Postcode lottery fears as report reveals health inequalities

The distribution of GPs in Scotland does not reflect the higher levels of poor health and greater need in poor areas, a report has found.

Despite general improvements in the health of the nation, deep-seated inequalities remain between the least and most deprived communities, according to the Audit Scotland publication, Health inequalities in Scotland.

Men in the most deprived areas typically die 11 years earlier than those in the most affluent, and the gap is 7.5 years for women, the report found.

People in deprived areas also have higher rates of heart disease, obesity, diabetes, drug and alcohol misuse and poor mental health.

The Scottish Government takes account of deprivation when allocating funds to NHS boards and councils but it is not clear how, at local level, resources are targeted to the areas with the greatest need.

Distribution of primary care services, such as GPs, across Scotland does not fully reflect the higher levels of ill health and wider needs found in deprived areas, or the need for more preventative healthcare, Audit Scotland also found.

Meanwhile, universal services provided on the NHS, including cancer screening and eye tests, may widen health inequalities if uptake is lowest among those who would gain the greatest benefits.

The Auditor General for Scotland, Caroline Gardner, said: "Health inequalities are long-standing and entrenched in Scotland. Tackling this has been a priority for successive governments but most indicators show the problem remains substantial.

"Across the country, there are particular areas of poverty where people have higher healthcare needs. Resources should be better targeted at those who require them most."

Iain Gray, convener of Holyrood's Public Audit Committee, said: "Audit Scotland has said today that the distribution of primary care services does not always reflect the areas of greatest need, and these are issues that the Government must look at carefully if we are to reduce health inequality in Scotland.

"Within our own work on cardiology services we asked the Government why the distribution of GP services does not reflect higher levels of ill health in deprived areas.

"When the Scottish Government appears before this committee next week we will be asking what evidence it has to demonstrate that the money being spent is making a difference to reducing inequality and to explain how performance is being measured."

Peter Johnston, health and well-being spokesman for Cosla, the national association of Scottish councils, said local authorities need to make sure that all agencies work together within community planning partnerships to co-ordinate services and plan investment decisions.

"We know that there is a long, hard road ahead of us in tackling health inequalities," he said.

"But the local government community in Scotland is determined to walk that road with our partners, and we look forward to the day that our citizens have a more equal prospect of living healthy and fulfilling lives."

Labour's Jackie Baillie said the report shows that "the SNP is failing Scotland's poorest and most deprived".

She said: "Everyone knows that our health inequalities are immense but this report shows that, five years into government, the SNP's health programmes lack focus, show few outcomes, health services are located in the wrong places and tracking progress is virtually impossible.

"While the inequalities remain, whole communities of Scotland continue to suffer from poorer health and lower life expectancies. In a 21st-century Scotland, it is a disgrace that this continues to be the case."

Dr Alan McDevitt, chairman of the British Medical Association's Scottish general practitioners committee, said: "It can be difficult for patients in the most deprived communities to access health services and it is important that we use the unique relationship that GPs have with their patients and in their communities to target healthcare to those who need it most.

"GPs working in areas of high deprivation work in a particularly challenging environment and frequently see patients with multiple health needs and social problems.

"It is therefore difficult to provide the care each individual needs within the normal consultation time available, and resources to support an increase to the average consultation time for GPs would mean they can spend more time with their patients.

"Providing appropriate resources and premises would enable an extended group of health professionals such as community nurses, social work services and counsellors to provide a comprehensive range of services in familiar surroundings which could help patients access care at a time when intervention will be most effective."