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Published: 15/01/2004, Volume II4, No. 5888 Page 12 13

Many of the prime minister's constituents are served by a PCT with the biggest funding shortfall in the country. Ann McGauran reports

A community in the prime minister's constituency has the most underfunded health economy in the country.

Easington primary care trust, which covers five wards of Tony Blair's Sedgefield constituency, has the biggest shortfall in its funding of any PCT. Its allocation is an estimated 20.2 per cent below target this financial year.

So what has happened to government initiatives in an area with an appalling legacy of deprivation, given government statements on the importance of reducing health inequalities?

Last summer, health secretary John Reid told the NHS Confederation conference that addressing inequalities in health was one of his four key priorities.Yet Easington PCT will fall short of its funding target by£27m this financial year.

Over the next three years to 2005-06, it will be under-funded by£78m.

The target allocations reflect population numbers, standardised mortality rates and levels of deprivation. Even after a 40 per cent uplift in funding for the current three-year revenue allocation - the sixth largest uplift in England - Easington still only has 80 per cent of the target set by the Department of Health to cope with the intensity of health need.

The figures are a stark revelation of the financial distance between the geographical haves and havenots (see table), despite a reorganisation of the funding formula for PCTs in an attempt to bring allocations closer to target.

According to the 2001 census, Easington has the highest instance of long-term disability, and the 2000 index of multiple deprivation, published by the Department for the Environment, Transport and the Regions, identifies the area as the sixth most deprived in health terms in England. Its death rates from cancer and heart disease are twice the national average and it has an incidence of serious mental ill-health that is 33 per cent above average.

Easington's Labour MP John Cummings says even the shortterm needs of the area are huge, and he has pleaded for the current three-year funding round for PCTs to be reopened. But a government source told HSJ he believes this would be destabilising. In any event, Easington - with its weak community infrastructure and NHS staff shortages - could not use additional cash effectively enough to deliver benefits, he argues.

But Easington PCT chief executive Dr Roger Bolas is adamant the area would have no problem putting the money it is acknowledged to deserve to good use.He says: 'We need the brass.

The funding formula is fine and we applaud the government for being honest about the differences in health equalities.What we need is for them to be brave in moving us towards target.'

With almost half of children in Easington growing up in poverty because of unemployment, 'jobs are one of the things the NHS can provide', Dr Bolas points out. 'We haven't got enough nurses, GPs and therapists in the community.

That is where we have to spend our time and effort.'

He rejects the view that recruiting them would be difficult, even if the cash was there: 'The problem is just a shortage of money.When we put job descriptions together, we can attract the people we need.'

Dr Bolas is now looking at ways to access other central funds which have not been released yet.

Just 0.8 per cent of the DoH's 2003-04 centrally financed initiatives and special service allocations budgets would make£6m available - 'a lot of nurses and half the children's centres'.

Easington district council director of regeneration and development Janet Johnson says all the other cash for the district is so specifically earmarked that 'the loss of this [target] money cannot really be resourced from other funding schemes'.

Dr Bolas says: 'Easington needs services that are balanced between hospital, inpatient, community and primary care. If we had a three-year programme to reach the target, we could develop a system to spend the money.'