Healthcare inequalities and ethical resource allocation: reconfiguring priority setting decisions to tackle inequalities of access and outcome

BACKGROUND

NHS guidance requires decision-makers to “focus on improving access and health equity for under served communities.” Deprived populations and certain ethnic minority groups had poorer healthcare access prior to the pandemic and experienced poorer health compared to the rest of the population. There is also clear evidence that unequal healthcare access and social injustices can compromise the health of those most vulnerable in times of crisis. In addition, the biggest increases in waiting lists are in the areas of greater deprivation. To respond to these problems, the NHS has set one of its main priorities during the Covid recovery “to create a system of health and care that tackles both the health inequalities and the other weaknesses that COVID-19 has exposed… with a particularly focus on analysing waiting times by ethnicity and deprivation.”

This focus on addressing inequalities in healthcare access, while long overdue, represents a shift in impetus, and suggests a need to go beyond the more standard ethical considerations used in healthcare priority setting, such as urgency, likelihood of benefit and value for money.

This project will begin to formulate the way in which this new focus on inequality can and should be introduced into existing ethical frameworks and processes for healthcare resource allocation. Particular attention will be paid to formulating decision-making processes that are equality-promoting, appropriately incorporate public input, and manage disagreement. It will involve two stages: (i) an empirical, evidence-gathering stage to determine how, if at all, inequality does feature in decision frameworks, and to identify how policymaking procedures that been successful in other contexts; and (ii) an ethical consideration of how inequality should feature in these frameworks and processes.

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

This project will combine theoretical research in bioethics and empirical ethics. Candidates will build their analytical and critical thinking skills through regular meetings with supervisors, and participation in the activities of the Ethox Centre. They will also receive professional mentorship and opportunities for career development.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

There may be opportunities to collaborate or be involved with NHS decision-making about resource allocation either at the local or regional level, through regional Priority Setting Committees or Individual Funding Request Panels. It is very likely clinicians, decision-makers and NHS managers who are involved in these processes will all be important points of contact for this project and its realisation.

Prospective student

The ideal candidate will have a background degree in bioethics (either at master’s or undergraduate level) and will have some experience in public health ethics and policy.