The Department of Health has known since 1997 that low-cost drug treatments could have a major effect in deprived areas, but they have still not been adopted on the scale required, say MPs in a damning new report. It is “unacceptable” that the Department took until 2006 – nine years after it announced the importance of tackling health inequalities – to establish this as an NHS priority, adds the House of Commons Committee of Public Accounts, in a report published this morning.
The Committee, which is chaired by Labour MP Margaret Hodge, points out that inequalities in health outcomes between the most affluent and disadvantaged members of society are longstanding, deep-seated and have proved difficult to change. In 1997, the government put tackling the problem at the heart of its health agenda, published a number of policy documents and related targets, and in 2004 it set the Department the target of reducing the gap in life expectancy between 70 “spearhead” local authorities with high deprivation and the population as a whole by 10% by 2010.
However, “the Department has not met this target and has been exceptionally slow to tackle health inequalities,” says the report. In 2002, it notes, three cost-effective health interventions that were known to improve life expectancy were emphasised by a Treasury-led review of health inequalities. They were: - the prescription of drugs to control blood pressure; - the prescription of drugs to reduce cholesterol; - and smoking cessation services.
“Yet it took the Department until 2007 to develop an evidence-based tool to help Primary Care Trusts (PCTs) implement these treatments and to start to monitor how to use them,” say the Committee members, who add that they have also been told by the Department that these three key interventions have not yet been adopted “to the scale necessary to close the inequalities gap.”
Criticising the Department’s slowness to develop an evidence base for cost-effective interventions, the MPs say it has also failed to put in place mechanisms to hold providers and commissioners to account over whether they apply these interventions. “Even now, implementation of the three most cost-effective treatments is inconsistent, with considerable variation by location,” they say, and in their recommendations they call on the Department and the NHS Commissioning Board to “identify and implement the action needs to stimulate the wider adoption of the treatments, so that GPs in all areas comply with accepted good practice.”
After the Department established the objective of tackling the “complex and intractable problem” of the continually-widening gap between people in deprived areas and the general population, it did not then “set about its task with sufficient urgency or focus,” they say. Moreover, it “did not deploy its own resources effectively or coherently, was too slow in making health inequalities an NHS priority and set a performance measure that proved too blunt an instrument to target those most in need effectively.”
The Department has also failed to address adequately GP shortages in the areas of highest need, and its officials are not clear why some areas are performing better than others, or of the extent of the NHS’ contribution in tackling health inequalities, says the report, which also notes that two-thirds of PCTs in areas with the highest deprivation still do not receive the money due to them under the Department’s funding formula.
During the transition period in which the change set out in the government’s White Paper on the future of the NHS is managed, it is important that tackling health inequalities does not slip down the Department’s agenda, say the MPs. “The Department will need to set a clear framework of accountability at all levels of the health service if it is to be successful in addressing health inequalities in future,” they conclude.
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