Observations Body Politic

Allocation of NHS resources: are some patients more equal than others?

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3362 (Published 15 May 2012) Cite this as: BMJ 2012;344:e3362

Re: Allocation of NHS resources: are some patients more equal than others?

Clear winners and losers under an age-only NHS resource allocation:

Hawkes is right to point out the dangerous implications for health inequalities of an age-only proposal for NHS resource allocation – there would certainly be winners and losers. Severing the link with deprivation will skew resources disproportionately towards areas with high utilisation and high concentrations of the elderly. This will lead to a considerable shift of health care funding away from the neediest, poorer areas of the North and the inner cities and towards the least needy, most affluent and most elderly areas of the South. It also means more money for Conservative voting areas and less for Labour voting areas.

Since Lansley’s April speech, I have been examining the possible impact of any ‘age-only’ allocation plan by recalculating the 2011-12 NHS resource allocation by English Strategic Health Authorities (SHA) and by Primary Care Trust (PCT).[1] Table 1 contrasts data for the original total target resource allocation by SHA with the results of a recalculation of the original 2011-12 data with co-efficient weightings for health-need, deprivation-related need and disability free life expectancy (DFLE) removed. It demonstrates that if such an ‘age-only’ allocation approach had been taken in 2011-12 there would have been a 14.9% loss of resource in the North East region (£265 per head) and 12.0% in the North West region (£209 per head). The regional winners under such an age-only allocation are the South East Coast with an increase of 12.6% or £188 per head and the South Central area with a gain of 15.8% amounting to £220 per head.

Table 1 also presents data showing the party political composition of the electorate at the 2010 general election. This shows that the SHA areas that would have the biggest NHS resource gains under an age-only resource allocation are those in which a higher proportion voted Conservative. Those SHAs with the biggest potential losses are those where there was more support for Labour. The final columns provide employment rates and DFLE data by SHA. These show that those areas which would gain most additional NHS spending under an age-only allocation are those with the highest employment rates (an indicator of relative affluence) and better health as measured by average DFLE.

Table 2 shows the same resource allocation data by PCT. If an age-only allocation had been done in 2011-12, some Northern PCTs would have lost in excess of £600 per head (e.g. Knowsley PCT) whilst some Southern ones would have gained in excess of £350 per head (e.g. Surrey PCT).

Taken together, this data suggests that an age-only NHS resource allocation model which ignores the important link between deprivation and health, would disproportionately benefit those areas of England that are the most healthy, the most affluent and the most likely to vote Conservative: ‘Medicine is a social science, and politics nothing but medicine at a larger scale’. [2]

Acknowledgements
Thanks to Alison Copeland and Adetayo Kasim for advice on the data analysis.

References
[1] Department of Health. 2011-12 PCT recurrent revenue allocations exposition book. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati... [accessed 5/5/12].
[2] Virchow R. Der Armenarzt Medicinische Reform. 1848. 18:125–7.

Competing interests: CB is a member of the Labour Party
17 May 2012
Clare L Bambra
Professor of Public Health Policy
Durham University
Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, TS17 6BH
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