NHS

Kate Allen

Last month, in advance of a report on 14 hospital trusts with relatively high death rates, it was widely reported that there had been 13,000 “unnecessary” deaths.

But, as a leading academic points out in today’s British Medical Journal, this demonstrates an epic lack of understanding of the concept of an average.

The 13,000 figure is the difference between the actual number of deaths in the 14 hospitals compared to the “expected” level. But what some writers failed to understand is that the “expected” level equated to the national average. As a result much of the coverage was seriously misleading, according to David Spiegelhalter, Winton professor for the public understanding of risk at the University of Cambridge. Read more

Sally Gainsbury

There has been speculation recently that the government is planning to divert millions of pounds in NHS funds from deprived urban areas in the north, to leafy, Conservative voting constituencies in the south.

This stems from health secretary Andrew Lansley’s recent comment that “age is the principal determinant of health need” and that distribution of the £100bn budget for the NHS in England should “get progressively to a greater focus on what are the actual determinants of health need.”

Somewhere along the line, those comments were interpreted by a generally cheesed-off medical profession that Mr Lansley intends to introduce an “age-only” NHS allocation formula, switching substantial NHS funds from, generally younger, Labour-voting constituencies in north to the octogenarians who thrive in the Conservative-voting villages of the south.

It’s a good story, which might even contain elements of the truth, but the reality, as ever, is a little more complicated.

At present, five separate allocation formulae are used to divvy up different bits of the £100bn NHS pot to different areas of England. The largest share – the hospital care budget – is divided up using one formula, while four others – mental health, GP prescribing, health inequalities (more on that in a later post) and maternity – are each allocated using their own separate formula. (Think for a second about the demographics driving the demand for maternity services as opposed to, say, hip replacements, and you will grasp why this makes sense.)

Health economists and statisticians frequently tweak and argue over these formula in order to move, hopefully, ever closer to the Holy Grail: a distribution of health resources which is fairly distributed on the basis of health need. Read more