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					                        NHS POSTCODE LOTTERY

‘My baby Ellie is a victim of the NHS
postcode lottery…’
BABBLING away to her big sister, there is
nothing to suggest that Ellie Wheatley is different
to any other 11-month-old.

But while everyone else can hear her endless baby
chatter Ellie herself cannot, because she is one of
the most profoundly deaf children in the country.

A life-changing operation to be fitted with two
cochlear implants is her best hope of being able to
hear and with it to learn how to speak.

But this week her local health trust ruled that she could only have one, a decision that her
family says would be pointless given the severity of her condition.

Mum Christine Wheatley says her daughter, among the five most profoundly deaf
children born last year, is the victim of a "postcode lottery" healthcare system.

This is, Thursday 7th August, 2008

Care divides…
Mental health
Top spender Islington PCT, north London, £332 per head of population
Bottom East Riding of Yorkshire, £114 per head of population

Top spender Knowsley PCT, Merseyside, £118 per head of population
Bottom Ealing PCT, west London, £47 per head of population

Circulatory diseases
Top spender Middlesborough PCT, £167 per head of population
Bottom Southwark PCT, south-east London, £76 per head of population

The Guardian, Monday Sept. 8, 2008
What do we mean by postcode lottery?
   The postcode lottery is shorthand for seemingly random countrywide variations in
    the provision and quality of public services - the huge gap between the best and
    the rest. Where you live defines the standard of services you can expect. So if you
    live in the "wrong" area, and, in extreme cases, on the "wrong" side of a road, you
    may get a poorer service than your neighbour or you may not get the service at all
    and have to pay for it privately.
Which services are provided by the postcode lottery?
   In practice, there are geographical variations in almost all aspects of care. Recent
    examples include variations in charges for disabled people's home care; NHS
    availability of the multiple sclerosis drug, beta interferon; availability of NHS in
    vitro fertilisation services; waiting times for NHS treatment; assessment of
    children on social service "at risk" registers, access to NHS cancer screening
    programmes, and availability of drugs for Alzheimer's disease.
Who is most affected by the postcode lottery?

   Generally speaking, the poorer you are, and the more socially deprived your area,
    the worse your care and access to it is likely to be. This is known as the "inverse
    care law". Well-off Kingston and Richmond, Surrey, has 50 per cent more GPs
    than deprived Barnsley, for example. But drug prescribing, and notoriously,
    abortion services, have been capriciously dependent on the whims, and in some
    cases, religious beliefs of local doctors, regardless of postcode. And, in the
    relatively wealthy south-east, shortages of key workers such as nurses mean
    waiting times for hospital treatment are longer than in less well-off areas in the
    midlands and the north.

How did the postcode lottery come about?
   The government argues that, since its inception in 1948, there have been no
    national standards of care in the NHS. For five decades, services grew
    haphazardly: decisions on which treatments and drugs should be made available
    were made locally and on an ad-hoc basis by individual health authorities and
    powerful medical consultants. For many, the epitome of the postcode lottery was
    GP fundholding, introduced during the internal market of the 1990s. Patients of
    budget-holding family doctor practices (now replaced with primary care groups
    and primary care trusts) had faster access to hospital treatment than patients of
    non-fundholding practices, leading to a two-tier postcode lottery.
What is the government going to do about it?

   In its "new NHS" white paper of 1997, ministers promised to "renew the NHS as
    a one-nation health service". The government has since introduced measures
    designed to ensure "fair access and high standards of care across the UK". These
    include: national service frameworks, which will set national standards of care for
    key conditions and diseases, such as mental health and heart disease; the
    commission for health improvement which will monitor quality in NHS services
    and have powers to send in "hit squads" to take over failing hospitals and Nice -
    the national institute for clinical effectiveness (in Scotland, the Scottish health
    technology assessment centre), which will make NHS-wide decisions on the
    availability of expensive new drugs and treatments.
What additional information do I need?                  What impact does the postcode lottery have in my

How does the topic link to the principal learning SHD   How can I embed Functional skills and PLTS in this
diploma?                                                topic?
HIV/AIDS Facts and Figures…
‘More than 90% of respondents did not understand
how HIV is transmitted…’ (National AIDS Trust
Survey, 2007).

      The number of people with HIV is growing by
       10% per year.
      By the end of 2008 about 60 000 people will
       have been diagnosed with HIV/AIDS.
      The number of deaths from AIDS has remained
       stable at around 500 a year since the late 1990s.
      There are about 73 000 people living with HIV
       in the UK; the figure will increase to 100 000 by
       2010. One third do not know they are infected.
      In 2003, the life expectancy of someone in the
       UK diagnosed with HIV was 17 years. Now it is
       30 years and expected to grow further.
      People with access to the highly active
       antiretroviral drug treatments have a
       significantly increased life expectancy and HIV
       can be treated as a long term condition.
      With the average age of diagnosis being 33-34,
       the UK could soon have a generation of HIV
       positive pensioners.

‘There is a lot of ignorance and a lot of fear about
HIV in the heterosexual population and we are also
seeing a lot of teenagers in the service…’
(John Walsh, Imperial College Healthcare)