Volume 1

Allocation of resources to health authorities : second report / Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
1996
Catalogue details

Licence: Open Government Licence

Credit: Allocation of resources to health authorities : second report / Health Committee. Source: Wellcome Collection.

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    ——— last 20 years is much more data has become available and it is therefore possible to use relatively complex statistical techniques to disentangle the effects of supply from the effects of need and that is what we have done. ”*? Application of Needs Indices 45. Although the York team’s development of needs indices has been widely welcomed, decisions taken by the DoH as to how to utilise those indices have been the subject of controversy. In adopting the revised formula, the DoH had to decide which needs index to use for distributing funds not relating to in-patient use. The York study was based on in- patient use, but this comprises only about 45 per cent of HCHS spending. The DoH chose to disaggregate total HCHS activity into three categories: an acute sector (acute in-patients and out-patients, geriatrics, ambulance services and maternity), a psychiatric sector (psychiatric in-patients and out-patients and community services) and an other sector (mental handicap, general community services, other hospital and administrative services, and various smaller items). 46. The DoH decided to allocate 64 per cent of the total HCHS budget according to the York acute index, 12 per cent according to the York psychiatric index, and 24 per cent without a needs weighting. This contrasts with the previous system of allocation, under which the “square root of under-75 SMRs’ was applied to the entire HCHS budget. We deal in a later section with the debate about the ‘zero-weighted 24 per cent’. The 64:12:24 split reflects existing HCHS spending on the relevant sectors, and the DoH has told us the proportions of the split will be changed annually as necessary to reflect changes in the pattern of spending. The Choice of Variables 47. The York team adopted the following variables within their two needs indices: General and acute index Standardised limiting long-standing illness ratio for persons under 75 Standardised mortality ratio for persons under 75 Proportion of economically active who are unemployed Proportion of pensionable age who are living alone Proportion of dependants in single-carer households oRO0op Psychiatric index Standardised mortality ratio for persons under 75 Proportion of pensionable age who are living alone Proportion of persons in lone-parent households Proportion of dependants in no-carer households Proportion of adult population permanently sick Proportion born in New Commonwealth.>! moaocce 48. In oral evidence members of the York team were questioned as to why they had chosen these particular variables. Their response was that they had considered many others, such as tenure of home ownership and private rented accommodation, the standards of amenities in households, car ownership, ethnic origin, the extent to which the population included students, the extent of migration within an area and a variety of social-class variables. They found that many of these variables were highly correlated: unemployed people were more likely to be living in overcrowded housing, and so forth.2 The variables finally chosen were those found to be the best predictors of need: a a eh So on EN Pi ipon Sigce we took our original evidence in this inquiry, the proportions of the split have been changed to 5! Ey p109. 2s Q9-10; see also Ev p3.