HC 1048-III Health CommitteeAddendum to the written submission by Public Health Manchester (PH 146A)

1. This addendum to our memorandum seeks to clarify the relationship between the effect on target allocations (attained in the longer term) and that on actual 2011-12 allocations, both caused by the reduction in the health inequalities weighting from 15% to 10%.

2. The change in target allocations represents the maximum annual effect in the future, attained at a time determined by future ministerial decisions on the pace of change and historically within a band of about 7-20 years.

3. The final maximum change represents a movement of £718.0 million from poorer health PCTs to better health PCTs, a relative movement of about 3.4%.

4. The current year 2011-12 equivalent effect is estimated at £55.9 million, which is 7.8% of the maximum effect and a relative movement of about 0.3%.

5. From the current year the effect will increase annually up to the maximum, giving a total aggregate movement of allocation over the period of many times the maximum annual effect.

6. In our tables and in the context of current policy on allocations where all PCTs are given growth, at least nominal growth, “losing” PCTs are those whose growth and hence allocations are less than would otherwise be the case and vice versa for “gaining” PCTs.

7. The following tables compare losing and gaining PCTs for target allocations (maximum annual future effect) and for the 2011/12 actual effect. A measure of mortality, the under 75 standardised mortality ratio (u75 SMR), is also given to indicate the health of the population of the PCT relative to the England average of 100, which demonstrates that losing PCTs have higher mortality than average and gaining PCTs have lower mortality than average.

Table 1

TOP TEN LOSING PCTS FROM REDUCTION IN HEALTH INEQUALITIES WEIGHT IN TERMS OF MAXIMUM FUTURE ANNUAL EFFECT (TARGET ALLOCATIONS)

PCT

Change £m

Change %

u75 SMR

1

Tower Hamlets

−18.7

−4.1

129.8

2

Manchester

−41.7

−4.0

158.2

3

Newham

−18.0

−3.6

133.4

4

Liverpool

−33.3

−3.5

147.3

5

City & Hackney

−15.9

−3.3

123.8

6

Nottingham City

−18.4

−3.2

132.9

7

Knowlsey

−10.1

−3.1

136.7

8

Barnsley

−14.7

−3.1

121.4

9

Hartlepool

−5.5

−3.0

131.7

10

Middlesbrough

−8.0

−2.8

131.4

Table 2

TOP TEN GAINING PCTS FROM REDUCTION IN HEALTH INEQUALITIES WEIGHT, IN TERMS OF MAXIMUM FUTURE ANNUAL EFFECT (TARGET ALLOCATIONS)

PCT

Change £m

Change %

u75 SMR

1

Surrey

+61.4

+4.2

78.5

2

Kensington & Chelsea

+11.2

+3.9

69.3

3

Richmond & Twickenham

+9.0

+3.8

76.6

4

Buckinghamshire

+24.5

+3.6

79.9

5

Berkshire West

+18.0

+2.9

85.3

6

Bromley

+13.3

+2.9

80.5

7

Hampshire

+52.1

+2.9

80.4

8

Wiltshire

+17.3

+2.7

81.2

9

Dorset

+16.7

+2.7

75.7

10

West Sussex

+32.3

+2.7

85.6

Table 3

TOP TEN LOSING PCTS FROM REDUCTION IN HEALTH INEQUALITIES WEIGHT, IN TERMS OF 2011-12 ACTUAL ALLOCATIONS

PCT

Change £m

Change %

u75 SMR

1

Leicester City

−7.7

−1.5

130.1

2

Nottingham City

−4.3

−0.8

132.9

3

Barnsley

−2.7

−0.6

121.4

4

County Durham

−4.8

−0.5

113.6

5

Wakefield District

−2.9

−0.5

114.4

6

Derby City

−2.0

−0.5

109.9

7

Bristol

−2.3

−0.3

110.7

8

Sandwell

−1.8

−0.3

132.6

9

Bassetlaw

−0.5

−0.3

105.3

10

Liverpool

−2.6

−0.3

147.3

Table 4

TOP TEN GAINING PCTS FROM REDUCTION IN HEALTH INEQUALITIES WEIGHT, IN TERMS OF 2011/12 ACTUAL ALLOCATIONS

PCT

Change £m

Change %

u75 SMR

1

Norfolk

+17.0

+1.5

84.6

2

North East Essex

+6.9

+1.3

93.5

3

South Staffordshire

+9.0

+1.0

96.4

4

Bedfordshire

+2.9

+0.5

92.2

5

Hertfordshire

+4.4

+0.3

85.9

6

Dorset

+1.7

+0.3

75.7

7

Gloucestershire

+2.3

+0.3

86.5

8

Devon

+2.0

+0.2

82.4

9

West Sussex

+1.9

+0.2

85.6

10

Buckinghamshire

+1.0

+0.1

79.9

Source: Allocations - PH Manchester analysis of DH exposition book

u75SMR – APHO 2005-09 data

Note on calculation of 2011-12 effect: The pace of change (PoC) algorithm was set up to be as similar as possible to the actual one used while growth on the two main gradients was constrained so that the actual overall pace was maintained ie movement of £74.5 million from over target to under target PCTs.

September 2011

Prepared 28th November 2011