Equity and Cost Growth in Specialised Services

Equity and Cost Growth in Specialised Services
The Strategy Unit January 2021

• NHS specialised services provide care for people with complex or rare medical conditions. Treatments for these conditions are often expensive: While specialised services support a small proportion of the population, approximately one-sixth of the total NHS budget - over £19 billon - was allocated to this area in 2019/20.
• The reports published here, address two important and enduring questions about specialised services:

1. To what extent do specialised services follow patterns of need?
2. What factors are driving the rapid increase in spend on specialised services?

Oral cancer in England - Incidence, survival and mortality rates

Oral cancer in England
PHE 27 May 2020

• This report presents oral cancer data for England held by the National Cancer Registration and Analysis Service (NCRAS) and includes incidence, survival and mortality rates. It covers the period from 2012 to 2016, and the data is presented at national, regional, upper-tier and lower-tier local authority level.
• Stark inequalities in oral cancer exist between geographic areas and population groups, and there are opportunities to prevent oral cancer and to support early detection and treatment. The data in this report identifies the geographic areas and population groups most at risk to facilitate the planning of health improvement initiatives and clinical services.

Cancer Inequalities Toolkit

Cancer Inequalities Toolkit
Health London Partnership

• The Transforming Cancer Services Team (TCST) has produced a toolkit to reduce inequalities in cancer care and outcomes in London and West Essex in terms of; marginalised groups, early diagnosis, access and treatment, personalised care, and a summary of recommendations.

Racial Disparities in Total Knee Replacement Failure are not Explained by Poverty

Racial Disparities in Total Knee Replacement Failure are not Explained by Poverty
Arthritis Care Res 15 Jul 2019 doi.org/10.1002/acr.24028

• A US study of total knee replacement failure found there was a trend towards higher TKR revision risk in blacks. Poverty did not modify the relationship between race and TKR revision or failure.

National Bowel Cancer Audit Short Report – End of Life

National Bowel Cancer Audit Short Report – End of Life
HQIP 11 July 2019

• Patients are defined as approaching the ‘end of life’ when they are identified as being likely to die within 12 months. Concerns have been raised about the variation in the quality of end of life care received by patients, with several reports highlighting poor care. This short report aimed to look at patients diagnosed with colorectal cancer who were at the ‘end of life’.
• As expected, patients who did not live for more than a year from diagnosis tended to be older, have metastases, have poorer performance status, and to undergo no surgical procedure. 
• However, what was not known was that these patients had, on average, two hospital admissions with a length of stay of 18 days each and that a third spent over a month of their last year in hospital. 
• 86% of those who lived for less than one year had at least one emergency hospital admission and, if  that admission was in their last month, nearly two thirds died in hospital.
• Of concern, patients with higher levels of deprivation appear to be more likely to die within 12 months of diagnosis, despite adjustment for other factors. This suggests that there may be some inequalities in access to colorectal cancer care services.

An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.

An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.
J R Soc Med. 2019 Jun 6:141076819851701

• Analysis of data around hip arthroplasties in England found that private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% compared to an increase of 186% among patients from the least affluent areas between 2007/2008 and 2012/2013. Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. 
• Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.

Abstract

Are Angioplasty Waiting Time Inequalities Growing Again?

Are Angioplasty Waiting Time Inequalities Growing Again?
CHE Policy & Research Briefing April 2018

• This report examines angioplasty, a common heart revascularization procedure performed more than 20,000 times a year in England. 
• In the early 2000s, when waiting times were long, patients in the most income deprived fifth of neighbourhoods waited about 50% longer for non-emergency angioplasty than those in the least income deprived fifth. This gap occurred within hospitals, and was not primarily due to richer patients choosing to travel further to hospitals with shorter waiting times. 
• The gap fell to 10% by 2008 when waiting times were shortest, but started rising thereafter to around 20% by 2015 as waiting times started to grow again.

An Inquiry into Geographical Inequalities and Breast Cancer

A Mixed Picture: An Inquiry into Geographical Inequalities and Breast Cancer
The All-Party Parliamentary Group on Breast Cancer, 27 February 2018

• Evidence presented to the inquiry showed that, although there are examples of innovative and high performing services, unacceptable variations exist across the country in particular  around organisation of local services, availability of specialist diagnostic staff and inadequate collection and sharing of data.This report sets out recommendations to tackle these problems and address unwarranted geographical inequalities in breast cancer.
• There is no formal mechanism for good practice to be replicated more widely.  
• The report includes a number of case studies including
• Improving screening uptake in NHS Tower Hamlets CCG
• Sharing data in NHS Scotland
• Secondary breast cancer at The Christie NHS Foundation Trust, Manchester - nurse-led clinics for all patients with new diagnoses of secondary breast cancer.
•  Implementing the Recovery Package in Greater Manchester