The NHS at 70

Baroness Bottomley’s sentiment is shared by Barry McCormick, former Chief Economist at the Department of Health:

Today, the University of York’s Department of Health Sciences, CHE, along with the Centre for Reviews and Dissemination and the fast-expanding Hull York Medical School, combine to form a powerful collaborative teaching and research asset for all those who work in the NHS or need its services.

Add in the health economics teaching activities of the Department of Economics and Related Studies, providing residential and distance learning courses for decades, and York makes good claim to be the undisputed go-to place for health and healthcare research and education.

Professor Karen Bloor, who is the University’s Research Champion for Health and Wellbeing, notes that York has been instrumental in changing the way decision makers think about health and healthcare, not just in the UK but around the world.

York has also educated a global cadre of health economists, and contributed to related scholarly debate in many ways, including creating the journal Health Economics. York’s thought-leadership is to be found in many major health and NHS initiatives, Professor Bloor says, including regulating the internal market, developing GP fundholding, measuring productivity, and refining hospital performance ratings, payment systems and incentive mechanisms for hospitals.

Take the work of the University's Professor Karl Claxton. His research revealed the damage the then Prime Minister, David Cameron, was doing to the health service with his much lauded Cancer Drugs Fund for expensive new cancer treatments.

Two years later, Professor Claxton’s withering critique was vindicated by a King’s College London and the London School of Hygiene and Tropical Medicine report which concluded that less than half the drugs provided by the fund had undergone adequate clinical trials before being used, and the average median life extension they afforded was just 3.2 months. In short, it was a 'quick-fix' election promise that wasted more than a £1bn.

Professor Goddard believes it is this rigour and independence that has led to every major committee of NICE having had one or more panel members from York since it began: proof of the value placed upon York’s contribution to the delivery of more effective, efficient and equitable healthcare. No surprise then that bibliometric analysis puts York as the only UK institution in the world top ten in health economics, alongside Harvard, Stanford and Berkeley. Or that CHE’s Queen’s Anniversary Prize for Higher Education described York as “a global leader in developing new economic approaches for national healthcare systems.”

But no-one is complacent. York’s army of methodological researchers – whose specialisms include statistics, economics, trials, epidemiology, qualitative social science and psychometrics – work together to address major health problems, increasingly joining forces with fundamental scientists, as well as healthcare professionals, patients and carers, to widen and deepen our understanding of health and healthcare decision making.

Professor Richard Cookson and Professor Tim Doran, for instance, are investigating the substantial socioeconomic inequalities in both life expectancy and healthcare use in England. Their work illustrates the costs of such inequalities in both human and financial terms – there are higher rates of hospital admissions, particularly emergency admissions, in more deprived neighbourhoods, and the likely costs associated with this inequality are estimated at a staggering £4.8 billion each year. Funded by the Wellcome Trust, Professors Doran and Cookson are now developing and applying methods to ‘re-engineer’ health policy research, ensuring that we assess the equity effects of policy change and public health measures.

“This research shows how interventions to reduce inequality and improve health in more deprived areas have the potential not only to improve population health but to save money for health systems,” Professor Atkin said. Such analysis would have given Professor Maynard cause for celebration, as these methods allow analysts to evaluate health interventions in terms of their impact on the distribution of health rather than on the mythical average citizen.

As Professor Maynard said in his reflections on 2012, the year of Danny Boyle’s spectacular success with the London Olympic extravaganza and Andrew Lansley’s spectacular flop with the formation of NHS England: “When well-intentioned policymakers and managers commit scarce resources to ‘improve’ the health service, the cry must be ‘where is the evidence?' Instead of believing in un-evidenced magic solutions, let’s confuse policymakers with facts.”

York is providing the facts. Let’s hope that this time, policymakers are not confused.