Written by Mike Birtwistle on 14 July 2009
The priorities of every local NHS organisation in England have been uncovered for the first time in a report published by us this week, giving a unique insight in to the Department of Health’s World Class Commissioning process. The report shows that major health issues are not being prioritised by all Primary Care Trusts (PCTs).
In some cases PCTs have chosen not to focus on the big health issues facing their local population, such as Hull, which has the highest adult population of smokers, with 40.9% (Alan Johnson’s constituency the former Secretary of State for Health) yet it hasn’t prioritised reducing smoking rates.
The recommendations made in the report are now being considered at senior levels in the Department of Health and has been quoted in this Department of Health report.
Key findings from the report have revealed that the NHS is predominantly focused on reducing the number of heavy smokers and drinkers:
- Smoking 104 of England’s 152 Primary Care Trusts (68%) the organisations charged with locally leading the NHS have identified reducing smoking rates as one of their key priorities. However, a number of PCTs with high smoking populations have ignored this, including Hull, which has the highest rates of smoking in the country, at 40.9% of the adult population smokers.
- Alcohol nearly half of England’s PCTs (49%) are focused on reducing the number of hospital admissions caused by alcohol. However, the list excludes a number of PCTs which have high rates of hospital admissions due to behavioural disorders of alcohol, including Hampshire, which had the fifth highest number of admissions in the country in 2007-08 for such disorders.
- Obesity the majority of PCTs are not focusing on childhood obesity, despite the fact that the condition is set to cost the country almost £50 billion by 2050, when half the population is projected to be obese. A number of PCTs with the highest proportion of obese children at year 6 did not identify childhood obesity as a priority, including Hartlepool, which has the third highest prevalence (25.6%) of obesity in year 6-age children in the country.
- Teenage pregnancy 53 of England’s 152 PCTs (35%) are prioritising reducing teenage pregnancy rates, although a number with high teenage pregnancy rates chose not to prioritise this, including Halton and St Helen’s PCT, which has the highest teenage pregnancy rate in the country (70.3 per 1000 female population aged 15-17).
- Healthcare associated infections only 31 of England’s 152 PCTs (20%) are focused on reducing Clostridium difficile infection rates even though the NHS has been set a target to reduce these infection rates by 30% by 2011 (compared to 2007-08).
- End-of-life care almost half of PCTs are focused on delivering better services for people at the end of their life, following the publication of the Department of Health’s end-of-life care strategy last year.
- Dentistry just 19 of England’s 152 PCTs (13%) are focused on delivering improved access to dentistry on the NHS, even though it is a priority and despite Health Secretary Andy Burnham declaring last month that NHS dentistry, œis an area of unfinished business.
- Drugs just one in twenty PCTs treating drug addiction as a priority in their area.
This report provides the first ever comprehensive national map of the issues which local NHS organisations care about most. NHS bodies have embraced the prevention agenda with enthusiasm, addressing key public health issues such as smoking and alcohol. However there are still concerning inconsistencies in how NHS priorities are being translated into local action.
As the health service enters a period of relative austerity, now is the time for the Department of Health to consider how key national objectives can best be implemented.
Key numbers:
- 152: Number of PCTs in England
- 54: Number of nationally determined indicators PCT’s can choose from
- 5-8: Number of indicators PCTs can select as priorities
- 0-3: Number of locally defined indicators PCTs can choose