Health secretary Andrew Lansley has suggested clinical commissioning group funding should take into account the age of a population rather than indices of deprivation, arguing age is the “principal determinant of health need” in an area.
From next year CCG budgets will be decided by the NHS Commissioning Board with guidance from the Advisory Committee on Resource Allocation.
Mr Lansley told the NHS Clinical Commissioners conference in London on Tuesday: “Age is the principal determinant of health need.
“What should happen – the advisory committee will do this, I won’t – the number crunching should get progressively to a greater focus on what are the actual determinants of health need.”
Answering a question from a CCG leader about whether areas without high levels of deprivation would be “penalised” by lower funding settlements, Mr Lansley said “wherever you are in the country you should broadly have resources equivalent with access to NHS services.”
Mr Lansley said: “They should be looking at what it is in your population data that is likely to give rise to a demand for NHS services - the respective burden of disease.
“What is likely to make the biggest difference, therefore? Actually it’s elderly populations who were not in substantial deprivation.”
He said some of the lowest spending on stroke and cancer services were in areas with high elderly populations such as Fylde and Eastbourne, “places where there were quite a lot of older people who weren’t poor”.
The secretary of state said council funding for public health would be based on indices of deprivation, but this would come with a “direct expectation” that the money would be spent on tackling poverty-related health need.
Mr Lansley also encouraged CCG leaders to be innovative in their approach to the tariff.
“The tariff is made for man, not man for the tariff”, he said. “If the tariff serves your purposes use it. If it doesn’t, create a different community tariff or an unbundled tariff”.
Mr Lansley said the debate around the Health Act had caused a “big burst of politics – not just party politics but politics in the health service”. However, “part of objective was to get beyond that for good”, to make the service more autonomous and directly accountable.
But Mr Lansley said the “mechanics of change” over the next six months would be more difficult than “any subsequent time” as the new NHS structures were created.
“A lot of people will be trying to live in two worlds at the same moment,” he said. “Try to do the day job while they’re trying to do the shaping of the future.”