BMJ 2014;348:g160 doi: 10.1136/bmj.g160 (Published 15 January 2014)
Page 1 of 2
Letters
LETTERS NHS RESOURCE ALLOCATION
Poor areas lose out most in new NHS budget allocation Ben Barr senior clinical lecturer in applied public health, David Taylor-Robinson Medical Research Council population health scientist Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
As reported in the BMJ, NHS England has included a “deprivation indicator” in the new resource allocation formula for Clinical Commissioning Groups (CCGs).1 This follows concerns about an earlier proposed version of the formula, which would have shifted resources from poor areas with the worst health to more affluent areas with better health.2 We used data provided by NHS England to consider the likely equity impact of the new formula.3 With regard to the level of overall allocation, although the total CCG programme budget will increase slightly above inflation over this period,1 taking into account the predicted increase in population,3 there will be an average cut of £8 (€9.7; $13.2) per head (authors’ calculations, available on request) in real terms.
But will these cuts hit poorest areas hardest? The figure⇓ shows that CCGs serving the most deprived populations will lose out the most. This is because the new formula gives less weight to deprived areas than the current pattern of funding. The new resource allocation is likely to increase health inequalities, despite being an improvement on the original
contested proposal. The King’s Fund recommends that resource allocation should be used to deliver policy objectives.4 It is hard to see how cutting NHS resources most from areas with the worst health will help NHS England achieve its stated objective of reducing inequalities in health.5 Competing interests: None declared. 1 2 3 4 5
Limb M. Deprivation is restored to funding formula for commissioning groups. BMJ 2013;347:f7626. (19 December.) Bambra CL. Clear winners and losers are created by age only NHS resource allocation. BMJ 2012;344:e3593. NHS England. NHS England publishes CCG funding allocations for next two years following adoption of new formula. 2013. www.england.nhs.uk/2013/12/18/ccg-fund-allocs/. Buck D, Dixon A. Improving the allocation of health resources in England. King’s Fund, 2013. www.kingsfund.org.uk/publications/improving-allocation-health-resources-england. NHS England. Promoting equality and tackling health inequalities. 2013. www.england. nhs.uk/wp-content/uploads/2013/12/brd-dec-1.pdf.
Cite this as: BMJ 2014;348:g160 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
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BMJ 2014;348:g160 doi: 10.1136/bmj.g160 (Published 15 January 2014)
Page 2 of 2
LETTERS
Figure
Change in real terms in clinical commissioning group (CCG) programme budget allocation per head between 2013 and 2015 by degree of deprivation (based on data from NHS England).3 Real terms in 2013 prices adjusted for inflation using gross domestic product deflator; fifths are five equally sized groups of CCGs based on deprivation level; NHS England estimates of registered populations
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
Letters
LETTERS NHS RESOURCE ALLOCATION
Poor areas lose out most in new NHS budget allocation Ben Barr senior clinical lecturer in applied public health, David Taylor-Robinson Medical Research Council population health scientist Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
As reported in the BMJ, NHS England has included a “deprivation indicator” in the new resource allocation formula for Clinical Commissioning Groups (CCGs).1 This follows concerns about an earlier proposed version of the formula, which would have shifted resources from poor areas with the worst health to more affluent areas with better health.2 We used data provided by NHS England to consider the likely equity impact of the new formula.3 With regard to the level of overall allocation, although the total CCG programme budget will increase slightly above inflation over this period,1 taking into account the predicted increase in population,3 there will be an average cut of £8 (€9.7; $13.2) per head (authors’ calculations, available on request) in real terms.
But will these cuts hit poorest areas hardest? The figure⇓ shows that CCGs serving the most deprived populations will lose out the most. This is because the new formula gives less weight to deprived areas than the current pattern of funding. The new resource allocation is likely to increase health inequalities, despite being an improvement on the original
contested proposal. The King’s Fund recommends that resource allocation should be used to deliver policy objectives.4 It is hard to see how cutting NHS resources most from areas with the worst health will help NHS England achieve its stated objective of reducing inequalities in health.5 Competing interests: None declared. 1 2 3 4 5
Limb M. Deprivation is restored to funding formula for commissioning groups. BMJ 2013;347:f7626. (19 December.) Bambra CL. Clear winners and losers are created by age only NHS resource allocation. BMJ 2012;344:e3593. NHS England. NHS England publishes CCG funding allocations for next two years following adoption of new formula. 2013. www.england.nhs.uk/2013/12/18/ccg-fund-allocs/. Buck D, Dixon A. Improving the allocation of health resources in England. King’s Fund, 2013. www.kingsfund.org.uk/publications/improving-allocation-health-resources-england. NHS England. Promoting equality and tackling health inequalities. 2013. www.england. nhs.uk/wp-content/uploads/2013/12/brd-dec-1.pdf.
Cite this as: BMJ 2014;348:g160 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g160 doi: 10.1136/bmj.g160 (Published 15 January 2014)
Page 2 of 2
LETTERS
Figure
Change in real terms in clinical commissioning group (CCG) programme budget allocation per head between 2013 and 2015 by degree of deprivation (based on data from NHS England).3 Real terms in 2013 prices adjusted for inflation using gross domestic product deflator; fifths are five equally sized groups of CCGs based on deprivation level; NHS England estimates of registered populations
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
