Unequal access to health care in England

In the linked study (doi:10.1136/bmj.c4092), Judge and colleagues assessed the geographical and sociodemographic factors associated with variations in access to total hip and knee replacement surgery in England. They found inequity in access to both types of surgery by age, sex, deprivation, area of residence, and ethnicity.1

The 1989 report Working for Patients set out the responsibilities of health authorities.2 These included assessing the health needs of their populations and ensuring that an appropriate range of services was available to meet them. It led to the development of a new set of methods, termed health needs assessment,3 which was backed up by a substantial body of research. The process of methodological development provided a major stimulus to research into health services, and it brought together clinicians, epidemiologists, and a variety of social scientists. It led, among other things, to the publication of a multi-volume textbook that offered guidance to those commissioning health care.4

Assessing need and monitoring whether it has been met remains a core function of primary care trusts, the successors of those …