When the NHS was founded on 5 July 1948, it was done out of an ideal that good healthcare should be available to all, regardless of wealth. More than 65 years on, few would argue that this commitment to healthcare for all has had anything less than a profound impact upon life in Britain. But the assumption that it is meeting the needs of everyone is being challenged by more than a decade’s worth of research from a multidisciplinary team from Plymouth University.
“Most people believe we have a universal NHS, one in which everyone has equal access to care,” said Sheena Asthana, Professor of Health Policy in the School of Law, Criminology and Government. “But actually, by prioritising healthcare inequalities, economists within the Department of Health have diverted funding for healthcare away from those who need it most - the elderly.”The origin of the University’s research in this area dates back to 1999 when Sheena secured Economic and Social Research Council funding to produce estimates of coronary heart disease in English Primary Care Trusts (PCTs), and then to compare those figures with actual rates of surgical intervention (e.g. coronary artery bypass operations) obtained from hospital data and other sources.
The results revealed that although the burden of coronary heart disease tended to be highest in areas with older populations - even if those populations were relatively affluent - hospitalisation and surgical intervention rates were highest in areas with socially disadvantaged, and usually younger, populations.
“The underlying driver was that those areas suffering from urban deprivation were assumed to have a greater claim to NHS resources,” said Sheena. “The legitimate healthcare demands of, in particular, ageing populations in rural and coastal areas were not being given appropriate weight within the allocation formulae used to distribute NHS resources.”Sheena, with her colleague Dr Alex Gibson, began to scrutinise in more detail the formula that was being used to allocate budgets to different PCTs. They discovered that, in 2004-05, just 7 per cent of trusts in deprived urban areas were running a deficit, compared with 70 per cent in affluent rural areas. This, they argued, implied an underlying flaw in resource allocation and, at least in part, explained the huge variations in per capita expenditure on critical healthcare. For instance, in 2010, about £4,000 was spent on each cancer patient in Dorset, compared to £15,000 in some areas of London.