Areas with worse life quality would be hit by allocation shake-up

The study, by public health academics and HSJ, also demonstrates how the areas which would lose out under the formula have on average seen local authority budgets cut by a greater amount in recent years.

NHS England has yet to decide whether and how it will implement the formula and is currently consulting with CCGs.

The first data on the quality of life of people with long term conditions – measured by a large patient reported outcome survey – was published by the Health and Social Care Information Centre on 26 September.

It is one of five headline measures in the NHS Outcomes Framework. The results show regional variation (see table).

Experts from the University of Liverpool have compared the potential affect of the revised CCG funding formula currently under consideration with performance on this key new outcome indicator.

It shows that in areas which would lose most under the proposed CCG formula, the quality of life of patients with long term conditions is on average noticeably lower. In the areas which would gain, the opposite is true.

The figure is based on an established method and questionnaire which asks patients, for example, about whether they have “problems walking about”, “problems washing or dressing myself” and feel “pain or discomfort”.

The analysis also compares the effect of the formula with another major NHS Outcomes Framework measure, the rate of life years lost to conditions considered amenable to healthcare. This measures how many people die early due to a set of conditions which could be avoided with better healthcare, including prevention. The relationship is similar, with areas with worse outcomes standing to lose.

The analysis is based on local authority areas rather than CCG areas, with the effect of the proposed CCG formula mapped to these, due to the availability of data.

Many of the areas which would lose out under the formula, which was proposed last year by the government’s independent advisory committee on resource allocation, are in the north of England.

University of Liverpool senior lecturer in applied public health Ben Barr, who carried out much of the analysis, said: “If we want to reduce inequalities in outcomes, we need to move more resources to the areas with worst outcomes.”

He called for, “allocation of resources to areas based on achieving outcomes that can then be distributed around the system based on what is going to create the best health improvement for those areas”.

NHS England last year decided against using the proposed formula, giving the reason that it “would predominantly have resulted in higher [funding] growth for those areas that already have the best health outcomes”. However, the national commissioning body is now reconsidering its position.

If it began to implement the formula it would be likely to gradually shift resources to areas whose “target” funding is higher than their current funding. The proposed formula includes no weighting towards areas which are deprived or have poor outcomes. It is based on a prediction of healthcare demand for a population.

Those in areas which would gain under the formula have said they must be funded based on their population and demand for healthcare, and that they are suffering from several years of their allocations not growing to reflect the needs of their area.