‘Target NHS spending on poor’ to cut health inequality

A hard-hitting report published by Audit Scotland today warns frontline health services are failing to support some of the most vulnerable people across the country.

The report, “Health inequalities in Scotland”, claims that those in more deprived areas tend to have “poorer  access” to NHS services, in what it claims is an unequal distribution of resources.

Scotland’s NHS spent £170 million, just over 1.5 per cent of its overall budget, on schemes to reduce health inequalities and the report’s authors said they found “limited evidence of impact” of the Scottish Government’s efforts to tackle the problem.

The Audit Scotland report said that the distribution of services across Scotland “does not fully reflect the higher levels of ill health and wider needs found in deprived areas”.

The Auditor General for Scotland, Caroline Gardner, said resources should be “better targeted at those who require them most” as she criticised the funding arrangements for the NHS.

Publishing the report, Audit Scotland issued a stark warning to ministers about how effectively taxpayers’ cash was being spent as the watchdog highlighted how “assessing value for money is difficult”.

The study found there are fewer GPs in the poorest areas of Scotland than are in the second most deprived areas, and only just more than in the middle-income areas of the country.

Scots living in the poorest parts of the country can expect to die up to 18 years earlier than those in wealthiest areas, according to the authors of the study.

They are also more likely to have higher rates of heart disease, mental health problems, obesity and cancer.

Children in the most deprived parts of Scotland also have “significantly worse health” than those in affluent areas, with one in four poorer children classed as obese compared to less than one in five from wealthier backgrounds.

Holyrood’s public audit committee convenor, Iain Gray, said Scotland’s health inequalities were “utterly stark” as he said that ministers would be forced to explain the gaps in provision to MSPs.

“While health has improved over the past 50 years, the picture presented in this report is utterly stark, with deprivation still the key factor,” he said.

“When the Scottish Government appears before this committee next week we will be asking what evidence it has to demonstrate that the money being spent is making a difference to reducing inequality and to explain how performance is being measured.”

Audit Scotland said that “it is not clear” how Scotland’s health boards and councils allocate spending to “target local areas with the greatest needs”.

Scotland’s poorest areas had 1,071 GPs, but the next most deprived areas had 1,183, while middle-income areas of Scotland had a similar level of service at 1,039 GPs. Patients from deprived areas are also more likely to miss hospital appointments due to problems such as a lack of transport, the report claimed.

About 11 per cent of the most deprived patients missed outpatient appointments during 2011-12 – more than double the proportion among those in the most affluent areas.

The study also warned that there will be a “decrease in real terms” in spending on the Scottish Government’s Keep Well programme to tackle problems such as alcohol misuse, smoking and obesity.

The Auditor General for Scotland insisted that the figures showed “entrenched” problems over public funds being targeted at the poorest parts of Scotland. She said: “Health inequalities are long-standing and entrenched in Scotland. Tackling this has been a priority for successive governments, but most indicators show the problem remains substantial.

“On average, people in Scotland’s poorest neighbourhoods die earlier and children in the most deprived areas have significantly worse health.

“Across the country, there are particular areas of poverty where people have higher healthcare needs. Resources should be better targeted at those who require them most.”

The west of Scotland, especially Glasgow and its surrounding areas, are gripped by “high levels of deprivation” which the report’s authors said accounts for a “significant proportion of health inequalities” in Scotland.

Meanwhile, people in the most deprived areas were much more likely to be treated for anxiety, with 62 consultations for the condition for every 1,000 patients.

The figure was just 28 GP consultations for every 1,000 patients in the most prosperous parts of Scotland.

Labour health spokeswoman Jackie Baillie claimed that the report showed the SNP government is “failing Scotland’s poorest and most deprived”.

She said: “Everyone knows that our health inequalities are immense but this report shows that, five years into government, the SNP’s health programmes lack focus, show few outcomes, health services are located in the wrong places and tracking progress is virtually impossible.

“While the inequalities remain, whole communities of Scotland continue to suffer from poorer health and lower life expectancies.

“In a 21st-century Scotland, it is a disgrace that this continues to be the case.”

Scottish Tory deputy leader Jackson Carlaw described the findings of the report as “shameful” and suggested that the figures on alcohol abuse and smoking showed some Scots were responsible for their own poor health.

He said: “Everyone knows smoking, drinking and eating junk food is bad for health. So while the authorities can take some responsibility for this problem, we cannot lay the blame squarely at their door.”

Scottish Liberal Democrat health spokesperson Jim Hume MSP blamed the stark differences on life expectancy on what he claimed was a low spend of the NHS’s overall budget on services for poor communities.

He said: “This report reveals the disturbing scale of health inequalities in Scotland.

“Wholesale differences in health between those living in the least deprived areas and the most deprived areas should have no place in 21st century Scotland.”

A Scottish Government spokeswoman said: “The Scottish Government is committed to reducing the health gap between the richest poorest people in Scotland and that is why we have recently reconvened the Ministerial Taskforce on Health Inequalities.

“The Equally Well framework sets out the Scottish Government’s strategy for reducing health inequalities, and this has already shifted the emphasis of our approach from dealing with the consequences of health inequalities to tackling the underlying causes such as poverty, employment, support for families and improving physical and social environments.”