Inequalities in health : report of a research working group.

  • Great Britain. Department of Health and Social Security.
Date:
1980
Catalogue details

Licence: Open Government Licence

Credit: Inequalities in health : report of a research working group. Source: Wellcome Collection.

    430/438 (page 412)
    7. In these determinations, in addition to the considerations mentioned in paragraph 4 above, Authorities will need to bear in mind the scale of facilities required to support the. agreed student intakes for clinical teaching. This scale of provision may, in some instances and in some specialties, particularly in London, exceed that required to meet the needs of the district populations served by the hospitals. Adjustments to target allocations for cross boundary flows of hospital inpatients are designed to compensate for patient's drawn from outside the district population, but authorities may need to make use of local information to ensure that such adjustments are sufficiently sensitive. Allowance should also be made for out-patient (including commuter) flows but, in the probable absence of reliable statistics, this may need to be a matter for judgement in the light of the best information available locally. Imbalances between the levels of provision required for service and teaching purposes respectively will no doubt be subject to longer term studies by all the interests concerned as part of the strategic planning process. It is important that short term resource allocation should not seek to pre-empt longer term planning decision. 8. As noted in paragraph 4(e) above, a particular issue arises in relation to dental education, exemplifying the fact that SIFT relates to a fraction only of the total cost of teaching hospitals. At Area or district level, special allowance will need to be made for the service costs of dental hospitals which relate for the most part to work more generally undertaken not in hospitals but by family practitioners. Cost information will be available to Authorities and should be taken into account in determining allocations. Unquantified factors 9. It was implicit in the RAWP report that when it became possible to quantify objectively for formula purposes the various unquantified factors referred to above and to weight the population basis of the target calcula- tion to allow for them, existing relationships between allocations and targets of districts, Areas and Regions would be significantly altered, At regional level it is clear that the targets of the Thames Regions, for example, would be significantly higher, so that their existing allocations would appear ~ much closer to their targets than under the illustrative calculation in the second report of the Resource Allocation Working Party or the calculation underlying the 1977/78 revenue allocations to RHAs. Because targets are simply shares of the total resources available, this would mean at the other extreme that other Regions! targets would be reduced so that they also were brought closer to their existing allocations. Within Regions there would be similar effects on the relationship between targets and allocations. It would accordingly be misleading to assume that targets calculated on the basis of those factors which can at this stage be quantified represent a level of allocation at which it would be appropriate to aim. They are indications of direction of change but not indicators of the amount of change which will be necessary. This needs to be kept closely in view when decisions are taken on the pace of change. There is clearly a maximum rate at which resources can sensibly be increased or can be diminished without damage to important services and insupportable organisational strain. As the Secretary of State said in his statement of 21 December 1976, while he is determined that resources should be more fairly shared, he does not think it practicable or reasonable to seek to achieve a rapid and mechanical equalisation of resources over a period of a few years. He wishes authorities to be guided by this