Editor's blog Thursday 11th February 2010: On health inequalities and dis-coordinated care

It's a depressing subject, is health inequality. We get worked up about it once a year, or whenever Michael Marmot publishes something, and broadly speaking, de-prioritise it the rest of the time.

Because health inequality is about wealth inequality. It connects in with Julian Tudor Hart's Inverse Care Law. It's like those ribbons or wristbands that you can get, whose colours show that you want to show that you care passionately about breast cancer, or diabetes, or mental illness. The contemporary online equivalent of these is probably signing up to a Facebook petition (another good reason to dislike Facebook - that invitation to invade your own privacy).

So Michael Marmot calls for action, and we nod sagely. We probably even feel bad about it for a few monutes.

But we don't seriously look at why the poorest people still, today, get the worst health services. We certainly don't like to consider whether our welfare culture encourages dependency, because we might not like the answer we would find. We don't even consider taxing the living shit out of highly health-damaging processed sugar, low-nutritional-value food, or factory-farmed, mechanically-recovered meat.

And if that's not depressing enough for you, then have a look at this section from the Care Quality Commission's new 'state of healthcare' report.

This is the bit on joined-up services, and it tells us that:
- just 53% of GPs said that they received discharge summaries from acute trusts in time for them to be useful, and 81% said that the details that they contained about people’s prescribed medicines were incomplete or inaccurate “all” or “most” of the time.
- While most GPs said that they provide information on patients with multiple conditions, known allergies and previous drug reactions, there was a considerable minority (14%, 11% and 24% respectively) who did not systematically do so
- 11 out of the 12 primary care trusts, with varying characteristics, that we visited had little or no reliable information on whether GPs were sending hospitals the correct information at the right time.
- In a survey of care homes, 17% had received no information about people’s infections from the hospitals that had discharged them. The information that standard NHS contracts require in a discharge summary, including information on infections, was often incomplete or missing

This is not good enough for a service that has had cash poured all over it for the past decade.