Inequalities in Health

and Health Care Provision

UK

National Inequalities in Health

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(Rate per 100,000 Population)

Heart Diseases

CVD Cerebrovascular

disease

Cancer Road Traffic Accidents

Suicides and Open Verdicts

Males

England 182 70 242 9 14 Wales 206 78 253 9 19 Scotland 231 88 287 11 26 N. Ireland 196 74 248 15 17

Females England 155 121 233 3 4 Wales 175 128 239 2 4 Scotland 193 150 275 4 9 N. Ireland 174 126 238 4 3

www.statistics.gov.uk

Death Rates and Infant Mortality Rates per 1,000, per country (2003)

Death Rateper 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 5.3

United Kingdom 10.3 5.3

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

% Women

14%2%

21%

38%

25%

% Men

12%4%

16%

39%

29%

RespiratorydiseaseIndjuries &poisoningAll other causes

CardiovasculardiseaseCancer

www.statistics.gov.uk

NHS Expenditure by country in the UK {2002-3 (bmj.com 2005) and 2004-5}

Per capita(£)

2002-3

Per capita(£)

2004-5

England £1085 £1249

Wales £1186 £1287

Scotland £1262 £1533

Northern Ireland £1214 £1371

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)

England 97% - 3%

Wales 104% + 4%

Scotland 114% + 14%

Northern Ireland 107% +7%

The UK average = 100

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 0.57Wales 5 1.4 6.4 0.61Scotland 6 1.8 7.4 0.76Northern 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

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

Inequalities in Health Care Provision

Studies show that wide variations in health care provision do exist within the UK.

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 provisionbetween Scotland and England (2001)

0

100

200

300

400

500

600

700

800

900

Consultants GPs Nurses

England

Scotland

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

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