By Richard Caulfield, Chief Executive, Voluntary Sector North West

I have a habit of bringing out old blogs as they become relevant again and now it is time to revisit my Redistribution of Health blog from July 2012.

At that time I was bemoaning the desire of government to implement the Advisory Council of Resource Allocation (ACRA) formula on public health funding to the settlements that local authorities would receive. The fear of that formula has not come true in public health as yet but in a dangerous twist, discussions about implementing the formula are now taking place with Clinical Commissioning Groups (CCGs).

The formula was initially developed (I believe) to address what the government perceived as anomalies in how health funding was distributed and a need to move to a ‘demand’ led approach to health care planning. This means essentially moving money to areas with ageing populations and away from those areas with greatest poverty (that may be a crude interpretation!).

Have a look at this table and see if you read what I read. Liverpool is perceived as having £50m too much spent by the CCG and Sefton £30m – the total ‘over target’ for Merseyside is £111m. When it comes to Manchester, the city itself looks like a big loser with over £40m over target which is outweighed by ‘under target’ areas across Greater Manchester. Lancashire is strange as Blackburn appears to be a big winner whilst the outlook for East Lancs seems terrible.

A quick glance at the figures for the North West overall looks like we are something over £140m above target – about the same as Thames Valley is under target. It seems the North alarmingly is £722m overfunded and any implementation of these funding targets could be disastrous, not just for health services and tackling health inequality but for the entire Northern economy.

There is no suggestion that the government are about to implement these changes in full but they might and if they do the timescale it is done over is crucially important. They also might use this formula to justify not giving increases to areas where they are seen as over funded as resources become available.

Education is going through a process of ‘ironing out’ what is considered spending anomalies and the government has stated the maximum cut that any school could receive in one year. It may be that the government is happy to do that, but the impact across the North West and the North as a whole could be huge.

The difference this year though is that the decision to move to a new formula and the pace of move to it is now an operational one belonging to NHS England. I cannot for the life of me believe that it will help NHS England in its aims of tackling health inequalities. The review terms of reference makes reference to the equality duties and one hopes it includes an Equality Impact Assessment on any changes being made. This has to be top of the list of questions.

I am aware that some in the health system are already briefing MPs and I heard a chief executive of a major provider describe these as the most pernicious attack on NHS services ever. The voluntary and community sector would undoubtedly see cuts in those areas where funding would need to be reduced to meet the formula, putting even more services at risk than at present. In the North West, we need to be joining forces with allies within the health system and local government to ensure these changes are not implemented.

It is worth raising this issue at our Health & Wellbeing Boards and voicing your concern with your CCG to see what they have to say at present and seeing if you can make joint representation. Voluntary Sector North West (VSNW) will raise awareness and concern where we can. This might include Local Enterprise Partnerships as I can’t see that taking such huge sums out of areas like Merseyside will help them deliver the growth in the economy they need!

Should there be any move to implement the formula, VSNW would expect:

  • A full Equality Impact Assessment to be undertaken
  • Reassessment of the formula by increasing the weighting based on poverty
  • A minimum funding guarantee – as they did with schools – which will guarantee that no CCG will receive a ‘cut’ of greater than 1% in real terms in any year: this feels like a least worse option right now!

The fact that some of the region may benefit significantly from these potential changes cannot mask the dangers this poses for our most vulnerable communities and we must not allow this thinking to go unchallenged. Surely a government committed to fairness and a NHS committed to tackling health inequalities can see that – can’t they?

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