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Feature Data Briefing

A 7/7 NHS: what price equity?

BMJ 2016; 352 doi: (Published 26 January 2016) Cite this as: BMJ 2016;352:i404
  1. John Appleby, chief economist, The King’s Fund, London, UK
  1. jappleby{at}

What are we willing to forgo to rectify unequal outcomes between weekend and weekday admissions? And, harder still, can the NHS justify spending the money to iron out these differences, asks John Appleby

A founding principle of the NHS is equal opportunity of treatment for those in equal need. It is this principle that underlies the way the NHS global budget is allocated across the country and the setting of nationwide standards and targets, for example. And it is this principle—expressed as “equality of treatment or clinical outcome regardless of the day of the week”—that underpins government policy to move towards a seven day NHS.1 But what does it mean in practical terms? What services need to be provided and at what cost?

There are two further fundamental questions. What is the evidence that there is inequality of treatment and outcomes? And, if inequality does exist, there is the standard economist’s question: given scarce resources that could be spent on something else to benefit patients, what are we prepared to forgo (for example, the reduction of other inequalities such as those arising from geographical variations in admission rates) to rectify the inequality?

All of these …

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