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Research report
Evaluating effects of recent changes in NHS resource allocation policy on inequalities in amenable mortality in England, 2007–2014: time-series analysis
  1. Jonny Currie1,
  2. Maria Guzman Castillo2,
  3. Victor Adekanmbi3,
  4. Ben Barr2,
  5. Martin O’Flaherty2
  1. 1 Public Health Wales, Cardiff, UK
  2. 2 Department of Public Health, University of Liverpool, Liverpool, UK
  3. 3 Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Maria Guzman Castillo, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3BX, UK; M.Guzman-Castillo{at}liverpool.ac.uk

Abstract

Background Health investment in England post-2010 has increased at lower rates than previously, with proportionally less being allocated to deprived areas. This study seeks to explore the impact of this on inequalities in amenable mortality between local areas.

Methods We undertook a time-series analysis across 324 lower-tier local authorities in England, evaluating the impact of changes in funding allocations to health commissioners from 2007 to 2014 on spatial inequalities in age-standardised under-75 mortality rates for conditions amenable to healthcare for men and women, adjusting for trends in household income, unemployment and time-trends.

Results More deprived areas received proportionally more funding between 2007 and 2014, though the reorganisation of commissioning in 2012 stalled this. Funding increases to more deprived local areas accounted for a statistically significant reduction in inequalities in male amenable mortality between local areas of 13 deaths per 100 000 (95% CI 2.5 to 25.9). Funding changes were associated with a reduction in inequalities in female amenable mortality of 7.0 per 100,000, though this finding did not reach significance (p=0.09).

Conclusion Current National Health Service (NHS) resource allocation policy in England appears to be contributing to a convergence in health outcomes between affluent and deprived areas. However, careful surveillance is needed to evaluate whether diminished allocations to more deprived areas in recent years and reduced NHS investment as a whole is impacting adversely on inequalities between groups.

  • inequalities
  • policy
  • time-series
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/jech-2018-211141

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    Footnotes

    • Contributors JC undertook the data collection, statistical analysis and drafted and revised the manuscript. He is guarantor. MGC provided specialist statistical modelling advice and drafted and revised the paper. VA was consulted on the statistical model and drafted and revised the paper. BB initiated the project, guided the methodological approach and drafted and revised the paper. MOF oversaw the project as supervisor and drafted and revised the paper.

    • Funding BB is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Health Research and Care (CLAHRC NWC).

    • Disclaimer The NIHR had no role in the study design, data collection and analysis, decision to publish or preparation of the article. This report is independent research arising from research supported by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

    • Competing interests VA is supported by the National Centre for Population Health & Wellbeing Research (NCPHWR).

    • Patient consent Not required.

    • Ethics approval No ethical approval was necessary given data were anonymised and publicly available.

    • Provenance and peer review Not commissioned; externally peer reviewed.