CCG allocations proposed to address health inequalities

29 January 2019 Seamus Ward

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Announcing the draft allocations for 2019/20 to 2023/24, the national commissioning body said every CCG will receive a cash increase of at least 17% over the five years. The draft allocations are to be put to the NHS England board on 31 January for approval.

With the formal tariff consultation launched during January, overall CCG programme cash growth is 5.7% in 2019/20. Without the increase in urgent and emergency prices and funding for the pay deal, overall CCG programme growth would have been 3.4%. Overall, core funding uplifts range from 3.6% to 15.25%.
Simon Stevens

NHS England chief executive Simon Stevens said the funding would support delivery of the NHS long-term plan.

The CCG target allocations are based on a revised funding formula that aims to tackle health inequalities.

Two of the areas with the worst rates of premature deaths, Bradford City and Blackpool CCGs, will receive the biggest percentage cash increases in their core services funding of 15.25% and 11.58%, respectively in 2019/20. Total allocations will leave Bradford 3.9% and Blackpool 4.99% under target. Twelve CCGs are more than 5% over target. Mr Stevens said around £1bn a year would be distributed according to need. ‘Tackling health inequalities in our society is not just about fairness but is a matter of hard-headed economics which will not only save lives but also save taxpayers’ money and NHS staff time,’ he added.

The two CCGs with the least growth are West London (3.6%) and Central London (Westminster) (4.65%).

An evidence review by the Nuffield Trust for the National Centre for Rural Health and Care said the allocations formula disadvantaged rural areas. Although it said the formula attempts to adjust for the higher levels of need in rural area, the trust argued these adjustments are hugely outweighed by factors that tend to move funding to urban areas – market forces and health inequalities.

The net effect was to move £600m from predominantly rural areas to urban or less rural areas, the review said.

Pace of change

To avoid destabilising the system, CCGs are moved to their target allocations over time. Over the next five years, NHS England said the CCGs most below target will receive extra growth, to ensure no area is more than 5% below target.

Additionally, a group of ‘typical’ CCGs – those between -2.5% and +5% from target in 2019/20 and between 0% and +5% for all later years – will receive as close to average growth as possible. CCGs more than 5% above target will receive lower funding growth, tapering down to floor growth levels for those more than 10% above target.

For core CCG allocations, CCGs more than 10% over target will receive average growth minus 1.5 percentage points. While this is more generous than the previous allocation round, NHS England said it reflected higher assumed price and activity growth, as well as higher policy pressures in 2019/20. For primary care, these CCGs will receive 1.25 percentage points below average growth.