Intended for healthcare professionals

Rapid response to:

Letters Allocation of NHS resources

Clear winners and losers are created by age only NHS resource allocation

BMJ 2012; 344 doi: (Published 22 May 2012) Cite this as: BMJ 2012;344:e3593

Rapid Response:

Re: Clear winners and losers are created by age only NHS resource allocation

Professor Bambra’s analysis of the impact of age-only resource allocation[1] written in response to Hawkes’s concerns [2] about the validity of the funding formula is pertinent but it fails to address the underlying assumption that demand for healthcare will be proportionate to need.

The inverse care law is well recognised as Tudor Hart has explained; underuse of healthcare by deprived people is a “great enemy[3]” It can be seen in the differential access to care for patients with bowel cancer according to site; patients resident in a deprived locality with colonic cancer are less likely to gain access to treatment than those with rectal cancer[4]. Perhaps this can be explained in terms of competition between patients; the patient with rectal bleeding is more competitive in the allocation of diagnostic resources than is the one with vaguer symptoms especially if the individuals concerned do not argue their case articulately. We must learn to interpret the NHS as a competition between patients for resources[5].

The consequence of this is that the resources allocated to deprived areas should not be reduced but it should be made easier for people from disadvantaged backgrounds to make use of them. Resources for more affluent areas should be increased to meet the fully-recognised needs of the articulate competitors and also to allow their less competitive deprived neighbours to have access to services.


[1] Bambra CL Clear winners and losers from age-only resource allocation. BMJ 2012; 344:e3593

[2] Hawkes N Allocation of NHS resources: are some patients more equal than others? BMJ 2012;344:e3362

[3] Tudor Hart JT Commentary: three decades of the inverse care law BMJ 2000;320:18-9.

[4] Crawford SM, Sauerzapf V, Haynes R. Social and geographical factors affecting access to treatment of colorectal cancer: cancer registry study. BMJ Open 2012;2:e000410. doi:10.1136/bmjopen-2011-000410

[5] CRAWFORD SM Personal View Competition is intrinsically wasteful. BMJ 2012;344:e3199

Competing interests: No competing interests

12 June 2012
S. Michael Crawford
Consultant Medical Oncologist
Airedale General Hospital
Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6TD