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Professor Trevor Bailey of the University of Exeter led the methodological and computational development of new improved mathematical models to more fairly allocate resources, and particularly mental health resources, to GP practices in the UK within an interdisciplinary research team from the universities of Plymouth, Southampton and St Andrews. The mental health services component of NHS Practice based commissioning (PBC) introduced by the Department of Health (DoH) from 2007 onwards, deals with resource allocation for specialist healthcare for some 400,000 patients with severe mental illness. From 2009 to 2011, the team's mental health estimates, based upon the modelling efforts of Bailey, were used to set practice-level PBC budgets accounting for around £8 billion of NHS funding, the DoH describing this as a `step-change improvement' in how mental health needs are modelled.
Methods developed at the University of York for measuring NHS productivity have changed how the Office of National Statistics values the NHS in the national accounts. Our methods, which take into account improvements in the quality of care, have been incorporated into submissions to the Comprehensive Spending Reviews that determine the NHS budget and are internationally influential. Research on productivity at hospital level has influenced the tariffs set by the Department of Health for reimbursement of specialist hospital care. Research on the productivity of hospital consultants influenced the reviews of doctors' pay and rewards by the Doctors' and Dentists' Pay Review Body and the National Audit Office and formed the basis of benchmarking tools distributed for use in the NHS.
The Department of Health seeks to distribute the NHS budget to local commissioning organisations to achieve equal access for equal need and reduce health inequalities. The formula upon which it bases this distribution must be evidence-based, robust and up-to-date. We summarise four pieces of applied econometric research undertaken at the University of Manchester (UoM) and commissioned by the Department of Health that have developed the methodology for setting budgets fairly and determined the content of the formula in use in England from 2008-date. Adoption of the findings of this research by government has led to a substantial redistribution of NHS funding between areas.
This body of research, led by Plymouth University, has challenged the model used for NHS resource allocation because it does not promote `equal opportunity of access to health care for equal needs', a core principle of the NHS. The research has stimulated debate amongst policy makers on NHS resource allocation and the team's mental health estimates were used to allocate £8billion of NHS funding. The Department of Health described this as a "step-change improvement". Their research is also one of the factors which led to the end of the Four Block Model, the £29 billion formula grant at the centre of the local government finance system.
The NHS spends about £11bn annually on pharmaceuticals, of which £8bn is on branded drugs, representing about 13% and 10% respectively of available NHS resources. Research at York has been central to the public and policy debate about how branded pharmaceuticals ought to be priced and has made a material contribution to the development of government policy to introduce a value based pricing (VBP) scheme for all new pharmaceuticals. VBP has significance for the prices that the NHS pays for pharmaceuticals, access to new drugs for NHS patients, and the return that manufacturers can expect from future research and development. There is also an international impact in two respects: UK prices are estimated to influence 25% of the world market and York has contributed to a wider policy debate about international pharmaceutical pricing and the potential role of value based pricing in European, North American, South American and South East Asian health care systems.
Empirical evidence generated by UEL research has directly influenced the reform of health financing in two Indian states with total populations of 154 million through changes to provider behaviour, the organisation and use of funds, and treatment verification processes and package rates. The impacts of this work have been commended by the UK Department for International Development (DFID) and the World Bank, and attracted interest from states with similar healthcare schemes. More widely, it has helped policymakers in India and the UK recognise the importance of including high quality comprehensive primary care in India's strategic planning for universal health care, and the benefits to the UK in prioritising primary care collaboration with India.
Research at York has had a direct impact on national guidance about the use of health technologies in the NHS. It provided methods that are used to assess whether a technology is expected to be a cost-effective use of NHS resources, how uncertain this assessment is likely to be and whether additional evidence is sufficiently valuable to recommend further research to support its widespread use. It has had an impact on the technologies available in the NHS and the evidence available to support their use: improving patient outcomes; saving NHS resources and strengthening the evidence base for clinical practice. It gives an explicit signal and incentive to manufacturers; informing development decisions and the type of evidence collected. It has had an international impact on how the adequacy of evidence is judged and research is prioritised; particularly in recent reforms in the United States (US) where the principles of this value of information (VOI) analysis are informing the prioritisation of $3.8bn for `comparative effectiveness research'. It has also informed the methods used in low and middle income countries, especially national agencies in health care systems in South East Asia and South America, as well as global funding bodies.
We have achieved significant and far reaching impact in the field of public health outcomes, policy and practice. For the first time, age/sex disaggregated estimates of smoking and ex-smoking prevalence were made available for approximately 7700 electoral wards in England and around 1000 postcode sectors for Scotland. The information has influenced national tobacco control policies (e.g. the ban of smoking in enclosed public spaces in England) and has impacted on national smoking-related health inequalities by targeting delivery of cessation services where they are most needed. Findings have also informed anti-smoking campaigns led by health authorities, charities and pressure groups.
A programme of methodological research undertaken by the University of York has shaped the economic evaluation methods used by the National Institute for Health and Care Excellence (NICE) since its inception, to assess the cost-effectiveness of healthcare interventions. Therefore the methods developed by York underpin many of the healthcare decisions by NICE on which new and existing interventions and programmes should be funded and used in the NHS. The methods used by NICE have also had a major influence on the approach taken to technology assessment internationally and so York's underpinning research has had wide impact beyond the UK.
Health inequalities are recognised as a critical UK policy issue with life expectancy gaps of up to 28 years between the least and most deprived areas. This case-study demonstrates how Durham University research has led to: (a) changing health service commissioning (with County Durham and Darlington Primary Care Trust [PCT]): (b) influencing NHS funding policy (by generating Parliamentary debate); as well as (c) contributing to the development of the new public health system in England and Wales (as part of the Strategic Review of Health Inequalities in England post-2010 [Marmot Review]).