Scotland's health gap is most dramatically illustrated by the 18-year difference in life expectancy, without a disabling illness, between people in the most deprived areas and those in the wealthiest.
It has long been recognised that improvement requires extra resources to be directed where need is greatest. However, a £2 billion investment over three years has yet to make a significant difference. This is a complex problem because social factors including employment, housing conditions, education and family structure all contribute to physical health and mental wellbeing. The NHS cannot be expected to tackle these underlying causes but, in allocating money to improve health in areas of severe deprivation, it should expect to see some results.
A critical report published today by Audit Scotland provides a timely reminder that a clear focus is necessary if improvement is to be achieved.
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Health improvement is difficult to measure. The diseases and conditions associated with poor lifestyles take time to develop so recent schemes may not produce measurable positive results for a number of years. The formula for allocating funding to health boards contains an element for deprivation but, unless the additional amount is spent on services in those areas, it will do nothing to reduce inequality. At present it is not known how health boards channel this funding to areas of greatest need. However, the distribution of primary care services, including GP surgeries, across Scotland, does not show increased resources in areas with high levels of ill health. A change in payments to GPs so that medical practices in deprived areas receive additional resources would be a practical approach. Other health care professionals, such as community nurses and physiotherapists, have a vital role to play in improving health care for people with chronic conditions and should be part of the practice team.
Community planning partnerships have been set up to match service with need, but the findings suggests there is a communications gap between the NHS and local authorities in some areas. The benefits of closer working between staff from the NHS, social work and education are obvious, especially in relation to pre-school children and the elderly. Providing a wider range of services, such as social work, from community health centres could make it easier for people to gain access to the help they need.
Easier access would also be likely to increase the low uptake of universal services such as eye tests and cancer screening in deprived areas. Holding screening sessions in health centres or leasing premises to opticians, dentists and pharmacists might also begin to change attitudes.
The NHS in Scotland has recognised that some people face significant hurdles in taking responsibility for their health through lack of resources or access to services. That amounts to a diagnosis of the problem. It is clear from the Audit Scotland report that a new focus on effective treatment is urgently required.