Charles Tallack

Intersectional modelling in health policy: a case study on remote GP appointments and patient… Across nearly all aspects of health and health care, there are disparities between different demographic groups. These are often the result…

Intersectionality describes how demographic disadvantages can interact to amplify inequalities. But how to model this?

New from colleagues in our analysis team: a case study of GP appmts & patient experience, illustrating the MAIDHA intersectional modelling approach.

medium.com/healthfdn-da...

Those confidence intervals in full!

So sorry to hear this Sam and wishing you all the best.

You started off talking about people you know. Now you're talking about friends, which is even more prescriptive.
Do most people really know how everyone they know votes? I don't tell everyone I know!

‘Extra appointments’ celebrated by govt deliver ‘modest impact’ on waiting lists The "4.6 million extra NHS appointments" championed by the prime minister and health secretary have only had a "modest impact" on reducing waiting list clock stops, a vital part of cutting the NHS's elective care backlog, according to new analysis shared exclusively with HSJ.

Nice report, covering our analysis and more, by @jamesillman.bsky.social for @hsj.co.uk here:
www.hsj.co.uk/quality-and-...

It’s not clear why appointments are growing faster than growth in completed pathways. More diagnostic tests per pathway is a longstanding trend linked to rise in demand for diagnostic tests. But 9% growth in outpatients, when there's a drive to avoid unnecessary outpatient appointments, is puzzling.

If the ratio had been maintained at 3.9, completions pathways would have grown by 7.9% or 1.16m rather than 344,000. Under this hypothetical scenario, the waiting list would have been 820,000 smaller.

Completed pathways increased by 2.3% vs 7.9% for appointments. They haven’t risen as quickly as appointments because appointments per completed pathways has increased from 3.9 in July 23 – April 24, to 4.1 a year later.

Second – how have the extra appointments translated into completed pathways (treatments) from the waiting list?

First – is it a notable achievement? 4.6m extra appointments is an increase of 7.9% (table 1). But applying exactly the same approach to the previous year, (ie Jul 23 – Apr 24) the growth in appointments under the Conservatives was 5.5m, an increase of 10.5% (table 2).

The methodology is sound (they standardise baseline to adjust for different working days). Some might quibble that the growth is artificially inflated because of strikes in the earlier period. But there are other issues.

Statistics » Recovery of Elective Activity Statistics » Recovery of Elective Activity

4.6 million is the number of appointments between July 2024 and April 2025 in excess of the number delivered in the same period in the previous year. It’s all set out in an NHS E publication.
www.england.nhs.uk/statistics/s...

Millions more appointments as more than 2,000 extra GPs recruited Boost is part of Plan for Change to rebuild the NHS by shifting healthcare from hospitals into the community and ending the 8am scramble.

At the end of July, the government said that it had delivered 4.6 million extra appointments since it came to power, more than double its manifesto pledge of 2 million.
www.gov.uk/government/n...

If the elasticity turns out to be as HMRC estimate, the measure wouldn't raise much money (from gamblers), but it would reduce gambling, including that which causes harm?

How can the government meet its commitment to halve the gap in healthy life expectancy between regions?

Reading this excellent summary of some of the @healthfoundation.bsky.social latest analysis from @charlestallack.bsky.social would be a good place to start!

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The NHS – a Suitable Case for Treatment? - Policy Exchange Download Publication Online Reader ‘The NHS – a Suitable Case for Treatment?’ makes the case that the NHS is not fit for purpose and is in urgent need of reform.The report finds that NHS performance r...

Policy exchange, backed by Sajid Javid, think we need to switch the NHS funding model to social insurance, and introduce new charges for NHS services, like to see a GP

policyexchange.org.uk/publication/...

These are not new ideas, but they are bad ideas

A thread with some evidence

100% agree with that. The government's approach so far, and measures in the 10 year plan, place far too much emphasis on personalised prevention approaches.
These can be beneficial but won't work at the scale necessary to address the vast health inequalities

Our full report on our analysis with the ONS is here:
www.health.org.uk/reports-and-...
The ONS write-up and underlying data is here:
www.ons.gov.uk/releases/geo...

(2) reducing the link between socioeconomic factors and the proximate causes of ill health (eg smoking, alcohol, diet/obesity, physical activity). This will require both population level approaches (eg regulation of unhealthy food) and more targeted interventions (eg weight loss).

Given the importance of socioeconomic factors, narrowing the difference in healthy life expectancy between regions will require both: (1) reducing socioeconomic inequalities e.g. through regional investment and economic development; and

What does all this mean? It’s well known that socioeconomic factors are amongst the most important wider determinants of health. But this analysis uniquely quantifies their impact drawing on individual level Census data.

These are the baseline and adjusted rates (for socioeconomic factors etc) for local authorities in all regions. When adjusted, around half have lower rates than Richmond. Compared to those in other regions, authorities in the North East do well.

This chart shows how the premature mortality rates of local authorities in the NE compare to those in Richmond. Some LAs have rates more than twice as LA.
But if the LAs had the same socioeconomic and ethnicity make-up as Richmond, all except Darlington would have lower rates.

They estimated what the premature mortality rate of each local authority would be if they had the same population make-up, on these characteristics, as Richmond upon Thames. This is uniquely possible through ONS’s linkage of Census 2021 to death on deaths.

What explains these differences? ONS looked at the contribution of individuals’ occupation, education level, deprivation level of the area in which they live, ethnicity and migration status (born in the UK or not).

Unsurprisingly, the ONS analysis shows premature mortality rates (adjusted for differences in age and sex) in the North East are higher than those any other region.

Amongst all local authorities, Richmond-upon-Thames has the lowest premature mortality, Blackpool the highest.

The North East has the lowest healthy life expectancy, lagging regions with the highest (London/SE) by almost 7 years. Halving that gap means increasing life expectancy and reducing ill health. The biggest gains in life expectancy will come from reducing premature mortality (death before age 75).

In its 10 Year Health Plan, the government recommitted to halving the gap in healthy life expectancy (HLE) between the poorest and richest regions. But how? Our new analysis with the ONS points to the underlying factors which any plan will need to take account of. 🧵

Important re NHS 10 Year Plan:

"making the plan happen with the resources on offer will be tough. Health spending will grow by 2.8% a year real between 25/26 & 28/29 – lower than historic average (3.7%) & much lower than Labour’s last period in government (6.8%)"

www.health.org.uk/press-office...

Will referrals growth stay down at 1.3% a year? And if so, what does this mean for patients? To answer these questions we need to understand why the referral rate is currently so low - and the exact opposite of a post pandemic bounce-back some expected. This is an important area of study.
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