Analysis

Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2364 (Published 26 April 2012) Cite this as: BMJ 2012;344:e2364
  1. Allyson M Pollock, professor1,
  2. Alison Macfarlane, professor2,
  3. Sylvia Godden, honorary senior research fellow1
  1. 1Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK
  2. 2School of Health Sciences, City University London, London, UK
  1. Correspondence to: A M Pollock a.pollock{at}qmul.ac.uk
  • Accepted 19 March 2012

A shift away from area based populations in England will have severe implications for population health data, argue Allyson M Pollock, Alison Macfarlane, and Sylvia Godden

The Health and Social Care Act 2012 will replace the administrative structure of the NHS in England, currently based on the resident populations of defined geographical areas, with one that relates instead to the shifting populations of individuals registered with specific general practices at given points in time.1 This will radically change the longstanding basis for collecting data routinely about the health needs of local populations, making it difficult to monitor the effect of new legislation on the health of the population locally or nationally.2 3 We discuss some of the implications of the act for existing routine data systems and the production of routine statistics that underpin essential NHS functions, including monitoring healthcare provision and ensuring equity of access, allocation of resources, and measurement of outcomes.

Shifting data

Population based data have had a key role in public health and the development of healthcare since the mid-19th century when, as a byproduct of the introduction of death registration for legal purposes, William Farr set up systems to use death data for the “promotion of practical medicine.”4

Since the NHS was established in 1948, the secretary of state’s unifying duty to promote, secure, and provide comprehensive healthcare for the whole population of England has been delegated to regional and subregional bodies responsible for the populations of geographical areas that collectively cover the whole of England.

All public health functions and health services provided by the NHS have been organised on the principle that everyone should be included and that no individual or group of individuals can be selected for exclusion. Information and resource allocation systems are organised on the same basis. …

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