Expenditure on mental health care by English health authorities: a potential cause of inequity

Background The York resource allocation formula includes a calculation of t he amount needed to purchase mental health services equitably in each healt h authority in England. However, the amount which is actually spent on serv ices is at the discretion of the authority. Aims To compare expenditure on mental health services with allocation, and test the hypothesis that differences between them are to the disadvantage o f services in deprived areas. Method A comparison of routine expenditure and allocation data, and linear regression modelling of the ratio of expenditure to allocation. Results The ratio of expenditure to allocation Varies widely Relative under spending occurs more frequently in deprived areas, although not in the four inner-London health authorities. Conclusions The intentions of the York formula are not achieved in practice . The implications of the formula for mental health should be made explicit to health authorities. and shortfalls in mental health expenditure relativ e to allocation should be justified at a local level. Declaration of interest None.