Recommendation 16

We asked DHSC if it had created a postcode lottery of support, and if people with certain conditions in some areas, would have different support to people in other areas with the same conditions.32 DHSC told us that it did everything possible to ensure that it had consistent application of the policy. NHS Digital and DHSC explained that where they saw areas that had high or low numbers of people being added, they had worked with NHS clinical directors to challenge these areas and followed some up directly.33 As a result of such work, DHSC was confident that it had not identified any systematic differences in approach, and that were there was variation, there was no indication that guidance had not been consistently applied. DHSC told us that it also worked with the Royal College of General Practitioners, who had training modules to try and ensure that there was a consistent understanding and approach in adding people to the list.34 DHSC also provided us details of NHS Digital’s analysis of the variation of 11 February 2021 which DHSC considered showed few local areas outside the normal expected range. Based on this analysis, DHSC concluded the level of variation in how local clinicians added people to the list to be acceptable. It contended that local variation in the number of people identified and added to the list could be explained by demographic variations in the English population and the “inevitable difference” in decision making arising from local clinical judgement.35 A centrally-directed system to support clinically extremely vulnerable people