Posted on 8 December 2022
Roy was one of the original members of CHE when it was founded in 1983 and he remained here for 27 years. He continued his link as an honorary fellow after his retirement in 2011. Roy was also an active researcher outside health economics, including in education through a long association with the Institute of Education at University College London. He also worked extensively in the field of inequality and poverty.
Roy worked with colleagues in publishing seminal research in 1993 to establish a step change in the methods by which a significant proportion of NHS resources were allocated to organisations responsible for providing or arranging healthcare for local populations. This provided a more robust way of ensuring resources were distributed on the basis of population needs than was previously the case. This became known as the ‘York formula’ and it has been hugely influential in guiding methods for allocation in other public services and healthcare jurisdictions both in the UK and abroad. With modifications, it remains the basis for resource allocation formulae used today.
The methods to determine capitation payments to GPs (PDF , 996kb) are also based on work by Roy and colleagues which became known as the ‘Carr-Hill formula’ which used novel data sources and methods to explore GP workload.
Together, this research helped to ensure that the resources allocated for healthcare - to local areas and to GPs in England - reflected needs and hence improved equity for all the population. The path-breaking nature of this research was referred to in a review of Resource Allocation for the Secretary of State for Health in 2008, which described the research as being the most impressive and sophisticated undertaken so far.
Roy enjoyed the reaction to this work. He received various strongly worded letters from GPs who disagreed with the reallocation of resources based on the ‘Carr-Hill formula’. He said that this ‘hate mail’ showed that he was making a real difference (i.e., diverting resources to where they were most needed which took some away from richer areas). Roy was also involved in developing resource allocation formulae in the 1980s. In Sally Sheard’s work on the history and development of health economics, Roy was quoted as saying “[I]t turned out [the DH administrator] meant [Margaret] Thatcher didn’t like the idea of having an anarchist running the resource allocation formula [laughter]".
Roy also worked over a number of years on research evidence related to skill mix in both primary and secondary health care, an area that remains a policy challenge in the NHS.
Demonstrating the breadth of Roy’s research interests, he worked extensively in low- and middle-income countries and for international organisations including World Bank and UNICEF. He had strong views about the quality of information used to guide policy. Roy was a long-term and active member of the Radical Statistics Group, which is concerned by the extent to which official statistics reflect governmental rather than social purposes. He was passionate about the survey methods used in some lower income countries to gather data and the fact that they excluded the very poorest in society. For example, his research cast doubt on statements regarding progress towards the Millennium Development Goals. His critical assessment of official statistics endured, including a recent piece on Covid-19 statistics.
Throughout his career, Roy’s focus was research for social good. This included his vigilance regarding the quality of data used by decision makers to inform and justify their policies, his careful analyses of how the least advantaged in societies are impacted by policies and social change, and the development of methods to support more egalitarian ways of organising health and education systems. There was never a dull moment in working with Roy and he would never knowingly remain outside any debate, whether regarding the quality of wine or a recent ministerial appointment.
Roy leaves behind his wife, 4 daughters and 7 grandchildren. He will be much missed by all who knew him.