What really works?

The Audit Commission takes a rather dim view of inequalities spending in its recent bulletin, Healthy Balance. After praising some achievements, it does rather suggest that there’s not too much to show for the estimated £21 billion NHS spend in 2009/10. There’s criticism of government’s lack of consistency and excess of policy and guidance, which leaves PCTs and local authorities facing “conflicting demands.” Absence of targeted spending and precise assessment is also attacked: what is needed is “much clearer sight of what is being spent and much sharper evaluation of its impact.” The report ends by bleakly quoting the conclusions of the Marmot review: “health inequalities will remain until we tackle the inequalities in society.” Findings from a study of systematic reviews in the Journal of Epidemiology and Community Health also focus on a lack of clarity as regards the effectiveness of interventions designed to tackle the wider social determinants of health inequality.