew in 2006 at a substantial cost to the company.

BT, which runs the programme in London, is the favourite to take over from Fujitsu as Computer Sciences Corporation, which runs the whole of the north and Midlands, uses different software to BT and Fujitsu for the record.

The breakdown is a blow to the programme, although its defenders will argue that the contract structure of having an original four big suppliers is likely to work as BT or CSC is likely to step in.

But the breakdown can only further delay a programme whose core product – the electronic record – is already running more than four years late.

Connecting for Health said: “Regrettably, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice.”

That is understood to give Fujitsu 20 days to register a counter claim, with the possibility that differences will have to be settled in court.

Connecting for Health said Fujitsu had made a commitment “to providing a smooth transition to new arrangements”, without specifying what those would be.

BT must be the clear favourite to take over if it wants the business.

Given that it uses the same Cerner software that Fujitsu has been installing in the south, BT will be in a strong negotiating position during any takeover talks.

A switch to CSC would be likely to involve a switch to iSoft’s as yet unproved Lorenzo software. BT said Wednesday night it would consider any approach from the NHS to take on the extra work.

Fujitsu confirmed that talks had broken down and the company had wanted to revert to the original contract, which provided less flexibility than the NHS is now seeking. Failure to agree a price for that lay behind the breakdown, a Fujitsu official confirmed.

From:
http://www.ft.com/cms/s/0/41dbc5f0-2cf3-11dd-88c6-000077b07658.html

Health Direct compares dangers of drug taking

Health Direct has compared the latest hospital admission figures by drug types which shows that drinking alcohol is by far the most damaging drug.

Health Direct compares risks to drugsCocaine overdose cases quadruple at hospitals

The number of cocaine users being admitted to hospital has quadrupled in eight years, it has emerged as concerns grow that it has become the drug of choice for middle-class men.

An average of more than two people a day are admitted to accident and emergency units for “cocaine-induced health emergencies”, official NHS labour Government data showed.

There were 740 incidents in 2006-07 compared with 161 in 1998-99.

In comparison, heroin overdoses and cannabis poisonings both fell in the same period, according to the figures obtained by Druglink magazine.

The figures for cannabis poisings fell from 171 to 96 and for herion overdoses from 1,962 to 1,530.

The statistics expose the scale and impact of cocaine’s growing popularity and come after a series of high-profile cases involving the drug.

From:
http://www.drugscope.org.uk/

However according to the NHS Information quango -in total 207,800 people were admitted to wards in 2006/7 because of their drinking, either they were drunk, had liver cirrhosis or a secondary disorder such as heart disease brought on by heavy drinking. They may also have been injured or assaulted while drunk.

The data from the NHS Information Centre revealed cases of alcoholic liver disease have trebled in 12 years to reach 43,548 in 2000

Health Direct is not surprised that DrugScope is ‘extremely disappointed’ by the recent labour U Turn to reclassification cannabis. Labour’s decision is not based on science, fact or common sense. Just plain nanny state political stupidity.

Hospitals hide funds to rein in NHS surplus

Hospitals and primary care trusts have prepaid suppliers many hundreds of millions of pounds and have hidden money in other ways in order to keep the National Health Service surplus for last year down to the forecast £1.8bn.

Without such action, senior NHS managers say, the declared surplus for the NHS in England in the financial year just ended is likely to have been nearer £3bn.

That money is in addition to the £2bn of cash in the bank, much of it working capital, that foundation trusts are expected to hold as they generate their own surplus of perhaps £500m.

The move appears to have two motives: first to avoid the political embarrassment of the massive swing to a huge surplus of about £3bn just two years after the NHS in England attracted months of dire headlines when it recorded a £571m deficit; and second, to reduce the risk that a cash-strapped Treasury will claw the money back.

Both ministers and David Nicholson, the NHS chief executive, have said the Treasury will allow the service to carry over its forecast surplus. The NHS also aims to carry over a similarly sized sum this financial year.

Last year, however, the Treasury quietly clawed back £2bn of unspent capital from the Department of Health, and there are fears that if the final surplus exceeds the £1.8bn forecast the Treasury – which is under pressure on its borrowing rules, has just had to fund a £2.7bn tax giveaway to tackle the 10p tax band issue and faces spending pressures from other departments, not least defence – will want the money back.

To reduce the risk, managers say NHS hospitals and primary care trusts have been given “control totals”, which stipulate that while they must deliver the surplus they were forecasting, they must also not exceed it.

Some chief executives have been told their personal performance rating would be under threat if they do.

According to people close to the situation, foundation trusts, which as free-standing businesses can keep the cash, were paid £300m-£400m in advance by primary care trusts for services before the end of the last financial year.

Doris-Ann Williams, director general of the British In-Vitro Diagnostics Association, whose members supply equipment to the NHS, said members had received “a flurry of unexpected cash orders for capital equipment purchases as long as they could be invoiced before the end of March [the end of the financial year]”.

The chairman of one London hospital said it had not only been prepaying suppliers but also shifting money to charitable trustees to get it off the books by the end of the financial year. Some primary care trusts are also said to have prepaid local authorities for services.

One senior NHS manager said: “I don’t think anyone knows what the true picture is, but my guess is that without these measures the real surplus is much closer to £3bn.”

From:
http://www.ft.com/cms/s/0/5f05f078-2aa1-11dd-b40b-000077b07658.html?nclick_check=1

As Health Direct posted yesterday- the NHS funding position is down to cost cuts not funding proper health services.

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on “black alert” – which involves closing their doors to new patients because they are full.

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on “black alert” – which involves closing their doors to new patients because they are full.

Patients’ groups described the loss of the beds, at a time when overcrowded wards have seen soaring rates of killer infections, as “a national scandal”.

The reduction contradicts a pledge from Tony Blair at the turn of the century that there would be 7,000 more NHS beds by 2010.

New figures, seen by The Telegraph, show that the number of health service beds fell more than 8,000 last year, as the NHS began a reorganisation process which will mean the closure of dozens of hospitals.

More than 40 per cent of maternity units turned away women in labour last year because they had no room.

Meanwhile, ambulances have been forced to queue outside overstretched hospitals, treating patients in car parks just yards from accident and emergency departments. The new statistics, revealed in response to a parliamentary question by Ed Vaizey, the Conservative MP, show that almost 32,000 NHS hospital beds went between 1997, when Labour took office, and 2007.

More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

The figures emerged as health authorities are drawing up plans which will see the likely closure of dozens of district general hospitals. The East of England health authority has admitted that two accident and emergency departments and a maternity unit could close.

Andrew Lansley, the shadow health secretary, said the labour Government’s financial mismanagement had forced hospitals to make cuts which could risk lives. “These bed cuts were financially driven: the sharp rise in the numbers closed happened at a time when the health service was under desperate pressure to clear a massive deficit.”

Katherine Murphy, from the Patients’ Association, said: “This is a national scandal. More than 30,000 beds have been lost at a time when demand is increasing.”

In the same decade that the beds were cut, death rates from the infections MRSA and Clostridium difficile rose five-fold. Investigations into the biggest C. diff outbreak in Britain, which killed 90 patients at hospitals run by Maidstone and Tunbridge Wells trust in 2005 and 2006, found that overcrowding amid pressure to meet hospital waiting targets was a factor behind the infection’s spread.

More than 2,000 maternity beds have been lost since 1997. Research by the Conservatives found that last year, 42 per cent of maternity units had refused to accept women in labour on at least one occasion.

Sue MacDonald, from the Royal College of Midwives, said: “We feel the cuts have gone too far.”

Norman Lamb, the Liberal Democrat health spokesman, met officials recently after pressures on his local hospital, the Norfolk and Norwich, forced it to declare an emergency “black alert,” closing to new admissions, with 10 ambulances “stacked” outside, treating patients.

From:
NHS-hospitals-lose-32%2C000-beds-in-a-decade.html

Cancer victim told to pay for his own drugs by NHS

A cancer patient who was sent home to die by hospital doctors but then discovered a cocktail of drugs that stabilised his illness has now been told that the NHS will not pay for his medicine.

Jack Hose, 71, a retired engineer, was receiving a chemotherapy drug called irinotecan on the NHS, but it was failing to halt his bowel cancer.

NHS doctors told Hose, from Bournemouth, that they could do no more for him and that he should go home and make the most of the rest of his life while taking painkillers.

Hose was not prepared to die and sought a second opinion from a private doctor who recommended trying another drug, called cetuximab, in combination with irinotecan.

The mix of drugs appears to have stabilised Hose’s cancer. However, cetuximab is not funded by the NHS.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, which is treating Hose, has told him that, if he takes the drug, he will need to pay for all his care, including the cost of the medicine he initially received on the NHS.

Hose is the latest victim of the labour government’s policy of denying NHS treatment to patients who pay for an additional private drug.

Alan Johnson, the health secretary, says such an arrangement, known as “co-payments”, would lead to a two-tiered NHS.

“It seems outrageous that, having paid National Insurance contributions for 50 years, they are now asking me to pay for my care,” said Hose.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999216.ece

NHS ordered to end care bias against men

The equality watchdog has ordered the National Health Service (NHS) to take urgent action to end it’s anti male discrimination in healthcare.

The Equality and Human Rights Commission (EHRC), headed by Trevor Phillips, has written to strategic health authorities warning them to ensure that doctors and hospitals in their areas give equal priority to men and women.

The commission has legal powers to issue compliance orders to NHS trusts that persistently fail to provide equal care for men.

While the commission does not cite specific examples of discrimination, it details evidence of poorer male health. Other groups have pointed to male-unfriendly surgery opening hours.

Men are twice as likely as women to die from the 10 most common cancers that affect both sexes and, typically, develop heart disease 10 years earlier than women. Men under the age of 45 visit their GP only half as often as women and are less likely to have dental check-ups.

On average, men die five years younger than women and 16% of men die while still of working age compared with 6% of women. Men are also three times more likely to commit suicide than women.

A new law, the gender equality duty, which came into force in April 2007, obliges all public services to ensure they care for both sexes equally. In March, Phil McCarvill, head of public service duties at the EHRC, sent warning letters to strategic health authorities, the bodies which manage local NHS trusts.

McCarvill said: “We are writing to you specifically regarding the gender equality duty in response to particular concerns raised with us by the Men’s Health Forum and the action we want you to take in response to this. We will view the failure to take any action as a result of this letter as a breach of your legal responsibilities in this area.”

Research carried out by the forum found that men were unhappy with the service provided by their local GP surgeries. The forum points out that since men are twice as likely as women to work full-time and three times as likely to work overtime, it is more difficult for them to see doctors during conventional opening hours.

Other experts have pointed to the fact that, while there is a national screening programme for breast cancer, there is no equivalent yet for men for prostate cancer, although it claims a similar number of lives. Women are also screened for cervical cancer.

Peter Baker, chief executive of the Men’s Health Forum, said: “The GP model doesn’t work particularly well for men, particularly young men aged between 16 and 45 who GPs tend not to see unless there is something very seriously wrong with them. There is discrimination because these services are being underused by the group with the greatest need.”

The forum also suggests trusts offer health checks in venues frequented by men, such as work-places or sports clubs.

The Commons health select committee inquiry into health inequality will next month hear evidence that men are being discriminated against in the NHS.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999217.ece

Health Direct points out that labour’s centralist politically correct doesn’t just extend to pro women bias. They also channel extra funds into labour voting areas.

On August 07, 2006 Health Direct posted: Rural areas lose out to cities over health spending postcode lottery
Money needed for patients in rural England is being diverted to inner-city areas where it is not even being spent, experts say. Researchers at Cambridge University Medical School say the 29 primary care trusts (PCTs) most in surplus in 2004-5 were virtually all in inner-city areas.

In comparison, the 29 most in-debt PCTs were in rural areas, which received on average £205 less per head of population.