Cancer Post Code Lottery

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25-Nov-2007 - DoH Data on Cancer Care

Revealed: 

Huge postcode lottery in funding for cancer services

Huge variations in the amount spent on cancer patients in different areas of the country are revealed today in new Government data.

The new figures reveal the huge discrepancies in funding between Primary Care Trust (PCT) areas:

Each cancer sufferer in Oxfordshire receives just £5,182 a year – but cancer sufferers in Nottingham receive more than three times as much: £17,028. Across England, the average spend per cancer patient is £8,437.

The figures may help to explain both why inequalities in cancer death rates have widened since Labour came to power, and the continuing variations in access to drugs for the treatment of cancer around the country. The large variations also highlight the challenge the Government must overcome if it is to implement its forthcoming Cancer Reform Strategy.

Notes.

1. Data on the amount of funding spent by Primary Care Trusts (PCTs) on cancer patients was published as an appendix to the Department of Health’s Public Expenditure Memorandum to the Health Select Committee, late on the afternoon of Friday, 16 November. It is available: Click Here .

Source:

Department of Health, Public Expenditure on Health and Personal Social Services 2006: Memorandum containing replied to a Written Questionnaire from the Health Select Committee, 16 November 2007; available here: Click Here .

2. The data on table 8b of the appendix show the amount spent in the 2006-07 financial year by each PCT area on cancer services (the table is reproduced as an annex to this document). The table also shows the amount spent on cancer services per head of population. However, a simple per capita calculation such as this is unfair on PCTs, since it takes no account of the number of cancer patients in their respective areas.

3. Under the Quality and Outcomes Framework (QOF) of the new GP contract, GPs produce lists of patients on their registers who are suffering from cancer. When these data are aggregated to PCT level, they show the number of patients suffering from cancer in each PCT area. A list of the number of cancer patients, broken down by PCT area, was published by the Information Centre for Health and Social Care in September 2007, and is available if you: Click Here (column W)

Source:

Information Centre for Health and Social Care, PCT QOF tables 2006-07 – prevalence, 28 September 2007.

4. It is therefore possible to construct the table below, using the data on cancer spending published by the Department of Health (column B), together with the QOF data showing the number of cancer patients in each PCT area (column C). Column D shows the amount spent on each cancer patient in the 2006-07 financial year, broken down by PCT (column B divided by column C).

The table shows that:

Cancer patients in Oxfordshire received the least NHS funding in 2006-07 – on average, £5,182 per head. • Cancer patients in Nottingham received the most NHS funding in 2006-07 – on average, £17,028 per head (more than three times the amount spent in Oxfordshire). • The average cancer patient in the whole of England received an average of £8,437 per head.

Cancer Spend per PCT per Patient

(A) PCT Name (B) Total Spend on Cancer in 2006-07 (C) Number of Cancer Patients (D) Spend on Cancer per Cancer Patient
Oxfordshire PCT £31,982,000 6,172 £5,182
Dorset PCT £29,391,000 5,589 £5,259
Bedfordshire PCT £17,954,000 3,412 £5,262
Cornwall and Isles Of Scilly PCT £35,945,000 6,252 £5,749
Harrow PCT £10,696,000 1,844 £5,800
South Gloucestershire PCT £14,921,000 2,528 £5,902
Herefordshire PCT £12,715,000 2,131 £5,967
West Sussex Teaching PCT £55,264,000 9,152 £6,038
Northumberland Care Trust £22,637,000 3,706 £6,108
East Riding Of Yorkshire PCT £22,542,000 3,637 £6,198
Somerset PCT £40,042,000 6,348 £6,308
South West Essex Teaching PCT £19,411,000 3,043 £6,379
Central and Eastern Cheshire PCT £30,247,000 4,736 £6,387
Solihull Care Trust £14,841,000 2,317 £6,405
North Tyneside PCT £15,103,000 2,348 £6,432
Wiltshire PCT £30,861,000 4,776 £6,462
West Essex PCT £18,092,000 2,786 £6,494
East Sussex Downs and Weald PCT £26,565,000 4,076 £6,517
Devon PCT £54,325,000 8,233 £6,598
Ealing PCT £16,425,000 2,470 £6,650
South Staffordshire PCT £43,503,000 6,464 £6,730
Cambridgeshire PCT £40,908,000 6,046 £6,766
Suffolk PCT £42,114,000 6,199 £6,794
Bath and North East Somerset PCT £14,010,000 2,056 £6,814
Gloucestershire PCT £41,042,000 6,006 £6,833
North Yorkshire and York PCT £63,460,800 9,222 £6,881
Hillingdon PCT £14,284,000 2,045 £6,985
Shropshire County PCT £24,095,000 3,441 £7,002
Bromley PCT £23,052,000 3,231 £7,135
Luton Teaching PCT £9,506,000 1,304 £7,290
North Staffordshire PCT £14,705,000 2,009 £7,320
Redcar and Cleveland PCT £10,173,000 1,387 £7,335
Telford and Wrekin PCT £10,774,000 1,462 £7,369
West Hertfordshire PCT £36,780,000 4,983 £7,381
Isle of Wight Healthcare PCT £10,573,000 1,428 £7,404
Eastern and Coastal Kent Teaching PCT £50,933,000 6,868 £7,416
Tameside and Glossop PCT £15,746,000 2,104 £7,484
Barnsley PCT £18,379,000 2,446 £7,514
North Somerset PCT £18,303,000 2,429 £7,535
Plymouth Teaching PCT £19,639,000 2,600 £7,553
Sefton PCT £24,794,000 3,266 £7,592
Brighton and Hove City Teaching PCT £17,945,000 2,359 £7,607
South East Essex PCT £26,532,000 3,476 £7,633
Leicestershire County and Rutland PCT £50,404,000 6,602 £7,635
Bassetlaw PCT £7,956,000 1,041 £7,643
Worcestershire PCT £44,799,000 5,840 £7,671
Wirral PCT £26,332,000 3,426 £7,686
Hampshire PCT £102,922,000 13,344 £7,713
Bexley PCT £15,690,000 2,014 £7,790
Norfolk PCT £63,452,000 8,097 £7,836
East and North Hertfordshire PCT £42,040,000 5,306 £7,923
Enfield PCT £18,962,000 2,389 £7,937
Hastings and Rother PCT £16,475,000 2,053 £8,025
Southampton City PCT £15,992,000 1,990 £8,036
North Lancashire PCT £29,662,000 3,672 £8,078
Central Lancashire PCT £32,888,000 4,065 £8,091
Northamptonshire Teaching PCT £50,252,000 6,207 £8,096
Milton Keynes PCT £13,408,000 1,649 £8,131
Wandsworth PCT £17,054,000 2,090 £8,160
Stoke On Trent Teaching PCT £20,254,000 2,481 £8,164
Great Yarmouth and Waveney Teaching PCT £21,070,000 2,573 £8,189
Derbyshire County PCT £56,106,000 6,791 £8,262
Kensington and Chelsea PCT £10,885,000 1,310 £8,309
Bury PCT £12,246,000 1,472 £8,319
West Cheshire PCT £22,205,847 2,650 £8,380
Westminster PCT £13,809,000 1,639 £8,425
Barnet PCT £26,131,000 3,094 £8,446
Buckinghamshire PCT £42,538,000 5,030 £8,457
Mid Essex PCT £25,215,000 2,977 £8,470
Stockton-on-Tees Teaching PCT £13,276,000 1,562 £8,499
Surrey PCT £96,043,000 11,272 £8,520
West Kent PCT £53,857,000 6,316 £8,527
Portsmouth City Teaching PCT £14,956,000 1,750 £8,546
Peterborough PCT £11,080,000 1,292 £8,576
Berkshire West PCT £34,798,000 4,046 £8,601
Warrington PCT £15,167,000 1,763 £8,603
Swindon PCT £14,635,000 1,689 £8,665
South Birmingham PCT £30,331,000 3,489 £8,693
North East Essex PCT £27,786,000 3,174 £8,754
Havering PCT £19,015,000 2,170 £8,763
Dudley PCT £25,114,000 2,848 £8,818
Rotherham PCT £20,605,000 2,334 £8,828
Stockport PCT £26,139,000 2,960 £8,831
Kingston PCT £11,780,000 1,329 £8,864
Halton and St. Helens PCT £25,104,000 2,828 £8,877
Sunderland Teaching PCT £23,126,000 2,605 £8,878
Bournemouth and Poole Teaching PCT £38,140,000 4,257 £8,959
Berkshire East Teaching PCT £27,904,000 3,114 £8,961
North Lincolnshire PCT £13,829,000 1,539 £8,986
Warwickshire PCT £47,607,000 5,241 £9,084
East Lancashire PCT £31,383,000 3,429 £9,152
Lincolnshire Teaching PCT £70,882,000 7,736 £9,163
Croydon PCT £25,132,000 2,742 £9,166
Brent Teaching PCT £18,461,000 2,014 £9,166
Nottinghamshire County Teaching PCT £53,248,000 5,806 £9,171
Oldham PCT £17,114,000 1,851 £9,246
Bristol Teaching PCT £35,468,000 3,800 £9,334
Calderdale PCT £18,219,000 1,948 £9,353
Leeds PCT £68,412,000 7,285 £9,391
Derby City PCT £23,125,000 2,461 £9,397
Kirklees PCT £28,504,000 3,026 £9,420
Richmond and Twickenham PCT £12,741,000 1,344 £9,480
Torbay Care Trust £15,994,000 1,686 £9,486
Doncaster PCT £24,298,000 2,552 £9,521
Cumbria PCT £50,342,000 5,233 £9,620
Newcastle PCT £23,427,000 2,433 £9,629
Darlington PCT £8,299,000 859 £9,661
Sheffield PCT £48,417,000 4,984 £9,714
Heywood, Middleton and Rochdale PCT £16,976,000 1,747 £9,717
Liverpool PCT £42,922,000 4,397 £9,762
Sutton and Merton PCT £31,277,000 3,178 £9,842
Hull Teaching PCT £23,000,000 2,327 £9,884
South Tyneside PCT £17,523,000 1,771 £9,894
Walsall Teaching PCT £22,140,000 2,206 £10,036
Ashton, Leigh and Wigan PCT £26,292,000 2,615 £10,054
County Durham PCT £50,578,000 5,003 £10,110
Medway Teaching PCT £20,049,000 1,982 £10,116
Bolton PCT £23,091,000 2,279 £10,132
North East Lincolnshire PCT £14,977,000 1,475 £10,154
Haringey Teaching PCT £18,717,000 1,814 £10,318
Sandwell PCT £26,123,000 2,520 £10,366
Southwark PCT £16,164,000 1,546 £10,455
Blackpool PCT £15,523,000 1,482 £10,474
Coventry Teaching PCT £27,796,000 2,648 £10,497
Camden PCT £17,663,000 1,676 £10,539
Hartlepool PCT £8,824,000 831 £10,619
Gateshead PCT £22,045,000 2,072 £10,639
Blackburn with Darwen Teaching PCT £13,589,000 1,260 £10,785
Wolverhampton City PCT £23,883,000 2,212 £10,797
Middlesbrough PCT £13,340,000 1,232 £10,828
Waltham Forest PCT £18,202,000 1,666 £10,926
Hammersmith and Fulham PCT £13,518,000 1,225 £11,035
Lewisham PCT £19,737,000 1,768 £11,163
Bradford and Airedale Teaching PCT £42,591,000 3,805 £11,193
Birmingham East and North PCT £41,392,000 3,594 £11,517
Trafford PCT £24,813,000 2,118 £11,715
Redbridge PCT £20,122,000 1,717 £11,719
Hounslow PCT £19,571,000 1,669 £11,726
Lambeth PCT £22,844,000 1,942 £11,763
Islington PCT £16,765,000 1,401 £11,966
Barking and Dagenham PCT £13,299,000 1,102 £12,068
Greenwich Teaching PCT £18,251,000 1,488 £12,265
Wakefield District PCT £40,513,000 3,253 £12,454
Newham PCT £15,724,000 1,233 £12,753
Leicester City Teaching PCT £28,138,000 2,129 £13,217
City and Hackney Teaching PCT £20,185,000 1,471 £13,722
Salford Teaching PCT £29,196,000 2,068 £14,118
Heart of Birmingham Teaching PCT £21,593,000 1,488 £14,511
Tower Hamlets PCT £18,281,000 1,238 £14,767
Manchester PCT £52,497,000 3,500 £14,999
Knowsley PCT £22,605,000 1,344 £16,819
Nottingham City PCT £36,235,000 2,128 £17,028
ENGLAND £4,122,279,647 488,576 £8,437
5. The large variations uncovered by the data may help to explain why health inequalities have continued to widen since Labour came to power. In the same written evidence to the Health Committee, the Department of Health is asked why – given its target to reduce the gap in relative life expectancy by 10 per cent between the most deprived areas and the population as a whole – the relative gap in female life expectancy is now 7 per cent higher for females than when the target was set. In response, the Department of Health has published a table, showing that widening inequalities in cancer outcomes accounts for 19% of the widening gap in health inequalities (as determined by the relative gap in life expectancy between the most deprived areas and the population as a whole) (table 119b, page Ev 211; Department of Health, Public Expenditure on Health and Personal Social Services 2006: Memorandum containing replied to a Written Questionnaire from the Health Select Committee, 16 November 2007; available to view just: Click Here ). 6. The data may also help to explain persisting variations in access to N.I.C.E. -approved cancer drugs. In reviews conducted in both 2003 and 2005, the Department of Health’s National Cancer Director identified the Thames Valley cancer network (of which Oxfordshire is a major part) as having, “generally low usage [of ]N.I.C.E. -approved medicines) compared to other networks”. Conversely, the Greater Manchester and Cheshire Cancer Network – of which high-spending Manchester forms a part – was identified as one of a number of “generally high users” of N.I.C.E. -approved medicines. However, the evidence is not entirely conclusive: for example, the highest-spending Nottingham City PCT forms part of the Mid Trent Cancer Network, which has only average usage of N.I.C.E. -approved medicines. Source: Department of Health, Usage of cancer drugs approved by NICE, 20 September 2006; available if you: Click Here . 7. The Department of Health aims to publish the Cancer Reform Strategy by the end of the year (Department of Health, Progress on the cancer reform strategy – July update, 20 July 2007; available for perusal if you: Click Here ).

ANNEX: TABLE ON CANCER SERVICES AS SUBMITTED TO THE HEALTH SELECT COMMITTEE

Amount spent on cancer services in the 2006-07 financial year: in total; as a proportion of PCT expenditure; and per head of population.

PCT Name £ in Thousands % of Total Expenditure £ per Head of PCT's Population
Ashton, Leigh and Wigan PCT £26,292 6.18% £87
Barking and Dagenham PCT £13,299 5.78% £79
Barnet PCT £26,131 6.18% £79
Barnsley PCT £18,379 4.63% £80
Bassetlaw PCT £7,956 5.82% £74
Bath and North East Somerset PCT £14,010 6.38% £77
Bedfordshire PCT £17,954 4.05% £44
Berkshire East Teaching PCT £27,904 6.48% £74
Berkshire West PCT £34,798 7.08% £77
Bexley PCT £15,690 5.82% £75
Birmingham East and North PCT £41,392 7.74% £103
Blackburn with Darwen Teaching PCT £13,589 6.19% £91
Blackpool PCT £15,523 6.13% £110
Bolton PCT £23,091 6.44% £87
Bournemouth and Poole Teaching PCT £38,140 8.99% £118
Bradford and Airedale Teaching PCT £42,591 6.16% £87
Brent Teaching PCT £18,461 4.19% £68
Brighton and Hove City Teaching PCT £17,945 4.98% £69
Bristol Teaching PCT £35,468 6.34% £87
Bromley PCT £23,052 6.15% £75
Buckinghamshire PCT £42,538 5.94% £69
Bury PCT £12,246 5.13% £67
Calderdale PCT £18,219 6.99% £94
Cambridgeshire PCT £40,908 5.87% £70
Camden PCT £17,663 4.65% £78
Central and Eastern Cheshire PCT £30,247 5.44% £68
Central Lancashire PCT £32,888 5.43% £75
City and Hackney Teaching PCT £20,185 5.44% £89
Cornwall and Isles Of Scilly PCT £35,945 5.36% £68
County Durham PCT £50,578 6.84% £102
Coventry Teaching PCT £27,796 5.32% £87
Croydon PCT £25,132 5.93% £75
Cumbria PCT £50,342 7.33% £102
Darlington PCT £8,299 5.84% £85
Derby City PCT £23,125 6.53% £85
Derbyshire County PCT £56,106 6.21% £82
Devon PCT £54,325 5.79% £75
Doncaster PCT £24,298 5.59% £83
Dorset PCT £29,391 5.94% £76
Dudley PCT £25,114 6.20% £83
Ealing PCT £16,425 3.64% £52
East and North Hertfordshire PCT £42,040 6.83% £77
East Lancashire PCT £31,383 5.75% £85
East Riding Of Yorkshire PCT £22,542 6.34% £75
East Sussex Downs and Weald PCT £26,565 6.02% £82
Eastern and Coastal Kent Teaching PCT £50,933 5.55% £71
Enfield PCT £18,962 5.23% £71
Gateshead PCT £22,045 7.24% £114
Gloucestershire PCT £41,042 5.88% £71
Great Yarmouth and Waveney Teaching PCT £21,070 7.31% £96
Greenwich Teaching PCT £18,251 5.26% £77
Halton and St. Helens PCT £25,104 5.50% £84
Hammersmith and Fulham PCT £13,518 4.84% £77
Hampshire PCT £102,922 7.31% £82
Haringey Teaching PCT £18,717 5.50% £80
Harrow PCT £10,696 4.27% £54
Hartlepool PCT £8,824 6.44% £98
Hastings and Rother PCT £16,475 6.46% £96
Havering PCT £19,015 5.83% £80
Heart of Birmingham Teaching PCT £21,593 4.96% £76
Herefordshire PCT £12,715 5.51% £72
Heywood, Middleton and Rochdale PCT £16,976 5.71% £83
Hillingdon PCT £14,284 4.63% £59
Hounslow PCT £19,571 6.42% £90
Hull Teaching PCT £23,000 5.91% £86
Isle of Wight Healthcare PCT £10,573 5.31% £75
Islington PCT £16,765 4.79% £91
Kensington and Chelsea PCT £10,885 4.27% £53
Kingston PCT £11,780 5.78% £70
Kirklees PCT £28,504 5.69% £74
Knowsley PCT £22,605 9.05% £152
Lambeth PCT £22,844 4.79% £82
Leeds PCT £68,412 6.89% £94
Leicester City Teaching PCT £28,138 6.62% £94
Leicestershire County and Rutland PCT £50,404 6.68% £79
Lewisham PCT £19,737 4.78% £80
Lincolnshire Teaching PCT £70,882 8.29% £101
Liverpool PCT £42,922 5.46% £95
Luton Teaching PCT £9,506 4.24% £52
Manchester PCT £52,497 6.57% £112
Medway Teaching PCT £20,049 6.37% £74
Mid Essex PCT £25,215 6.19% £72
Middlesbrough PCT £13,340 5.32% £94
Milton Keynes PCT £13,408 5.06% £59
Newcastle PCT £23,427 5.73% £91
Newham PCT £15,724 3.72% £60
Norfolk PCT £63,452 6.89% £89
North East Essex PCT £27,786 6.92% £91
North East Lincolnshire PCT £14,977 7.04% £92
North Lancashire PCT £29,662 6.56% £92
North Lincolnshire PCT £13,829 6.73% £89
North Somerset PCT £18,303 7.51% £95
North Staffordshire PCT £14,705 5.59% £72
North Tyneside PCT £15,103 5.13% £76
North Yorkshire and York PCT £63,461 6.78% £83
Northamptonshire Teaching PCT £50,252 6.47% £79
Northumberland Care Trust £22,637 4.07% £73
Nottingham City PCT £36,235 8.79% £125
Nottinghamshire County Teaching PCT £53,248 6.67% £85
Oldham PCT £17,114 5.42% £78
Oxfordshire PCT £31,982 5.75% £65
Peterborough PCT £11,080 4.37% £74
Plymouth Teaching PCT £19,639 5.62% £79
Portsmouth City Teaching PCT £14,956 5.66% £82
Redbridge PCT £20,122 7.09% £88
Redcar and Cleveland PCT £10,173 5.85% £79
Richmond and Twickenham PCT £12,741 6.08% £68
Rotherham PCT £20,605 5.76% £85
Salford Teaching PCT £29,196 7.82% £134
Sandwell PCT £26,123 5.91% £88
Sefton PCT £24,794 5.90% £91
Sheffield PCT £48,417 6.39% £93
Shropshire County PCT £24,095 6.85% £84
Solihull Care Trust £14,841 5.42% £74
Somerset PCT £40,042 6.22% £78
South Birmingham PCT £30,331 5.66% £89
South East Essex PCT £26,532 6.26% £80
South Gloucestershire PCT £14,921 5.23% £62
South Staffordshire PCT £43,503 6.25% £75
South Tyneside PCT £17,523 7.55% £117
South West Essex Teaching PCT £19,411 4.04% £50
Southampton City PCT £15,992 5.22% £67
Southwark PCT £16,164 3.87% £68
Stockport PCT £26,139 6.98% £93
Stockton-on-Tees Teaching PCT £13,276 5.55% £71
Stoke On Trent Teaching PCT £20,254 5.14% £80
Suffolk PCT £42,114 6.10% £72
Sunderland Teaching PCT £23,126 5.48% £84
Surrey PCT £96,043 7.20% £91
Sutton and Merton PCT £31,277 6.77% £85
Swindon PCT £14,635 6.37% £78
Tameside and Glossop PCT £15,746 4.98% £70
Telford and Wrekin PCT £10,774 5.47% £66
Torbay Care Trust £15,994 6.65% £114
Tower Hamlets PCT £18,281 5.13% £86
Trafford PCT £24,813 8.84% £117
Wakefield District PCT £40,513 8.58% £122
Walsall Teaching PCT £22,140 6.12% £90
Waltham Forest PCT £18,202 5.70% £80
Wandsworth PCT £17,054 4.22% £63
Warrington PCT £15,167 6.04% £79
Warwickshire PCT £47,607 7.26% £91
West Cheshire PCT £22,206 6.35% £91
West Essex PCT £18,092 5.15% £70
West Hertfordshire PCT £36,780 5.91% £68
West Kent PCT £53,857 7.20% £83
West Sussex Teaching PCT £55,264 5.55% £72
Westminster PCT £13,809 3.93% £56
Wiltshire PCT £30,861 5.97% £69
Wirral PCT £26,332 5.49% £84
Wolverhampton City PCT £23,883 6.92% £100
Worcestershire PCT £44,799 6.45% £82
ENGLAND £4,122,280 6.07% £82
Source:Department of Health, Public Expenditure on Health and Personal Social Services 2006: Memorandum containing replied to a Written Questionnaire from: The Health Select Committee, 16 November 2007 (annex); which can be viewed if you: Click Here To view the original of this article + tabulation Click Here
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