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Postcode lottery of NHS care revealed in full

The scale of the “postcode lottery” of care that patients can expect across England, and the different amounts of money health authorities spend on problems, has been highlighted for the first time in an NHS survey.
Postcode lottery of NHS care revealed in fullThe NHS Atlas of Variation has found that some NHS trusts are failing in key areas including cancer, stroke, and diabetes care.

For the first time geographical differences have been drawn together into a series of 34 maps that the public can view online to see how well their region is performing.

It shows a 14-fold difference in spend on broken hips between best and worst areas; a four-fold variation in the proportion of stroke patients who spend almost all their hospital time in a dedicated stroke unit; and a 38-fold difference in rates of obesity surgery.

Some health authorities spent more than two-and-a-half times as much on mental health services, while there were similar differences in spend on inpatient cancer care.

Lord Howe, the Health Minister, welcomed publication of the atlas, saying: “In order to improve unwarranted variations in services, it is vital to expose existing flaws in the system.”

Charities said the move demonstrated greater openness but warned the variations showed patients were being let down in many areas.

Prof Chris Ham, chief executive of The King’s Fund, a health think-tank, said the atlas “brings into sharp relief variations in the quality and cost of care across the NHS”.

He said: “With the NHS needing to find £20 billion a year in productivity improvements, reducing unwarranted variation is no longer an option – it is a necessity.”

Many of the maps are standardised to take account of differences in age, sex and prevalence of the condition – some of the major reasons typically cited for variations in care.

The report therefore reveals that practices between NHS trusts vary in ways that cannot always be explained by social or patient factors.

The amount spent on broken hips by primary care trusts (PCTs) ranged from little over £500 per 1,000 people to more than £8,000 – even after differences in local population need were taken into account.

Rates of obesity surgery ranged from just 1.1 operation per 100,000 population to 38.9, with higher rates tending to be in poorer areas.

On cancer, some PCTs spent more than £40,000 per 1,000 population on inpatient care while others spent less than £20,000. Devon, Suffolk and Cambridgeshire were among the higher spenders and parts of London towards the lower end.

However, Mike Hobday of Macmillan Cancer Care said this was one area when higher spend was not necessarily a good thing.

He said: “We think spending less money on inpatient cancer care is better, because that means people are being supported more effectively.”

Shorter hospital stays – and hence lower inpatient costs – indicated better cancer therapies and back-up-treatment were being used, he explained.

Regarding variations as a whole, he added: “What this shows is that the NHS still isn’t very good at sharing good practice from one hospital to another.”

However, he welcomed publication, saying it demonstrated greater “openness”.

The percentage of patients receiving nine key checks on their diabetes control – including for kidney damage, cholesterol and weight – varied from 60 to 70 per cent in Norfolk and parts of Yorkshire to zero to around 40 per cent in places like Cornwall, Lincolnshire and Northamptonshire.

Barbara Young, chief executive of Diabetes UK, said the charity was “seriously concerned”.

“This demonstrates that the NHS is failing to provide universally high quality care across the country and shows that diabetes care is still a postcode lottery,” she said.

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