I read with interest the article by Sheena Asthana and Alex Gibson (HSJ 16 November 2006). The article sets out some interesting data which we would be unwise to ignore in terms of what it means for the NHS. However, I do believe that the conclusions drawn from the data analysis are erroneous and I would give you an alternative take on what may be the underlying issues.
It has been well aired in this journal that many of the health economies experiencing financial difficulties have struggled with the reconfiguration of services that are largely established around the historic configuration of estate.
It is also widely known that prior to the 1970s when much of the current NHS estate was established, there was no effective means of equitable resource allocation across England. It is therefore unsurprising that parts of the country that may have enjoyed inequitable investment prior to the 1970s, as set out in the map within the article, are now struggling with the reconfiguration legacy bestowed upon them.
Secondly, an alternative theory can be drawn that it is not so much the needs funding formula which is inequitable but rather the inequitable demand unrelated to need for services that is creating the geographical pattern set out on the map.
I believe that the conclusions drawn in the article are specious and would simply compound the inverse care law problem.
As ever data provides us with a rich source from which a range of conclusions may be drawn.
Dr Mike Burrows, chief executive, Salford Primary Teaching Primary Care Trust