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

The continuing divide in health status illustrates the need for a fair funding formula for the NHS. Life expectancy at birth has been used as a measure of the health status of the population of England and Wales since the 1840s. Recently published statistics from the UK Office for National Statistics show that the North-South divide in distribution of life expectancy across England continues, with people in local areas in the North generally living shorter lives than those living in the south.[1]

The figure shows life expectancy (LE) for males at birth by local authority district in England and Wales during the period 2010–12. Male life expectancy at birth was highest in East Dorset (82.9 years) and lowest in Blackpool (74.0 years). For females, life expectancy at birth was highest in Purbeck at 86.6 years and lowest in Manchester at 79.5 years. Life expectancy at birth increased across England and Wales by 1.3 years for males and 1.0 year for females between 2006–08 and 2010–12.

Life expectancy at age 65 was highest for men in Harrow, who were expected to live for an additional 20.9 years on average compared with 15.8 years for men in Manchester. For women at age 65, life expectancy was highest in Camden (23.8 years) and lowest in Blaenau Gwent (18.7 years). In 2010–12, approximately 28% of local areas in the East, 49% in the South East and 28% in the South West were in the 20% of areas with the highest male life expectancy at birth. In contrast, there was no local area in the North East and Wales in this group. A similar pattern was observed for females.

A number of factors underlie the North- South divide in life expectancy, most importantly, socio-economic factors such as deprivation and lifestyle factors such as smoking and diet. A funding formula for the NHS that targets resources at areas with poor health status is an essential component of strategies to tackle these on-going health inequalities.[2]


1. Office for National Statistics. Life expectancy at birth and at age 65 for local areas in England and Wales, 2010-12. Newport, Wales, 2013.

2. Majeed FA, Chaturvedi N, Reading R, Ben-Shlomo Y. Monitoring and promoting equity in primary and secondary care. BMJ. 1994;308:1426–1429.

Competing interests: No competing interests

28 October 2013
Azeem Majeed
Professor of Primary Care
Imperial College London
London W6 8RP