Top health officials face questioning by health select committee

BMJ 2008; 336 doi: (Published 20 March 2008) Cite this as: BMJ 2008;336:633
  1. Adrian O’Dowd
  1. 1Margate

    Less than half of England is on track to meet government targets to reduce health inequalities, MPs have been told.

    Across the country only 41% of local government areas (which tie in with primary care trusts (PCTs)) are expected to meet the national strategy targets of reducing inequalities in health outcomes by 10% by 2010.

    Department of Health officials confirmed the figure when giving evidence to the parliamentary health select committee as part of the first evidence session of the committee’s inquiry into health inequalities.

    The session took place on the same day that the department published its third update report of its Tackling Inequalities: A Programme for Action, a strategy it published in 2003 (see News doi: 10.1136/bmj.39521.428657.DB).

    MPs on the committee asked how confident the department was of meeting the targets. Fiona Adshead, deputy chief medical officer, giving evidence, said, “It is too early for any of us to know whether we are going to be meeting those targets, but we have tried to constantly refine the way we are tackling things at a local level through toolkits and also getting more timely data.”

    The committee’s inquiry is looking at the extent to which the NHS can help to achieve a reduction in health inequalities, particularly through primary care and public health services.

    Howard Stoate, Labour MP for Dartford and a GP, said, “Although life expectancy is improving for everybody, the gap is, if anything, widening between manual and non-manual workers over the last 60 years. Why isn’t it getting better?”

    Dr Adshead replied: “There are a broad range of reasons for that, some of which are socioeconomic reasons captured in the Tackling Inequalities report. Some of them are [because] we are not doing the things we know we should do systematically and on a scale that would work.”

    The health department was talking to trusts and local authorities about simple interventions such as getting people to stop smoking, she said.

    Fellow witness Mark Britnell, director general for commissioning and system management at the health department, said that PCTs were likely to improve how they dealt with inequality as they became more established.

    “PCTs now have a good investment platform on which they can plan over the next three to five years. PCTs will get better at long term health investment planning.”

    When asked which three policies had been most successful in reducing health inequalities in the past 10 years, Dr Adshead cited government action on child poverty; tobacco control and smoke free legislation; and efforts made with the food industry on more accurate labelling and on production of healthier food with lower sugar, salt, and fat content.

    Concerning the quality and outcomes framework (QOF) that GPs have to work under, the MPs asked whether PCTs should have the power to vary the QOF according to local circumstances, as some critics argue that it is much easier to hit targets in more affluent areas.

    Mr Britnell said, “There is an argument for making sure you have good national evidence that is consistently applied. However, in parts of the contract, in terms of access and responsiveness, it may well be a good thing for PCTs to have more local discretion about what works.”

    The inquiry continues.

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