‘Equity gap’ in health spending is £15.1m


Over £15m more had to be spent on health in the western counties last year than allocated by the Department of Health per head of population

The ‘equity gap’ in health spending in the Western Local Commissioning Group was higher last year than at any time in the last five years.

Figures released by the Health and Social Care Board (HSCB) show there was significant overspend above the western area’s ‘capitation share’.

The parts of Derry, Limavady, Tyrone and Fermanagh falling within the Western Trust area were allocated £667m (16.84%) out of £3.959billion distributed across the North in 2018/19.

Planned expenditure in the western counties, however, was £682m, which was £15.1m or 2.3 per cent more than our share based on population and age profile.

Because fewer people lived in the western counties and those that did were, on average, younger than in other parts of the North, the academic formula used to calculate allocations deemed the WLCG should have received 16.84% of the £3.959bn total.

That compared with 20.89 per cent for Belfast, 24.24 per cent for the Northern LCG, 18 per cent for the South Eastern LCG and 20.03 per cent for the Southern LCG.

Spending on health in the west has regularly outstripped ‘capitation share’ and the ‘equity gap’ has been consistently higher than elsewhere.

It has risen from £9.9m (1.8 per cent) in 2014/15; to £11.5m (2 per cent) in 2015/16; to £12.8m (2.1 per cent) in 2016/17; to £12m (1.9 per cent) in 2017/18; to £15.1m (2.3 per cent) in the last financial year.

Only in Belfast has the gap been higher and only over the past three years.

By contrast the Southern LCG’s capitation share was £793m in 2018/19 but planned expenditure stood at just £752m (-£40.7m or 5.1 per cent).

A breakdown of spending by programme of care in the west shows that the largest contributors to the equity gap were Older People’s services, Acute Services and Family and Child Care services.

For example, Acute Services - Non Emergency (£4.5m), Acute Services - Emergency (£3.7m), Maternity and Child Health (£0.9m), Family and Child Care (£3.9m), Older People (£6.8m), Mental Health (-£1.4m), Learning Disability (-£2.9m), Physical and Sensory Disability (-£2.2m), Health Promotion (£0.1m) and Primary Health and Adult Community (-£1.4m) accounted for a total equity gap of £12m in 2017/18, the last year for which a breakdown was available.

The HSCB indicates that a number of factors can contribute to the movement of equity gaps.

These can include updates to population data in the capitation formula and changes in planned expenditure.

The Department states that the capitation formula “determines the target fair shares of the available resources for hospital and community services which should be used to serve the population of each LCG.” While the west scores lower in terms of population it scores higher in terms of additional need due to deprivation and its impact on morbidity.