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The NHS postcode lottery – alive and well still?

Providing a comprehensive service that is available to all is one of the guiding principles of the NHS. Yet inequality has hampered its ability to deliver a consistent health service to patients regardless of where they live. The so-called ‘postcode lottery’ has continued to fuel newspaper headlines for years.

Various initiatives have attempted to address the issue. In fact, NICE (the National Institute for Health and Care Excellence) was established to ensure patients could access innovative treatments fairly and equally, and in an attempt to improve transparency around the issue Clinical Commissioning Groups (CCGs) are now required to publish data so their performance can be assessed.

These reporting requirements include data on how many patients are still waiting for treatment 18 weeks after referral and the details of treatments provided, which are combined to provide a national ‘Atlas of Variation’.

However, making sense of that huge volume of information – unless you have the gift of patience and are a dab hand with an Excel spreadsheet – is not easy. That’s why the Medical Technology Group decided to crunch the data and report on these measures in a number of clinical areas: cardiology; cardiothoracic; ophthalmology; urology; trauma and orthopaedics; colonoscopy; limb amputations; and stroke care – where innovative medical technology can be hugely beneficial.

Our report findings surprised us even more than we expected.

Firstly, the extent of the variation was astonishing. For example, less than one patient per 100,000 population in Southampton was referred for a computed tomography colonoscopy (a vital procedure for diagnosing and ruling out bowel cancer) compared with 59 patients per 100,000 in neighbouring Fareham and Gosport. Meanwhile, eight out of ten patients were admitted to a stroke unit within the recommended four hours of arrival at hospital in Hillingdon, compared to two out of ten in Wyre Forest.

Secondly, a distinct north-south divide emerged, with nine out of ten of the poorest performing CCGs located in the south of England.

Such wide variation is unacceptable, especially when patients are being denied access to medical technology that can not only improve their quality of life, but can save the NHS money in the long term through fewer complications and additional treatment.

Is the postcode lottery still alive and well? It seems so. In fact, as the BBC’s Hugh Pym pointed out in his report on our study: ‘The fragmented nature of the NHS in England with local commissioners making their own decisions on what to offer patients has accelerated the trend.’

The full report, including the MTG’s seven recommendations, can be found here.

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