Authors' objectives: The National Health Service uses formulae based on historic patterns of service use to distribute funding locally. These formulae are adjusted using avoidable mortality rates, to account for unmet needs and address health inequalities. We do not know whether this approach accurately reflects variation in unmet need between areas.

Authors' results and conclusions: This programme of research has developed four adjustments targeting separate facets of unmet needs that can be implemented with the National Health Service resource allocation process as well as providing a tool that can be used to model the impact on health inequalities of any adjustment.

Authors' methods:  We define need for National Health Service resources as the expected expenditure required to provide all standard National Health Services from which a population can benefit. We clarify the two components required to measure need: the relevant characteristics of the population living in each area and the cost weights indicating the expected needed expenditure associated with each of these characteristics. Four public advisor workshops were conducted to support the plain English description of the aims and methods used in the National Health Service resource allocation process. These led to the production of an animation to support public understanding of National Health Service resource allocation procedures. We developed four adjustments to the current National Health Service allocation formulae to better account for unmet need using electronic health records for England from 2010 and 2018 and linked primary care, hospital and mortality data from 2008 to 2020 from the Clinical Practice Research Datalink. Limitations in the data available and a lack of coherence between adjustments for unmet need, derived from this research, indicate that a great deal of uncertainty remains. Further work is needed to enhance the availability of linked electronic health records and survey-based symptom and biomarker data to support the modelling of unmet needs.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR136080

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/published-articles/GJBB1722

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJBB1722

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk