Shaping how billions of pounds is spent on healthcare access across the UK

With an infectious laugh and love of being around people, a first meeting with Professor Sheena Asthana is like getting a hug and some gossip from an old friend. “You won’t believe what I said in my last Zoom meeting when I thought the camera was off!”

But behind the gregariousness is a determined and motivated woman whose research and analysis at the University of Plymouth is shaping how billions of pounds is spent on healthcare access across the UK.

A geography degree from the University of Oxford, a PhD in Community Medicine from the London School of Hygiene and Tropical Medicine and subsequent community healthcare projects in India might make it surprising, on paper, that Sheena chose to stay in the UK. But her main drive (or to use her word, ‘obsession’) has always been a strong sense of equity.

“I’m a bit of a flibbertigibbet really – I’ve worked on projects ranging from HIV and AIDs prevention among sex workers to health service utilisation and formula funding. But everyone deserves fair access to healthcare and, whatever I’m doing, that is in the front of my mind.” 

Following the birth of her five children throughout the 1990s and 2000s, Sheena shifted her research focus from India to the UK. Her defining work began at the University of Plymouth in 2001, when she questioned the resource allocation formula used by the Department of Health and Social Care to apportion money to healthcare services.

“I conducted a study on disease prevalence estimates which showed that rural and coastal areas, which were more affluent on paper, were shown to have higher levels of need than urban areas. It felt like such a counter-intuitive finding that we decided to delve further.”

She then found out about the national resource allocation formula, and smiles as she relays a contact’s explanation of its limitations: “He was a statistics professor, who told me that it was like throwing ‘eye of newt, toe of frog’ into a cauldron – you put in all the historical utilisation of services, stir it up, do the stats and expect the needs indicators to jump out.”

But her tone soon becomes more serious. “The problem with this ‘econometric’ approach is that it introduces circularity. Areas that are well funded use more services and are thus shown to have higher levels of ‘needs’ and vice versa” she says. “Most people can see that this does not give rise to ‘fair’ funding.”

After giving evidence to the Health Select Committee, Sheena managed to secure a review of the formula, but another team’s version was chosen over her suggested epidemiological approach. “Being from a post-92 university, I felt like I wasn’t taken as seriously – and in some spheres I feel like that attitude still exists. But I know the incredible research taking place here at Plymouth, and how determined I became to make a difference at a national level.”

As well as engaging in academic research, Sheena has been actively involved in external board work – which she sees as another way of making a policy difference. Roles have included being a non-executive director of the Commission for Rural Communities, the Royal Society of Public Health, the National Institute of Health and Care Excellence (NICE), Change Grow Live (a national substance use charity) and the Advisory Committee for Resource Allocation (ACRA), run by the Department of Health and Social Care.

Sheena said: “ACRA is the independent committee that informs the distribution of £100 billion of NHS funding. I’m not an economist, I offer a critique, so it’s a great place to be.” 

It was in this role that she strongly argued about the imbalance of community services funding, and influenced the redistribution £78 billion to rural and coastal areas.

Her understanding of coastal deprivation also comes first hand, having seen several young people known to her children lose their lives to suicide.

“Five kids died within a short space of time – three suicides and two in a car crash. We’ve had three suicides since. I thought, what on Earth is happening to our young people? If you’re living in London, regardless of your background, you get a bigger educational per capita funding and you’re surrounded by the world of work. Here in the South West we don’t see nearly as many opportunities so don’t get the same motivation. It can be easy for young people to feel inadequate and invisible.”

Read more: Forget about the North-South divide, children in coastal communities are being left behind

In 2020 Sheena and her husband, and research collaborator, Dr Alex Gibson gave evidence to the Education Select Committee explaining that achievement is very much based on location. “Disadvantaged pupils in London do well regarding educational outcomes, regardless of their ethnicity, whereas disadvantaged pupils in places like Blackpool or Scarborough do terribly by comparison,” she said.

For Sheena, education is the single most important determinant in health inequalities, and she explains why public health and education needs to align.

“Your psychosocial health is better with higher level of education, making you more resilient. You’re less likely to develop a ‘nothing to lose attitude’ and engage in unhealthy behaviours like smoking and substance use, and then there’s the plain old economic link – better money equals better food and housing, and you’re less likely to be depressed worrying about your job and income. I’m passionate about trying to level up education. In the South West, for example, 48% of kids go to University, compared to 64% in London – we need to balance that up.”

Her ‘obsession’ with coastal healthcare is not to say that she’s not committed to helping people in all areas. “We need to make clarification between addressing health inequalities and promoting equal access to equal need. It’s not a case of saying coasts should have all the money – it’s making sure that the people who need the healthcare access are able to get it, and it’s not dependent on a postcode lottery.” 

On a local level, she’s now Director of the Plymouth Institute of Health and Care Research at the University. “Plymouth is the largest provider of healthcare training in the South West,” she said. “And the research conducted here is just as comprehensive. We do some really brilliant work and I want the world to know about it! The University is also known for its Marine Institute and so there’s a real USP in helping to boost the welfare of coastal communities.”

With her own insight ranging from national policy to personal observations, Sheena is as passionate now as she’s ever been to make a difference – and is palpably proud that she has been able to do this through her many, varied and impactful roles.

I sometimes think that we discourage younger researchers by placing more emphasis on performance indicators than the reason – passion – they started researching in the first place. I hope my research career shows that you can take risks, produce high quality research and really enjoy the journey.