2022 must be the year to end the NHS postcode lottery 

2022 is a pivotal year in the history of the NHS. We will see a £10 billion cash injection from the elective care recovery plan and historic reorganisation under the Health and Care Bill. 

This will not work for all patients in the country unless there is a serious plan to address this postcode lottery. 

In its report into backlogs and waiting times published on Wednesday, the Public Affairs Committee called for a ‘national plan’ to address precisely this. This was no surprise to the Medical Technology Group. Since 2019, we’ve been campaigning through our Ration WatchProgramme to expose the stark regional variation in waiting times, recovery time and access to treatment that has been evident in our health care system for decades. 

Regional variation is something that runs deep through the heart of the NHS’s devolved management structures. Too often, care quality can be affected by arbitrary decisions made in the local area by commissioners mindful of budgets.


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This results in a dramatic regional variation in waiting times, access to pain-saving and sometimes life-saving treatment. As the report stated, patients in the worst performing geographic areas were twice as likely as those in the best-performing to have been waiting more than 18 weeks for elective treatment as of September 2021. 

‘Need NHS treatment? You’re better off up North!’, we announced with similar findingsWe found these areas in the Midlands, and the South’s worst performing regions in October. 

The sardonic message of the headline is now a sensible policy of government to address the backlog. It was unveiled earlier this month by Sajid at the Royal College of Physicians. Patients who are at risk of having to wait for elective care are offered travel and accommodation.

But it shouldn’t have to be like this, and it certainly must not continue to be like this beyond this year of investment and reform. No matter where you live you should have access to the best parts of the NHS. 

NHS England is correct that different areas of the country fared worse during the pandemic. But as the committee pointed out, this doesn’t explain the variation of poor performance of different Clinical Commissioning Groups (CCGs) prior to 2020. The pandemic has been a blessing in disguise. Exacerbating Instead, it should be a solution to the problem of regional diversity. 

The Health and Care Bill will become the largest overhaul to the health system since 1948 by the end of this summer. This, alongside the £10 billion of extra funding promised by the elective recovery plan represents a golden opportunity to address the drastic regional variation in NHS performance and services. 

Under the Health and Care Bill – CCGs – responsible for services offered in a local area will be abolished and replaced by 42 Integrated Care Systems (ICSs) They will aim to provide a more collaborative approach to healthcare across Commissioners, providers and local authorities to plan and manage population health. 

Using patient data, Commissioners will be able to home in on smaller geographical areas – even neighbourhoods – and plan their health policy accordingly.

In principle these are much welcomed changes – prioritising patient need and using data technology to efficiently manage medical interventions.

However, we are also concerned about the functioning of these new ICSs. We want to know how they will be accountable. There is currently nothing in the legislation that suggests that the same structure which has led to stark regional variations in waiting times and services won’t be continued. 

Beyond the greatest reform in its history – the NHS postcode lottery could still be alive and well.

What is a national plan to eliminate this lottery in the light of this reform? First, the ICSs must be held accountable by a proper framework. Sanctions exist for underperforming ICSs through the NHS System Oversight Framework – but in consultation with our network we’ve heard this is not working effectively. If these ICSs fail to perform, there should be a stronger system of appeal that is linked to funding and legislation.

Secondly, there are concerns that the new ICS Commissioning Budget Pot will need to cover everything that the previous CCGs did. Part of the branding for the Health and Care Bill is to remove the ‘competitive aspect’ of NHS commissioning, but unless these budgets are ring-fenced around specific services it is very likely this aspect, and the subsequent restrictions on treatments and services it encourages will remain. 

Finally, patients must have a voice at ICS board. If a patient is denied treatment, they must have clear recourse to take action on where they can go and what they should do. It is not possible to bus patients across the country to the most effective ICSs in the long-term. Patients must be able and willing to hold ICSs accountable to their communities. 

The postcode lottery can be ended and a better NHS can be achieved beyond this great year for reform and investment: improving waiting times, improving commissioning and technology access, reducing backlog, reducing waiting times, increasing diagnostic capacity, and prioritizing patient needs through a robust system to accountability.

Since 2019, we have heard from patients across the country about how they feel let down by the NHS lottery postcode lottery. I believe that 2022 will be a year of progress towards a national plan that can deliver a health service that is accessible to all regardless where they live.