Performance against national inequality targets may tell us little about how successful primary care trusts are in dealing with local challenges, the NHS Confederation has warned MPs.

Giving evidence in front of the Commons health select committee last week, the confederation's PCT Network director David Stout said local targets were needed to tackle area-specific health inequality issues effectively.

His comments came two weeks after government officials admitted it would be "difficult" to meet the Department of Health's target to reduce inequalities in infant mortality and life expectancy at birth by 10 per cent by 2010.

Mr Stout said issues such as life expectancy could be affected significantly by population changes in an area. "The key is that targets around [life expectancy] should be set locally, agreed locally between the health service and local government," he said.

"Taking a formulaic approach might not work as well in these areas."

The committee also heard that some inequalities were not covered by the government targets.

Mr Stout cited inequalities between different ethnic groups and for people with mental health problems or learning difficulties.

He said: "There are a whole range of inequalities that the national targets don't measure, but I suspect PCTs pick up on this in local plans."

Mr Stout later told HSJ that even though PCTs would be able to use "vital signs" performance indicators to create local objectives, national targets were still necessary in order to ensure that improvements were being made in tackling health inequalities across the country.

But he added: "There must be sufficient capacity at a local level to pick up on local priorities as well as national ones and basically not overload the system with national priorities."

The Healthcare Commission, which also gave evidence to the health select committee last week, raised further questions over the way the success of strategies was measured locally. It demanded better comparative information to show whether trusts and councils were making a difference once variation in deprivation and demographics had been taken into account.

The commission added its backing to the national targets, but said that longer term goals would have encouraged more focus on younger people - with the potential to reduce pressure on NHS services in the future.

Both bodies have called for reform of aspects of the GP contract to incentivise practices to target deprived areas.

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