Supplementary memorandum by the Department
of Health (COA 59(a))
Annex A
1. Many submissions to this inquiry suggest
that coalfields regeneration is quite well advanced. How successful
have the various Government programmes been to date in terms of
meeting the needs of coalfield communities?
The Department of Health is strongly committed
to reducing health inequalities in deprived communities such as
coalfields areas, and recognises the part that regeneration policies
have to play in engaging communities and addressing the wider
determinants of health. I am working closely with colleagues in
the Office of the Deputy Prime Minister to support the work that
they do. In addition, there are a number of Department of Health-led
programmes which are having an impact on health and regeneration
in coalfields communities, the details of which are outlined below.
RESOURCE ALLOCATION
The new funding formula:
The NHS Plan stated that "following
the review of the existing weighted capitation formula used to
distribute NHS funding, reducing inequalities will be a key criterion
for allocating NHS resources to different parts of the country"
(paragraph 13.9).
The review of the formula has now taken place.
The new formula has been used for the latest round of NHS allocations
covering the three years 2003-04 to 2005-06.
The need element of the formula has been updated
to use better measures of deprivation and to take some account
of "unmet need".
The need element uses better measures of deprivation
which are now available, eg ODPM's Indices of Multiple Deprivation
(2000) which provide a useful up-to-date set of validated measures
of area deprivation, capable of being updated regularly.
The need element of the formula includes mortality
measures (which measure death rates for certain age groups compared
to the national average) and morbidity measures (limiting long-standing
illness ratios and disability measures).
The formula also takes some account of "unmet
need" where certain groups in the population eg socio-economically
deprived groups do not receive the same level of healthcare services
as that of others with the same health characteristics.
The new formula therefore provides a better
measure of health need in all areas.
Health inequalities adjustment:
The health inequalities adjustment (HIA) was
introduced in 2001-02 while longer-term work on the new formula
took place. For 2002-03 HIA funding of £148 million was shared
between 54 Health Authorities. HIA funding was based on years
of life lost for circulatory diseases, all cancers, accidents,
suicides, undetermined injury and infant deaths under one year
for all causes.
The new formula replaces both the old formula
and the interim health inequalities adjustment. To protect those
PCTs who have benefited from the interim health inequalities adjustment,
the existing 2002-03 allocation of £148 million has been
added to those PCTs' baselines.
Table 1 identifies the three-year percentage
increases in revenue allocations for those PCTs in the coalfield
communities. It also notes HIA funding for these PCTs now included
in baselines for 2003-06.
It is important to remember that the funding
formula calculates PCT target shares of available resources based
on the age distribution of the population, additional need and
unavoidable geographical variations in the cost of providing services.
It does not determine actual allocations, which reflect pace of
change policy decisions on the speed at which PCTs are brought
nearer to target.
Table 1
PERCENTAGE INCREASE IN ALLOCATIONS &
HEALTH INEQUALITIES ADJUSTMENT FUNDING IN COALFIELD COMMUNITY
PCTS FOR 2003-06
|
| PCT | 2003-06 three
year percentage
increase
(%)
| 2003-04 health
inequalities
adjustment
(£000s)
| 2004-05 health
inequalities
adjustment
(£000s)
| 2005-06 health
inequalities
adjustment
(£000s)
|
|
| Ashton, Leigh and Wigan | 31.44
| 1,284 | 1,284
| 1,284 |
| Barking and Dagenham | 42.48
| 0 | 0
| 0 |
| Barnsley | 31.00
| 1,990 | 1,990
| 1,990 |
| Chesterfield | 30.52
| 417 | 417
| 417 |
| Derwentside | 30.74
| 357 | 357
| 357 |
| Doncaster Central | 30.61
| 879 | 879
| 879 |
| Doncaster East | 30.19
| 726 | 726
| 726 |
| Doncaster West | 33.62
| 922 | 922
| 922 |
| Durham and Chester-Le-Street | 28.15
| 580 | 580
| 580 |
| Durham Dales | 28.71
| 363 | 363
| 363 |
| Easington | 40.56
| 454 | 454
| 454 |
| Eastern Hull | 30.25
| 1,366 | 1,366
| 1,366 |
| Eastern Wakefield | 32.47
| 1,517 | 1,517
| 1,517 |
| Halton | 31.06
| 517 | 517
| 517 |
| Hartlepool | 30.27
| 515 | 515
| 515 |
| Langbaurgh | 30.09
| 521 | 521
| 521 |
| Mansfield District | 31.19
| 367 | 367
| 367 |
| Middlesbrough | 31.12
| 1,402 | 1,402
| 1,402 |
| North East Lincolnshire | 30.39
| 656 | 656
| 656 |
| North Eastern Derbyshire | 31.29
| 559 | 559
| 559 |
| North Stoke | 30.63
| 1,023 | 1,023
| 1,023 |
| North Tees | 30.61
| 2,331 | 2,331
| 2,331 |
| Northamptonshire Heartlands | 31.22
| 0 | 0
| 0 |
| Northumberland Care Trust | 29.19
| 2,482 | 2,482
| 2,482 |
| Rotherham | 30.45
| 2,019 | 2,019
| 2,019 |
| Sedgefield | 30.42
| 390 | 390
| 390 |
| South Stoke | 30.77
| 1,041 | 1,041
| 1,041 |
| St Helens | 34.64
| 1,556 | 1,556
| 1,556 |
| Wakefield West | 29.41
| 1,165 | 1,165
| 1,165 |
| West Cumbria | 28.08
| 1,120 | 1,120
| 1,120 |
| West Hull | 28.42
| 1,360 | 1,360
| 1,360 |
|
NHS LIFT (LOCAL IMPROVEMENT
FINANCE TRUST)
NHS LIFT is an ambitious programme to rebuild and refurbish
primary and social care facilities to help increase the range
of services patients can access closer to where they live. In
each LIFT area a local LIFT company with public and private sector
shareholding is being established.
Initially LIFT developments have been prioritised in deprived
areas (such as former coalfields) where investment in primary
care facilities has historically been difficult to attract. There
are now 42 local LIFT projects in development.
Sixty per cent of the PCTs covering the coalfield communities
are within a LIFT area (see table 2). The initial capital value
of the investment in primary care facilities (over the period
2004-06) in these LIFT projects areas is estimated to be £170
million.
For example, in Barnsley (where construction work is due
to begin in the next month) there are plans for three brand new
primary care centres with a capital cost of £10 million providing
services to three former mining villages (Goldthorpe, Thurnscoe
and Worsbrough).
Table 2
CURRENT LIFT SCHEMES COVERING COALFIELD AREAS AND INITIAL
CAPITAL INVESTMENT
|
| NHS LIFT scheme | Initial capital
Value (£m)
|
|
| Barnsley LIFT | 10
|
| Barking & Havering LIFT | 17
|
| Hull LIFT | 17
|
| North Notts LIFT | 20
|
| Ashton, Leigh and Wigan | 15
|
| Doncaster LIFT | 16
|
| Greater Nottingham LIFT | 27
|
| St Helens, Knowlsey, Halton and Warrington LIFT
| 22 |
| Tees Valley LIFT | 25
|
|
NHS DIRECT
NHS Direct is a nurse-led telephone helpline providing health
information and advice 24 hours a day, 365 days a year. The NHS
Direct principle is to provide people at home with easier and
faster advice and information about health and the NHS. NHS Direct
nurses are highly experienced, trained professionals who provide
patients with the same high quality, consistent, safe level of
service across the country. The benefits apply not only to patients
who get appropriate advice on the best way of tackling health
problems, but also to the NHS because it is an efficient way of
using NHS resources.
NHS Direct has grown from a small pilot project to a substantial
national service handling over half-a-million telephone calls
and half-a-million internet visitor sessions every month.
NHS Direct has delivered sustained performance by focusing
on eight key measures known as service delivery targets. These
indicate how NHS Direct is delivering as a service. To complement
these targets, information is also gathered on the final recommended
outcomes suggested to patients and additional data on age and
gender. Collecting information from theses sources helps NHS Direct
determine how best to refine and focus the services in order to
continue with improving the patient experience.
NHS Direct Online has responded to the growing appetite for
high quality health information, which makes health one of the
most important reasons for using the Internet.
Over the next couple of years a number of exciting possibilities
exist to develop this multi-channel approach further in particular
in terms of increased interactivity. These include:
— significant expansion of the content of the site
including the development of video content; and
— delivering the concept of a personal health space
that could provide secure access to patient records and on-line
transactions.
In addition to expanding the range of services offered by
NHS Direct Online, we will further extend choice through the new
NHS Digital service. Following the successful completion of the
pilots, work has now begun to develop and run a NHS Direct information
service across all digital TV platforms nationwide. The NHS Direct
digital TV service, which will start 2004, will provide information
on health conditions and treatments, healthy living, medicines,
health advice for travellers, health and safety advice, and details
of local NHS services, including performance information.
The expanded role for NHS Direct Online and the launch of
the NHS Direct digital TV service will not only greatly increase
access but is symbolic of a changing role for patients as co-partners
in care. The use of NHS Direct digital TV is particularly relevant
for deprived communities, given the fact that Digital TV subscription
has a high correlation with lower income groups.
PRIMARY CARE
ACCESS
NHS Plan Target: By 2004, patients will be able to see a
primary care professional (PCP) within 24 hours, and a GP within
48 hours.
Progress towards the target is measured by PCTs who undertake
monthly telephone surveys of their GMS practices and PMS providers
to establish when the next routine appointment with a GP and primary
care professional are available.
At October 2003, nationally 93.9% of patients were able to
be offered an appointment to see a GP within two working days
and 92.6% of patients were able to be offered an appointment to
see a primary care professional within one working day.
The 2003 National Patient survey also indicated access is
improving—77% of all patients were able to be seen within
two days. Excluding those seen without an appointment or pre-booked
appointments, then 58% of patients had this level of access. This
indicates a 15% improvement over the 2002 result of 43%.
As part of the commitment to improving access to primary
care, PCTs received £168 million for 2003-04 to improve access
to primary care. This was made recurrent from 2003-04 and forms
part of PCT resource allocations.
At October 2003, the National Primary Care Development Team's
(NPDT) Advanced Access model covered over 4,900 practices representing
a population coverage of 32 million patients. This is set to increase
to 37 million by March 2004. Practices taking part in the programme
have seen a 72% reduction in waits to see a GP and a 50% reduction
to see a nurse.
NHS WALK-IN
CENTRES
The 42 NHS Walk-in Centres were developed as part of the
wider plan to modernise and improve access to and convenience
of NHS services. Open 365 days a year most NHS Walk-in Centres
are open from 7am to 10pm, Monday to Friday, and 9am to 10pm,
Saturday and Sunday. They are situated in convenient locations
that allow the local population quick and easy access to advice
and treatment for minor ailments and injuries where no appointment
is necessary. As well as providing a core service, the centres
are helping to improve access for specific groups with particular
needs, including young people, homeless people, students, refugees
and asylum seekers.
42 NHS walk-in centres are operational across the country,
currently offering a service to around 11 million people.
Since the first centre opened in 2000, the centres have seen
4 million people. On average each centre now sees around 100 patients
a day.
There are currently three walk-in centres serving the local
populations of coalfield communities. These are located in St
Helen's, Wakefield and Leigh.
In recognition of the success of the WICs and of their potential
to address specific local access issues, £40 million is being
invested in new NHS walk-in centres over the next three years.
They are being introduced to extend the level of choice for patients
to access services, to reduce pressures on A&E and to help
deliver better primary care access.
11 new NHS walk-in centres are being developed to open in
2004. More will follow in 2004-05—2005-06.
Primary Care Workforce
We are addressing inequities in primary care services with
new ways of distributing resources to PCTs.
From 2002-03 cash limited unified allocations have taken
account of the distribution of non-cash limited spending on primary
care services provided by GPs. So those areas who are spending
less than their fair share on these services ("under-doctored
areas") may get a larger increase for their other services.
And if they are spending more than their fair share ("over-doctored
areas") they may get a smaller increase.
PCTs have also been given an average cash increase exceeding
30% over the three years 2003-06. None of the growth money has
been identified for specific purposes. PCTs will be able to use
these extra resources to deliver on both national and local priorities
including recruiting additional staff in primary care.
Under-doctored areas are getting extra training places and
GPs going to work in those areas are entitled to receive a higher
"Golden Hello Payment".
General Practitioners
Table 3
THE NUMBER OF GPS (EXCLUDING GP RETAINERS AND GP REGISTRARS)
IN ENGLAND AND IN EACH COALFIELD COMMUNITY BY PCT AREA BETWEEN
SEPTEMBER 2001 AND MARCH 2003
GPs (excluding retainers and registrars) General Medical Practitioners
for specified Primary Care Trusts
|
| PCT | Sept 2001
| March 2002 | Sept 2002
| March 2003 |
|
| ENGLAND | 28,802
| 28,950 | 29,202
| 29,709 |
| Ashton, Leigh and Wigan | 151
| 149 | 145
| 157 |
| Barnsley | 120
| 122 | 119
| 117 |
| Chesterfield | 56
| 56 | 68
| 70 |
| Derwentside | 44
| 41 | 41
| 48 |
| Doncaster Central | 56
| 57 | 59
| 58 |
| Doncaster East | 46
| 46 | 43
| 43 |
| Doncaster West | 55
| 54 | 55
| 54 |
| Durham and Chester-Le-Street | 90
| 88 | 87
| 93 |
| Durham Dales | 54
| 53 | 52
| 57 |
| Easington | 54
| 51 | 53
| 58 |
| East Kent Coastal | 129
| 133 | 133
| 137 |
| East Leeds | 92
| 93 | 89
| 90 |
| Eastern Wakefield | 103
| 106 | 107
| 111 |
| Halton | 67
| 74 | 69
| 71 |
| Hartlepool | 47
| 48 | 49
| 51 |
| Langbaurgh | 60
| 61 | 60
| 62 |
| Mansfield District | 46
| 45 | 45
| 48 |
| Middlesborough | 113
| 111 | 114
| 114 |
| North Eastern Derbyshire | 78
| 78 | 81
| 85 |
| North Stoke | 73
| 71 | 63
| 63 |
| North Tees | 93
| 97 | 96
| 97 |
| Northamptonshire Heartlands | 142
| 139 | 147
| 145 |
| Northumberland Care Trust | 203
| 200 | 207
| 211 |
| Rotherham | 125
| 123 | 136
| 139 |
| Sedgefield | 54
| 51 | 53
| 54 |
| South Leeds | 81
| 82 | 81
| 86 |
| South Stoke | 60
| 57 | 66
| 68 |
| St Helens | 106
| 106 | 108
| 104 |
| Wakefield West | 95
| 98 | 101
| 98 |
| West Cumbria | 89
| 89 | 91
| 90 |
|
Note:
Data as at 31 March 2002-03, 30 September 2001-02
Source:
Department of Health General and Personal Medical Services Statistics
|
Whole time equivalent (WTE) GPs (excluding GP retainers
and GP registrars) per 100,000 weighted population:
All PCT areas, which are below the England average of 55.55
are classed as under-doctored.
Table 4
THE NUMBER OF WTE GPS (EXCLUDING GP RETAINERS AND GP REGISTRARS)
PER 100,000 WEIGHTED POPULATION AS AT MARCH 2003
|
| PCT | GP per 100,000
PCT population
|
|
| ENGLAND | 55.55
|
| Ashton, Leigh and Wigan | 45.48
|
| Barnsley | 42.69
|
| Chesterfield | 56.05
|
| Derwentside | 48.84
|
| Doncaster Central | 50.01
|
| Doncaster East | 44.35
|
| Doncaster West | 43.32
|
| Durham and Chester-Le-Street | 56.99
|
| Durham Dales | 58.60
|
| Easington | 46.66
|
| East Kent Coastal | 51.43
|
| East Leeds | 54.18
|
| Eastern Wakefield | 52.04
|
| Halton | 53.47
|
| Hartlepool | 49.19
|
| Langbaurgh | 51.20
|
| Mansfield District | 45.34
|
| Middlesborough | 51.81
|
| North Eastern Derbyshire | 48.85
|
| North Stoke | 40.70
|
| North Tees | 49.32
|
| Northamptonshire Heartlands | 51.58
|
| Northumberland Care Trust | 60.79
|
| Rotherham | 49.34
|
| Sedgefield | 49.74
|
| South Leeds | 51.66
|
| South Stoke | 44.38
|
| St Helens | 48.08
|
| Wakefield West | 57.95
|
| West Cumbria | 60.07
|
|
General Practitioner Registrars
Table 5
THE NUMBER OF GP REGISTRARS IN ENGLAND AND IN EACH COALFIELD
COMMUNITY BY PCT AREA BETWEEN SEPTEMBER 2001 AND MARCH 2003
GP registrars for specified Primary Care Trusts
|
| Numbers (headcount)
|
| Primary Care Trust | Sept 2001
| March 2002 | Sept 2002
| March 2003 |
|
| ENGLAND | 1,883
| 1,908 | 1,980
| 2,069 |
| Ashton, Leigh and Wigan | 4
| 4 | 6
| 6 |
| Barnsley | 8
| 6 | 6
| 8 |
| Chesterfield | 7
| 4 | 3
| 3 |
| Derwentside | 3
| 3 | 3
| 2 |
| Doncaster Central | 3
| 2 | 3
| 2 |
| Doncaster East | 4
| 3 | 4
| 4 |
| Doncaster West | —
| — | —
| — |
| Durham and Chester-Le-Street | 7
| 7 | 7
| 12 |
| Durham Dales | 3
| 1 | 5
| 3 |
| Easington | 1
| — | 1
| 2 |
| East Kent Coastal | 7
| 6 | 5
| 7 |
| East Leeds | 8
| 7 | 4
| 11 |
| Eastern Wakefield | 10
| 11 | 13
| 13 |
| Halton | 4 |
3 | 4
| 6 |
| Hartlepool | 2
| 2 | 3
| 4 |
| Langbaurgh | 2
| 2 | 1
| 1 |
| Mansfield District | 1
| 1 | 3
| 2 |
| Middlesborough | 4
| 4 | 5
| 4 |
| North Eastern Derbyshire | 7
| 3 | 5
| 4 |
| North Stoke | 2
| 3 | 3
| 3 |
| North Tees | 5
| 6 | 5
| 6 |
| Northamptonshire Heartlands | 9
| 9 | 8
| 10 |
| Northumberland Care Trust | 24
| 26 | 34
| 26 |
| Rotherham | 7
| 9 | 12
| 8 |
| Sedgefield | 5
| 3 | 6
| 6 |
| South Leeds | 5
| 4 | 3
| 3 |
| South Stoke | —
| — | —
| — |
| St Helens | 4
| 4 | 5
| 4 |
| Wakefield West | 5
| 7 | 7
| 7 |
| West Cumbria | 5
| 4 | 4
| 7 |
|
Data as at 31 March 2002-03, 30 September 2001-02
Source:
Department of Health General and Personal Medical Services Statistics
|
2. WHY IS
THE LEVEL
OF DEPRIVATION
ON THE
COALFIELDS STILL
SO HIGH,
GIVEN THE
VOLUME OF
PUBLIC FUNDS
INJECTED INTO
THEM?
"Tackling Health Inequalities—A Programme for
Action" recognises that health inequalities are "persistent,
stubborn and difficult to change". A step-change set of interventions
are needed in order to cut into the cycle of deprivation that
currently affects certain parts of the country, such as coalfield
communities.
Considerable investment has been made to help bring about
this change. In his 2002 Budget, the Chancellor announced the
largest sustained increase in funding of any five-year period
in the history of the National Health Service (NHS). Over the
years 2003-04 to 2007-08, these plans mean that expenditure on
the NHS in England will increase on average by 7.4% a year over
and above inflation—a total increase over the period of
43% in real terms. This will take the total spent on the NHS in
England from £56 billion in 2002-03 to over £90 billion
in 2007-08. This is a significant increase over historic levels
of growth, eg compared with just 3.0% per annum under the previous
administration.
Table 6 shows the trends in mortality from all causes from
1990 to 2000, among ONS area classifications. The table shows
that although there is not a big difference between the profiles
of the different ONS area classifications, all cause mortality
in coalfield areas has been falling more quickly in the last two
years than all other areas except for "west inner London".
| 
