Examining inequalities in the provision of elective surgical and diagnostic procedures

Newcastle University requires access to NHS England data for the purpose of the following research project: Impact of patient choice in inequality in surgical and diagnostic procedures.

The following is a summary of the aims of the research project provided by Newcastle University:

"Newcastle University seek to examine the impact of patient choice in the NHS in both secondary care as choice of provider and in primary care as choice of GP. Following the NHS Plan in 2000, providers of health care services have expanded rapidly through the commercial contracting of NHS services. In 2003, privately owned independent sector treatment centres (ISTCs) were commissioned to treat NHS patients, focussing on high–volume elective surgical procedures and this was further expanded in 2005 and later repackaged as ‘free choice’ agenda, allowing any private provider of healthcare to provide elective care to any NHS patient provided they had registered with the relevant body. The 2012 Health and Social Care Act, has made commercial tendering of NHS contracts almost compulsory.

"Also, as a result of the 2012 Act, the General Practice Choice Policy was introduced and since 05 January 2015 has allowed NHS patients to choose to register with a GP despite living outside the practice’s boundary area marking a change from the traditional place based method of organising GP practice lists. The aim of the scheme is to enhance convenience for patients who, for example, may choose to register with a GP near their work rather than their home and to improve the quality of access for patients to GP services. What is not known is the potential for destabilising of general practices with innovations, exploiting the new freedoms, as funding follows patients and local GPs are left with increasing proportions of older, sicker patients. The British Medical Association fear a widening of inequalities where the “choice” for many patients will be determined by their health, wealth and age leading to a destabilisation of practices through the loss of “commuter patients” disadvantaging the “frail, old or poor".

"Aim

The research will address the following specific research questions:

1. Since the introduction of patient choice of general practitioner (GP) in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

2. Since the introduction of patient choice of provider in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

3. Have any changes in the measures in 1 and 2 above of treatment access and quality occurred equally with respect to age, sex and socio-economic deprivation and what is the effect of different provider types (acute NHS trusts; foundation NHS hospital trusts; Independent Sector treatment Centres (ISTCs); and other private providers) on equality by these measures?

"To examine the impact patient choice has had on inequality in access and NHS provision, Newcastle University require data on NHS funded elective surgical and diagnostic procedures (specifically relating to cataracts, hip replacements, knee replacements, inguinal hernia, cholecystectomy and arthroscopy, plus all readmissions within 30 days of these procedures). Newcastle University researchers will analyse this pseudonymised data and report numbers, trends and rates of provision by both the NHS and private sector. The researchers will examine the impact increasing private provision of NHS care has had on inequality by gender, age and socio-economic deprivation. HES admitted care data is required for use in this “Examining inequalities in the provision of elective surgical and diagnostic procedures” study."

The level of data is pseudonymised.

The data is minimised as follows

· Limited to a study cohort identified by NHS England as meeting the following criteria: All patients between 1997-2019 who had any of the following 6 treatments: Cataracts, Hip Replacements, Knee Replacements, Inguinal Hernia, cholecystectomy, or arthroscopy

· Limited to conditions relevant to the study identified by specific ICD or OPCS codes: Cataracts, Hip Replacements, Knee Replacements, Inguinal Hernia, cholecystectomy, and arthroscopy

Organisations

The study is a research project carried out by researchers at Newcastle University. Newcastle University are the sole data controller for the study and will also process the data. The work will follow on from previous work investigating service changes and effects on inequality of access for NHS funded treatment in Scotland and England. All data access will be through Newcastle University.

Newcastle University work with a number of clinicians from the NHS in Scotland, England and nationally in the fields of orthopaedics and ophthalmology who have collaborated in writing papers derived from the analysis. None of these clinicians have access to record level data, and Newcastle University have only shared results with them.

Why are Newcastle University undertaking this work?

The 2012 Health and Social Care Act established a duty on the Secretary of State for Health to “have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.” The research proposed here will analyse whether this duty is being fulfilled in the context of UK government health policy driving NHS reform and patients’ ability to access NHS treatment equitably. This work follows on from previous work on investigating equality of access in the context of service changes and was instigated by the researchers themselves.

The lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller.

The lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Health inequalities are a major public health issue. It is important that any measures taken to reduce the large waiting lists now in existence following Covid are such that they do not lead to a worsening of already existent health inequalities among the public.

Funding

The funding is provided by Newcastle University. The funding is specifically for the study described. Funding is in place until the end date of the study.

As detailed above, the Secretary of State for Health has a duty to have due regard to reducing inequalities in a patient’s experience of using the NHS in England. This research will provide the government with evidence of the effects of health policy on patient choice of GP and provider on patient’s ability to access treatment equitably.

Integrated Care Boards (ICBs) in England, planners and policy makers with responsibility for ensuring equity of access to health services need to understand the impact of service changes on differing patient groups especially the vulnerable and potentially disadvantaged. Knowledge is power and the purpose of this research is to provide ICBs, planners and policy makers an understanding of the possible effects of implemented service changes, in this case patient choice both in terms of GP and provider of health care. This should enable those organisations to instigate changes locally and nationally to ameliorate any unintended consequences of service changes which are often introduced untested and may be harming patient equity.

Prior to any publication of findings, these will be fed back to NHS England. The results will be made available to local authorities, UK and devolved government ministers and opposition political parties. As well as being of interest to planners and policy makers in local government, central government and the NHS with responsibilities in the areas of public health, health care and health inequalities, Newcastle University expect the research findings to be of interest to advocacy groups and charities working on behalf of potentially disadvantaged patients. Results from this project will also be compared to those from a separate analysis from Scotland and conclusions drawn will be used to inform policy and practice debates in Scotland and England.

Newcastle University will be flexible and tailor outputs depending on findings but these are likely to include a series of ‘policy briefings’ for politicians in the UK governments, healthcare commissioners, policy makers and planners at local and national level.

An impact strategy has been developed to influence policy and practice and has been designed to ensure robust translation and communication plans. The outputs will be of the greatest value to the study's intended beneficiaries (ICBs, planners and policy makers) and other key audiences. The study team will build on existing networks and in collaboration with their non-academic partners will influence key policy and practice arenas and ensure long-term use of the research findings.

Newcastle University researchers will analyse data and publish a research report, reporting:

- Annual numbers of elective procedures, by type of procedure and provider type (acute NHS trusts, foundation NHS trusts, Independent Sector Treatment Centres and other private providers).

- Crude annual rates of elective procedures, by type of procedure and provider type.

- Standardised rates of elective procedures, by type of procedure and provider type.

- Changes in inequalities between ages, sexes and deprivation categories by type of procedure and provider type through regression modelling.

Number and rates will be reported at national and ICB level. These outputs will be made available in an academic publication such as in the British Medical Journal, accessible by academics, clinicians and the public. Data will not be used for sales and marketing purposes.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

There have so far been two publications relating to this work:

Kirkwood G, Buchan J, Pollock AM. Waiting Times for Cataract Surgery in Scotland since 2002 and the Effect of Austerity: An Interrupted Time Series Analysis. Ophthalmic Epidemiol. 2022:1-8.

Kirkwood G, Pollock AM. Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies. J R Soc Med. 2022:1410768221090672.

The following are in draft form and expect to be submitted for publication in the next six months:

Marketisation and patient choice in the NHS in England. An analysis of admissions for NHS funded elective primary hip and knee replacements.

Marketisation, patient choice and austerity in the NHS in England and Scotland. An analysis of NHS waiting times for NHS funded elective primary hip and knee replacements (and cataract) operations using interrupted time series and survival models.

Part of this work takes the form of an associated staff PhD by publication.

The findings so far as detailed in the completed and draft publications above are highlighting that inequalities in utilisation of NHS funded treatment are widening to the detriment of patients living in the poorest areas of England.

Findings have also shown how inequalities in access as measured by waiting times by socioeconomic deprivation have widened in England since 2002 when marketisation began unlike Scotland where inequalities have narrowed.

Early findings from work on the effect of the market overall in terms of waiting times suggest that the more NHS funded treatment is moved into private providers, waiting times for patients overall increase.

These findings are important for those designing pathways into NHS funded healthcare if the duties under the Health and Care Act 2022 are to be fulfilled in terms of reducing inequality between patients.

Newcastle University seek to examine the impact of patient choice in the NHS in both secondary care as choice of provider and in primary care as choice of GP. Following the NHS Plan in 2000, providers of health care services have expanded rapidly through the commercial contracting of NHS services. In 2003, privately owned independent sector treatment centres (ISTCs) were commissioned to treat NHS patients, focussing on high–volume elective surgical procedures and this was further expanded in 2005 and later repackaged as ‘free choice’ agenda, allowing any private provider of healthcare to provide elective care to any NHS patient provided they had registered with the relevant body. The 2012 Health and Social Care Act, has made commercial tendering of NHS contracts almost compulsory.

Also, as a result of the 2012 Act, the General Practice Choice Policy was introduced and since 05 January 2015 has allowed NHS patients to choose to register with a GP despite living outside the practice’s boundary area marking a change from the traditional place based method of organising GP practice lists. The aim of the scheme is to enhance convenience for patients who, for example, may choose to register with a GP near their work rather than their home and to improve the quality of access for patients to GP services. What is not known is the potential for destabilising of general practices with innovations, exploiting the new freedoms, as funding follows patients and local GPs are left with increasing proportions of older, sicker patients. The British Medical Association fear a widening of inequalities where the “choice” for many patients will be determined by their health, wealth and age leading to a destabilisation of practices through the loss of “commuter patients” disadvantaging the “frail, old or poor".

To examine the impact patient choice has had on inequality in access and NHS provision Newcastle University require data on NHS funded elective surgical and diagnostic procedures (specifically relating to cataracts, hip replacements, knee replacements, inguinal hernia, cholecystectomy and arthroscopy, plus all readmissions within 30 days of these procedures). Newcastle University researchers will analyse this pseudonymised data and report numbers, trends and rates of provision by both the NHS and private sector. The researchers will examine the impact increasing private provision of NHS care has had on inequality by gender, age and socio-economic deprivation. HES admitted care data is required for use in this “Examining inequalities in the provision of elective surgical and diagnostic procedures” study.

Organisations

The study is a research project carried out by researchers at Newcastle University. Newcastle University are the sole data controller for the study and will also process the data. The work will follow on from previous work investigating service changes and effects on inequality of access for NHS funded treatment in Scotland and England. All data access will be through Newcastle University.

Pulsant provide a backup data storage facility, this is a storage location for the Newcastle University servers and no Pulsant employees can access the data. This organisation is therefore not considered to be acting as a data processor for the data under this Agreement.

Why are Newcastle University undertaking this work?

The 2012 Health and Social Care Act established a duty on the Secretary of State for Health to “have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.” The research proposed here will analyse whether this duty is being fulfilled in the context of UK government health policy driving NHS reform and patients’ ability to access NHS treatment equitably. This work follows on from previous work on investigating equality of access in the context of service changes and was instigated by the researchers themselves.

Aim

The research will address the following specific research questions:

1. Since the introduction of patient choice of general practitioner (GP) in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

2. Since the introduction of patient choice of provider in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

3. Have any changes in the measures in 1 and 2 above of treatment access and quality occurred equally with respect to age, sex and socio-economic deprivation and what is the effect of different provider types (acute NHS trusts; foundation NHS hospital trusts; Independent Sector treatment Centres (ISTCs); and other private providers) on equality by these measures?

Background to the work

This project carries on from previous work analysing these issues using data from both NHS Scotland and NHS England. The two Newcastle based researchers have been working on this topic since 2007. The objectives have developed particularly to include patient choice of GP as a focus of analysis.

To carry on with this work Newcastle University require admitted patient care data from NHS Digital.

The GDPR lawful basis for Newcastle University to process this data is Article 6(1)(e) 'task in the public interest' and Article 9(2)(j) 'scientific or historical research purposes or statistical purposes'.

As detailed above, the Secretary of State for Health has a duty to have due regard to reducing inequalities in a patient’s experience of using the NHS in England. This research will provide the government with evidence of the effects of health policy on patient choice of GP and provider on patient’s ability to access treatment equitably.

CCGs in England, planners and policy makers with responsibility for ensuring equity of access to health services need to understand the impact of service changes on differing patient groups especially the vulnerable and potentially disadvantaged. Knowledge is power and the purpose of this research is to provide CCGs, planners and policy makers an understanding of the possible effects of implemented service changes, in this case patient choice both in terms of GP and provider of health care. This should enable those organisations to instigate changes locally and nationally to ameliorate any unintended consequences of service changes which are often introduced untested and may be harming patient equity.

Prior to any publication of findings, these will be fed back to NHS England. The results will be made available to local authorities, UK and devolved government ministers and opposition political parties. As well as being of interest to planners and policy makers in local government, central government and the NHS with responsibilities in the areas of public health, health care and health inequalities, Newcastle University expect the research findings to be of interest to advocacy groups and charities working on behalf of potentially disadvantaged patients. Results from this project will also be compared to those from a separate analysis from Scotland and conclusions drawn will be used to inform policy and practice debates in Scotland and England.

Newcastle University will be flexible and tailor outputs depending on findings but these are likely to include a series of ‘policy briefings’ for politicians in the UK governments and CCGs, policy makers and planners at local and national level.

An impact strategy has been developed to influence policy and practice and has been designed to ensure robust translation and communication plans. The outputs will be of the greatest value to the study's intended beneficiaries (CCGs, planners and policy makers) and other key audiences. The study team will build on existing networks and in collaboration with their non-academic partners will influence key policy and practice arenas and ensure long-term use of the research findings.

Newcastle University researchers will analyse data and publish a research report, reporting:

- Annual numbers of elective procedures, by type of procedure and provider type (acute NHS trusts, foundation NHS trusts, Independent Sector Treatment Centres and other private providers).

- Crude annual rates of elective procedures, by type of procedure and provider type.

- Standardised rates of elective procedures, by type of procedure and provider type.

- Changes in inequalities between ages, sexes and deprivation categories by type of procedure and provider type through regression modelling.

Number and rates will be reported at national and Clinical Commissioning Group level. These outputs will be made available in an academic publication such as in the British Medical Journal, accessible by academics, clinicians and the public. Data will not be used for sales and marketing purposes.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

As the study is ongoing there have been no yielded benefits to date

Introduction

Newcastle University seek to examine the impact of patient choice in the NHS in both secondary care as choice of provider and in primary care as choice of GP. Following the NHS Plan in 2000, providers of health care services have expanded rapidly through the commercial contracting of NHS services. In 2003, privately owned independent sector treatment centres (ISTCs) were commissioned to treat NHS patients, focussing on high–volume elective surgical procedures and this was further expanded in 2005 and later repackaged as ‘free choice’ agenda, allowing any private provider of healthcare to provide elective care to any NHS patient provided they had registered with the relevant body. The 2012 Health and Social Care Act, has made commercial tendering of NHS contracts almost compulsory.

Also, as a result of the 2012 Act, the General Practice Choice Policy was introduced and since 05 January 2015 has allowed NHS patients to choose to register with a GP despite living outside the practice’s boundary area marking a change from the traditional place based method of organising GP practice lists. The aim of the scheme is to enhance convenience for patients who, for example, may choose to register with a GP near their work rather than their home and to improve the quality of access for patients to GP services. What is not known is the potential for destabilising of general practices with innovations, exploiting the new freedoms, as funding follows patients and local GPs are left with increasing proportions of older, sicker patients. The British Medical Association fear a widening of inequalities where the “choice” for many patients will be determined by their health, wealth and age leading to a destabilisation of practices through the loss of “commuter patients” disadvantaging the “frail, old or poor".

To examine the impact patient choice has had on inequality in access and NHS provision Newcastle University require data on NHS funded elective surgical and diagnostic procedures (specifically relating to cataracts, hip replacements, knee replacements, inguinal hernia, cholecystectomy and arthroscopy, plus all readmissions within 30 days of these procedures). Newcastle University researchers will analyse this pseudonymised data and report numbers, trends and rates of provision by both the NHS and private sector. The researchers will examine the impact increasing private provision of NHS care has had on inequality by gender, age and socio-economic deprivation. HES admitted care data is required for use in this “Examining inequalities in the provision of elective surgical and diagnostic procedures” study.

Organisations

The study is a research project carried out by researchers at Newcastle University. The work will follow on from previous work investigating service changes and effects on inequality of access for NHS funded treatment in Scotland and England. All data access will be through Newcastle University.

Why are Newcastle University undertaking this work?

The 2012 Health and Social Care Act established a duty on the Secretary of State for Health to “have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.” The research proposed here will analyse whether this duty is being fulfilled in the context of UK government health policy driving NHS reform and patients’ ability to access NHS treatment equitably. This work follows on from previous work on investigating equality of access in the context of service changes and was instigated by the researchers themselves.

Aim

The research will address the following specific research questions:

1. Since the introduction of patient choice of general practitioner (GP) in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

2. Since the introduction of patient choice of provider in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

3. Have any changes in the measures in 1 and 2 above of treatment access and quality occurred equally with respect to age, sex and socio-economic deprivation and what is the effect of different provider types (acute NHS trusts; foundation NHS hospital trusts; Independent Sector treatment Centres (ISTCs); and other private providers) on equality by these measures?

Background to the work

This project carries on from previous work analysing these issues using data from both NHS Scotland and NHS England. The two Newcastle based researchers have been working on this topic since 2007. The objectives have developed particularly to include patient choice of GP as a focus of analysis.

To carry on with this work Newcastle University require admitted patient care data from NHS Digital.

The GDPR lawful basis for Newcastle University to process this data is Article 6(1)(e) 'task in the public interest' and Article 9(2)(j) 'scientific or historical research purposes or statistical purposes'.

Newcastle University expect analysis to be completed within eighteen months.

As detailed above, the Secretary of State for Health has a duty to have due regard to reducing inequalities in a patient’s experience of using the NHS in England. This research will provide the government with evidence of the effects of health policy on patient choice of GP and provider on patient’s ability to access treatment equitably.

CCGs in England, planners and policy makers with responsibility for ensuring equity of access to health services need to understand the impact of service changes on differing patient groups especially the vulnerable and potentially disadvantaged. Knowledge is power and the purpose of this research is to provide CCGs, planners and policy makers an understanding of the possible effects of implemented service changes, in this case patient choice both in terms of GP and provider of health care. This should enable those organisations to instigate changes locally and nationally to ameliorate any unintended consequences of service changes which are often introduced untested and may be harming patient equity.

Prior to any publication of findings, these will be fed back to NHS England. The results will be made available to local authorities, UK and devolved government ministers and opposition political parties. As well as being of interest to planners and policy makers in local government, central government and the NHS with responsibilities in the areas of public health, health care and health inequalities, Newcastle University expect the research findings to be of interest to advocacy groups and charities working on behalf of potentially disadvantaged patients. Results from this project will also be compared to those from a separate analysis from Scotland and conclusions drawn will be used to inform policy and practice debates in Scotland and England.

Newcastle University will be flexible and tailor outputs depending on findings but these are likely to include a series of ‘policy briefings’ for politicians in the UK governments and CCGs, policy makers and planners at local and national level.

An impact strategy has been developed to influence policy and practice and has been designed to ensure robust translation and communication plans. The outputs will be of the greatest value to the study's intended beneficiaries (CCGs, planners and policy makers) and other key audiences. The study team will build on existing networks and in collaboration with their non-academic partners will influence key policy and practice arenas and ensure long-term use of the research findings.

Newcastle University researchers will analyse data and publish a research report, reporting:

- Annual numbers of elective procedures, by type of procedure and provider type (acute NHS trusts, foundation NHS trusts, Independent Sector Treatment Centres and other private providers).

- Crude annual rates of elective procedures, by type of procedure and provider type.

- Standardised rates of elective procedures, by type of procedure and provider type.

- Changes in inequalities between ages, sexes and deprivation categories by type of procedure and provider type through regression modelling.

Number and rates will be reported at national and Clinical Commissioning Group level. These outputs will be made available in an academic publication such as in the British Medical Journal, accessible by academics, clinicians and the public. Data will not be used for sales and marketing purposes.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Introduction

Newcastle University seek to examine the impact of patient choice in the NHS in both secondary care as choice of provider and in primary care as choice of GP. Following the NHS Plan in 2000, providers of health care services have expanded rapidly through the commercial contracting of NHS services. In 2003, privately owned independent sector treatment centres (ISTCs) were commissioned to treat NHS patients, focussing on high–volume elective surgical procedures and this was further expanded in 2005 and later repackaged as ‘free choice’ agenda, allowing any private provider of healthcare to provide elective care to any NHS patient provided they had registered with the relevant body. The 2012 Health and Social Care Act, has made commercial tendering of NHS contracts almost compulsory.

Also, as a result of the 2012 Act, the General Practice Choice Policy was introduced and since 05 January 2015 has allowed NHS patients to choose to register with a GP despite living outside the practice’s boundary area marking a change from the traditional place based method of organising GP practice lists. The aim of the scheme is to enhance convenience for patients who, for example, may choose to register with a GP near their work rather than their home and to improve the quality of access for patients to GP services. What is not known is the potential for destabilising of general practices with innovations, exploiting the new freedoms, as funding follows patients and local GPs are left with increasing proportions of older, sicker patients. The British Medical Association fear a widening of inequalities where the “choice” for many patients will be determined by their health, wealth and age leading to a destabilisation of practices through the loss of “commuter patients” disadvantaging the “frail, old or poor".

To examine the impact patient choice has had on inequality in access and NHS provision Newcastle University require data on NHS funded elective surgical and diagnostic procedures. Newcastle University researchers will analyse this pseudonymised data and report numbers, trends and rates of provision by both the NHS and private sector. The researchers will examine the impact increasing private provision of NHS care has had on inequality by gender, age and socio-economic deprivation. HES admitted care data is required for use in this “Examining inequalities in the provision of elective surgical and diagnostic procedures” study.

Organisations

The study is a research project carried out by researchers at Newcastle University. The work will follow on from previous work investigating service changes and effects on inequality of access for NHS funded treatment in Scotland and England. All data access will be through Newcastle University.

Why are Newcastle University undertaking this work?

The 2012 Health and Social Care Act established a duty on the Secretary of State for Health to “have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.” The research proposed here will analyse whether this duty is being fulfilled in the context of UK government health policy driving NHS reform and patients’ ability to access NHS treatment equitably. This work follows on from previous work on investigating equality of access in the context of service changes and was instigated by the researchers themselves.

Aim

The research will address the following specific research questions:

1. Since the introduction of patient choice of general practitioner (GP) in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

2. Since the introduction of patient choice of provider in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?

3. Have any changes in the measures in 1 and 2 above of treatment access and quality occurred equally with respect to age, sex and socio-economic deprivation and what is the effect of different provider types (acute NHS trusts; foundation NHS hospital trusts; Independent Sector treatment Centres (ISTCs); and other private providers) on equality by these measures?

Background to the work

This project carries on from previous work analysing these issues using data from both NHS Scotland and NHS England. The two Newcastle based researchers have been working on this topic since 2007. The objectives have developed particularly to include patient choice of GP as a focus of analysis.

To carry on with this work Newcastle University require admitted patient care data from NHS Digital.

Newcastle University expect analysis to be completed within eighteen months.

As detailed above, the Secretary of State for Health has a duty to have due regard to reducing inequalities in a patient’s experience of using the NHS in England. This research will provide the government with evidence of the effects of health policy on patient choice of GP and provider on patient’s ability to access treatment equitably.

CCGs in England, planners and policy makers with responsibility for ensuring equity of access to health services need to understand the impact of service changes on differing patient groups especially the vulnerable and potentially disadvantaged. Knowledge is power and the purpose of this research is to provide them with an understanding of the possible effects of implemented service changes, in this case patient choice both in terms of GP and provider of health care. This should enable them to instigate changes locally and nationally to ameliorate any unintended consequences of service changes which are often introduced untested and may be harming patient equity.

Prior to any publication of findings, these will be fed back to NHS England. The results will be made available to local authorities, UK and devolved government ministers and opposition political parties. As well as being of interest to planners and policy makers in local government, central government and the NHS with responsibilities in the areas of public health, health care and health inequalities, Newcastle University expect the research findings to be of interest to advocacy groups and charities working on behalf of potentially disadvantaged patients. Results from this project will also be compared to those from a separate analysis from Scotland and conclusions drawn will be used to inform policy and practice debates in Scotland and England.

Newcastle University will be flexible and tailor outputs depending on findings but these are likely to include a series of ‘policy briefings’ for politicians in the UK governments and CCGs, policy makers and planners at local and national level.

An impact strategy has been developed to influence policy and practice and has been designed to ensure robust translation and communication plans. The outputs will be of the greatest value to the study's intended beneficiaries and other key audiences. The study team will build on existing networks and in collaboration with their non-academic partners will influence key policy and practice arenas and ensure long-term use of the research findings.

Newcastle University researchers will analyse data and publish a research report, reporting:

- Annual numbers of elective procedures, by type of procedure and provider type (acute NHS trusts, foundation NHS trusts, Independent Sector Treatment Centres and other private providers).

- Crude annual rates of elective procedures, by type of procedure and provider type.

- Standardised rates of elective procedures, by type of procedure and provider type.

- Changes in inequalities between ages, sexes and deprivation categories by type of procedure and provider type through regression modelling.

Number and rates will be reported at national and Clinical Commissioning Group level. These outputs will be made available in an academic publication such as in the British Medical Journal, accessible by academics, clinicians and the public. Data will not be used for sales and marketing purposes.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Yielded Benefits is not a requirement for new applications.