The post code lottery

An odd phrase but rather apt and one that has been around for many years but it really hasn’t helped people get an answer as to whether there area has a good service or a bad one; particularly as it often depends on the service itself. It seems there are no areas where everything is good and efficient, and sadly not even each service can be said to be good or bad for everyone as the numbers of people accessing a service vary considerably throughout a year. One thing that can be seen is investment, where is the money however this has it’s own set of peculiar problems.

You may has seen this article or ones like it that say investment in mental health services has fallen for the second year running. I find it interesting as the figures quoted in their reference don’t show this to be true. In fact what it does show is that

However he may be talking about investment in 2012/2013 which is not included in this report. I do love it when people don’t put all the figures in their references. (please note this table shows what they term real increases, percentages adjusted for inflation)

Despite this I really came to this report because I was interested in what had been invested where. So further down in the report investment is broken down by SHA (strategic Health Authority)

And it shows that 5 of the SHA have decreased their investment from last however I am not satisfied that pure monetary investment necessarily helps anyone understand what is happening within the services as money could have been spent on buildings or equipment or infrastructure  in one year and will reap the benefits from this year on year. So in the next year it may be that investment appears lower despite more staff being employed or services being set up.

It also begs the question of whether it is cheaper to build or employ staff in certain areas as compared to London for instance.

This image represents levels of investment within England and Wales per weighted adult and as far as I can tell adjusts for both expense in funding facilities and the need of the area. However the report gives no clear indication of how it was done and only shows what is invested. Dark green being the highest invest per weighted head and white the lowest.

London breakdown and please note that sharing of facilities and staff in London makes it far more difficult to see where investment has been made as money for staff may come from outside a PCT’s budget but buildings may not, in real terms it’s difficult to tell who has invested what.

However investment only tells you that these places aimed to improve their services, it doesn’t tell you how or what, nor whether they have invested a great deal previously and so it’s not a good indication of whether a service is any good.

So are things improving?

Not really and the problem is far worse in some areas than others. For instance these five SHAs would certainly not be on my list of best performers

South Central (-5.3%)

London (-4.2%)

North East (-2.6%)

West Midlands (-2.0%) and

Yorkshire and the Humber (-0.5%)

However what I would really like to see is investment adjusted for inflation compared to where the greatest need is to see if the investment is going where it needs to go to help the population. As it stands the best you can tell is who is investing, and although all investment needs to be increased to meet demand, I would feel a lot happier about the spread of investment if I felt the areas most in need where actually getting more money. Sadly I am not convinced that they are.