"The Department of Health has made a concerted effort to
tackle a very difficult and long-standing problem. However, it was
slow to take action and health inequalities were not a top priority
for the NHS until 2006. We recognize that this is a very
complicated issue and that it took time to develop an evidence
base. However, the best, cost-effective interventions have been
identified and now must be employed on a larger scale in order to
have a greater impact and improve value for money.
"The Department should target its efforts on the most
deprived areas of the country and develop costed proposals to
maintain or increase investment in preventative interventions to
tackle the conditions which lead to health
inequalities."
Amyas Morse, head of the National
Audit Office, 2 July 2010
The Department of Health has made a serious attempt to tackle
health inequalities across England. But, according to a National
Audit Office report published today, having set a target in 2000 to
reduce health inequalities, it took time to embed the issue in the
policy and planning framework of the NHS and to develop an evidence
base of the most cost-effective interventions.
Given the slowness in applying cost-effective interventions on
the scale required in the early and mid-2000s, the NAO was unable
to conclude that the Department’s approach provided value for money
up to this time. More recently the improved take-up of these
interventions is likely to have improved value for money.
The NAO report found that, although life expectancy overall has
increased, the gap in life expectancy between the national average
and the Government’s dedicated “spearhead” areas has continued to
widen. The Department will not meet its target to reduce the health
inequalities gap by 10 per cent by 2010, as measured by life
expectancy at birth, if current trends continue.
The Department’s strategy, published in 2003, lacked effective
mechanisms to achieve the target because the evidence base was
still being developed. It was not until 2006-07 that the strategy
was matched by focused action to tackle health inequalities,
leaving little time for these actions to have an impact before the
2010 target date.
Three key, cost-effective interventions to reduce the gap in
life expectancy were identified by the Department’s 2007 Health
Inequalities Intervention Tool: increase the prescribing, first, of
drugs to control blood pressure and, secondly, of drugs to reduce
cholesterol, by 40 per cent; and double the capacity of smoking
cessation services. But these interventions have not yet been used
on the scale required to close the gap and progress in improving
the take-up of these interventions is not monitored.
Primary care trusts are required to address health inequalities
from within their general budgets and, therefore, it is not
possible to identify how much money has been spent. PCTs in
spearhead areas had £230 more per head to spend than the PCTs in
non-spearheads, but there is evidence that some of the extra money
is absorbed by higher hospital costs in deprived areas.
Publication details:
HC: 186, 2010-2011
ISBN: 9780102965322