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Equitable allocation of resources for community services and social care

The NHS in England uses various formulae to share out its budget for local services of £87 billion to local areas. However, these formulae do not take into account the fact that some people are more likely than others to receive the health care they need from the NHS. This is referred to as unmet need. Unmet need may vary systematically between different kinds of people with different health conditions in different parts of the country. If so, the NHS formulae will be biased against areas with higher unmet needs. Better measurement of unmet need would lead to a fairer allocation of NHS resources in proportion to need and potentially also to improved health and reduced health inequalities.

In this research, we will measure unmet need in two main ways. First, we will seek to enhance the current formulae based on existing patterns of health care utilisation. For example, we will make better adjustments for the fact that some population groups (e.g certain ethnic groups) have lower than expected levels of utilisation. Second, we will adopt a more radical “epidemiological” approach. Using high-quality nationally representative survey data alongside, linked primary and secondary we will estimate how many people there are in each CCG who have a chronic health condition but have not been diagnosed or received treatment. We will estimate how much it would cost to treat these people and propose an adjustment to the formula that would allow CCGs to more effectively diagnose and treat these people. Finally, we will work out how making this adjustment will affect overall levels of health in each CCG and differences in health between more and less socially disadvantaged populations.

The research will outline a number of different ways to change how NHS resources are shared out between places to better meet people’s needs. We will also produce a tool that local NHS planners can use to identify groups of people who are not currently getting the health care they need, and the benefits and costs of addressing this problem so that they can redesign services to be more responsive to the needs of the populations they serve.


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