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Education And Debate

Equity in the NHS Allocating resources for health and social care in England

BMJ 1994; 308 doi: (Published 21 May 1994) Cite this as: BMJ 1994;308:1363
  1. K Judge,
  2. N Mays
  1. King's Fund Institute, London W2 4HT.
  1. Correspondence to: Dr Mays.

    The fair allocation of resources for health and social care in relation to the needs of the population in different parts of the United Kingdom has become particularly important since the implementation of the new arrangements for community care in April 1993. These depend on close collaboration between health authorities and local authority social services departments. Yet funding reaches these authorities by different means and according to different criteria. Most health authority funds come through a weighted capitation formula that overemphasises the effects of age, while family health services funding is largely not cash limited and hence demand led. Funds to local authorities for community care are being transferred from the social security budget but on a basis that partly reflects past provision of residential and nursing home care. None of these mechanisms responds to underlying needs that give rise to demands on the health and social care system as a whole, and none makes any attempt to compensate for defects in the others. The solution includes better research and a unified weighted capitation system for all sources of funding.

    Equity of access to health care on the basis of need alone remains one of the central values of the National Health Service. Since its inception the NHS has endeavoured to distribute resources across the United Kingdom on the basis of population needs.1 Most social care, however, is provided not by the NHS but by local authorities. Here again resources are distributed on the basis of need, but the criteria used are different from those used to fund NHS health care needs. Moreover, local authorities have some discretion over how much to spend on social care in the light of local priorities. Local priorities may not, however, reflect local needs. This fact, combined with the major shifts that have …

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