Jeremy Laurance: This may not be political cynicism, but it looks bad

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It looks bad. An NHS board under a Tory-led government is considering taking away funds from the most deprived areas and giving them to more affluent, Tory-voting, areas. Does politics get any more cynical?

But look more closely. The most deprived parts of England may have the highest rates of death relative to their populations. But that doesn't necessarily mean they have the greatest need for healthcare. The highest rates of chronic illness are actually to be found in areas with older, more affluent populations – because it is the elderly who get sick.

So where should the NHS's resources go? It depends on what you think it should achieve – equal access for those in equal need, or equal opportunity to be healthy. In the past, health economists have favoured the latter, as the more "ethical" option, and funnelled extra resources to deprived areas. The "health gap" between rich and poor has nevertheless widened as it is more influenced by socio-economic factors.

The strategy has also delivered gross inequity, as Professor Sheena Asthana of Plymouth University explained in the Health Service Journal last week. Dorset, for example, with the highest elderly population, spends £4,000 per cancer patient compared with Tower Hamlets' £13,000.

Allocating funds by age would promote equal access for equal need. It would also help get the biggest bang for the NHS's bucks – critically important as demand rises and its budget is cut.

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