By using age to allocate NHS funding, Lansley rewards Tory voters


8:45 am - May 24th 2012

by Unity    


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Health secretary Andrew Lansley said at a NHS Clinical Commissioners conference in April: “age is the principal determinant of health need”.

It follows from this the NHS should devote a greater proportion of its resources in areas with the largest elderly populations.

But the evidence doesn’t stack up. Furthermore, it looks like the funding is being shifted for political reasons.

I’m using two data sources here: population estimates for local authorities in England, for people over retirement age; health deprivation indices for each local authority. Both are from the Office of National Statistics’ Neighbourhood Statistics website.

If Andrew Lansley is correct, we should see a correlation between the number of elderly people living in each local authority and their health needs.

That’s the theory now lets look at the facts, starting with the comparative illness and disability ratio, which is a general measure of the prevalence of ill heath and disability for each local authority.

But the evidence does not bear this out.

This graph is far from showing a positive correlation between the size of the elderly population and the prevalence of ill health and disability.

The same goes for acute morbidity, i.e. emergency hospital admissions

We find the same pattern when we look at both the overall health deprivation index (-0.19) and the potential life years lost, which is a measure of premature mortality (-0.27).

In other words, basing NHS resource allocations on age alone is a very poor method of determining local funding levels as it.

When Clare Bambra, Professor of Public Health at Durham University, ran the numbers and looked the impact that Lansley’s age-based funding regime would have on regional NHS resource allocations, she found that the winners and losers fell into a very familiar pattern.

This will lead to a considerable shift of health care funding away from the neediest, poorer areas of the North and the inner cities and towards the least needy, most affluent and most elderly areas of the South. It also means more money for Conservative voting areas and less for Labour voting areas.

How considerable a shift? Well, based on current per capita funding allocations Bambra came up with these estimates for the impact that a shift to age-based funding would have on existing NHS regions.

Strategic HA

% gain/loss
North East

-14.9
North West

-12.0
Yorkshire & Humber

-5.8
West Midlands

-5.1
London

-0.5
East Midlands

-0.4
South West

7.4
East England

9.8
South East Coast

12.6
South Central

15.8

Age-based funding would give Kensington and Chelsea a boost in funding of around 16% while Richmond and Twickenham could expect an increase of just over 30%.

Meanwhile, Tower Hamlets would see its funding cut by 19-20%%, as would Newham and Hackney, while the worst hit areas in England would be Knowsley, Liverpool, Manchester and Stoke-on-Trent, all of which could expect to see anything from a fifth to a quarter of their current funding heading south – literally.

By using age to determine allocation of health funding, Andrew Lansley is not-so-subtly shifting money from poorer, Labour areas to richer Conservative areas, even when there’s no evidence that people in latter areas have higher health needs.

—
A longer version of this post, with methodology and details is here.

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About the author
'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
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Story Filed Under: Blog ,Conservative Party ,Health

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Reader comments


1. Martyn

Very hard to see how this funding shift will not increase existing health inequalities between richer and poorer areas. And in principle at least, that seems to be in breach of Section 4 of Lansley’s own NHS Act.

2. Paul

I agree that Lansley’s new funding ‘rationale’ is likely to be politically driven, but Unity’s post doesn’t really get to the bottom of what Lansley’s up to with his “age is the principal determinant of health need” argument (by which I take Lansley to mean health CARE need).

Lansley is in fact correct to say that age is the principal determinant of healthcare need. That’s obvious. As people approach being dead, their call on health services increases dramatically. From: a US study summary googled quickly to illustrate my this:

“From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/

What you can’t then do (unless you’re Lansley) is say that because of this normal skewing of healthcare uptake to the point when you’re nearly dead, you should skew the whole of the healthcare budget. This is because most of the healthcare budget is NOT spent on those bits of care related to people being nearly dead: the biggest part of the budget is spent on the percentage of the population which happens to need it at a point or points in their life before their nearly dead point.

For lots of people, that’s never or nearly never, but the whole point of the NHS is that those who never need it (until they’re nearly dead, and sometimes not even then) contribute anyway, so that the NHS exists if they do need it at some point.

So, just as Pickles/Shapps did with their spurious rationale re: council cuts (arguing that Manchester is loads of times better financed than Wokingham because their cash comes from central taxation rather than (notional) local tax receipts), Lansley seeks to use a fact that is true, and then extrapolate from it in a totally invalid manner. The problem is that it may be an easy sell to the papers precisely because the first part of his rationale is undeniable.

Devious bastards.

3. Tyler

The OP has convieniently forgotton that the UK population is getting older – thus whatever you do healthcare budgets will be forced to shift towards older people.

4. JC

I find it fascinating how a trend can be extracted from the points on those graphs to make any reasonable sense. The distribution of data suggests that the error involved will be enormous.

Could you explain the standard deviation and the trend to justify your conclusions?

5. steveb

3

The UK population may be getting older but age has no bearing on class and this is really about class/age.

6. the a&e charge nurse

[3] so a significant shift of health resources from deprived to more affluent regions is simply because Andy is SO concerned about oldies, is it?

Some say he is actually more worried about whatever the likes of SERCO or beardy branson tell him to worry about – and these outfits will undoubtedly configure services to winkle as much money as possible out of customers, sorry, patients.

Now just remind me, which parts of the country have the greatest spending capacity?

7. Tyler

@ 5 Steveb

Please show me the data that shows this move based on class?

As far as I can tell, even from the OP’s own data, is that it moves funding from younger people to older people.

I thought lefties were all about care for the old?

8. Shatterface

Even if you have demonstrated a correlation you haven’testablished a causal relationship between this shift in funding and electoral advantage – unless you make the automatic assumption that Tories are EVIL so everything they do is EVIL.

9. john b

Some say he is actually more worried about whatever the likes of SERCO or beardy branson tell him to worry about – and these outfits will undoubtedly configure services to winkle as much money as possible out of customers, sorry, patients.

There’s no reason why private NHS contractors would make more money out of providing healthcare to posh rich oldies. In fact, they’d probably prefer the opposite: posh rich oldies are likely to complain when they’re treated badly, so there isn’t the same scope to cut costs and grow margins.

The Tories are fundamentally a party of class warfare and gerontocracy. This plan is dedicated explicitly to gerontocracy and near-explicitly to class warfare. You don’t need to invent additional grounds for conspiracy…

10. the a&e charge nurse

[8] ‘unless you make the automatic assumption that Tories are EVIL so everything they do is EVIL’ – no, I prefer the coalitions health policies since coming into power have all been shit, and this is probably more shit – I mean, how can anybody take Andy seriously after the health and social care bill debacle?

11. the a&e charge nurse

[9] ‘There’s no reason why private NHS contractors would make more money out of providing healthcare to posh rich oldies’ – no reason, how about profit?

Just think of all those preemptive investigations and procedures that will be offered in the sexy new health care environment – MRI is not cheap, you know.

12. Merrymaker

I am a bit puzzled by this furore. I am long retired from the NHS, but even in my day resource allocation was always weighted towards age. As I understand it, the basic starting point is actual population numbers, then other factors (age, youngsters, mental health, chronic illness) are used to ameliorate the raw population numbers. Various areas differ as to their actual resources in comparison with the formula ( called distance from target) and are given speed of adjustment allowances. The way in which this formula is constructed and works in practice, which is in the public domain, would make it very difficult to fiddle for political reasons. However, I used to argue that the age related element of the formula can give a misleading allocation in some areas of high morbidity where people die before they get old.

13. Unity

@Paul

Unity’s post doesn’t really get to the bottom of what Lansley’s up to with his “age is the principal determinant of health need” argument

Well, no – spsce precluded taking things to that level of detail, so I thought it best to show people what the problem is and let them debate the ‘why’.

@JC

They’re scatter plots, so its the correlation coefficient (which I’ve given) and not the SD that’s meaningful here.

14. Tyler

I think what the OP is essentially trying to say is that the NHS is a Labour thing, so NHS spending should indeed go to old people, unless they happen to live in Tory areas.

Nice.

15. john b

Even if you have demonstrated a correlation you haven’testablished a causal relationship between this shift in funding and electoral advantage – unless you make the automatic assumption that Tories are EVIL so everything they do is EVIL.

Well, there are two possibilities: either they’re acting for electoral advantage, or they’re doing it because they’re so utterly stupid that they genuinely think “oldies need more healthcare, so targeting regional funds by % of oldies will provide healthcare to the people who need it most” – ie the fallacy that Unity has exposed here.

(the latter also requires them to be so utterly stupid that they’ve failed to comprehend the reports that the DoH will have given them on proposing the plan, which will say much the same thing as Unity’s article…)

16. Shatterface

Well, there are two possibilities: either they’re acting for electoral advantage, or they’re doing it because they’re so utterly stupid that they genuinely think “oldies need more healthcare, so targeting regional funds by % of oldies will provide healthcare to the people who need it most” – ie the fallacy that Unity has exposed here.

That may by the fallacy Unity is exposing but the heading and the entire latter half of the OP suggests the shift in funding is intended to reward Tory voters – which makes it a conspiracy theory rather than an argument the government has got its sums wrong.

17. Paul

@Unity

Sorry, my reply sounds more critical of the OP than I meant it. Your post does what you intended it to.

Anyway, in terms of explaining why and what Lansley (in league with other hard-right Tories in the cabinet like Pickles) are up to – a strategy of deliberate deception – I’ve now filled out my earlier comment at http://thoughcowardsflinch.com/2012/05/24/deconstructing-lansleys-hns-budget-lie/

18. john b

Shatterface: way to ignore the point. There are dozens of analysts at the DoH who would be familiar enough with the data to instantly make the the same critique Unity made. Either the government failed to run its plan past any relevant experts at all, or it ignored the results of the experts in the hope of conning the populace. It is equally culpable either way.

19. steveb

7

Show me where I said the move was based on class?

I said that it was about class/age, in fact reducing funding for healthcare for younger people is hardly about ‘caring’ is it.?

In fact all funding for social care for the elderly is being cut, this means that the working-class elderly will have to do without if they cannot fund it themselves. The worst hit are relatives caring for those with dementia, this is totally about class/age.

It’s also dishonest because all that is being done for the combined health/social care budget is robbing from Peter to pay Paul, I doubt if there is any increase in the total budget.

20. ukliberty

Either the government failed to run its plan past any relevant experts at all, or it ignored the results of the experts in the hope of conning the populace. It is equally culpable either way.

“Sufficiently advanced incompetence is indistinguishable from malice.”


Reactions: Twitter, blogs
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  4. Martin Grouch

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  58. Deconstructing Lansley’s HNS budget lie « Though Cowards Flinch

    […] has a useful post up at Liberal Conspiracy showing how Lansley’s proposals to weight NHS funding towards areas with higher percentages […]

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