David Pole, who has died aged 95, was a key player in what amounted to a revolution in the allocation of health care resources in the 1970s.
Economists including Brian Abel-Smith at the London School of Economics had long been critical of health inequalities and, with Barbara Castle as Labour secretary of state and David Owen as health minister, there was a fair political wind for some kind of reform.
Pole, as economic adviser at the Department of Health and Social Security (DHSS), convinced Owen of the need for a new, more objective mechanism, and in 1975 the rather unexciting sounding RAWP (Resource Allocation Working Party) was set up.
There was a personal element in this, as Pole had found enormous imbalances between places such as Leicester, where he had been born, and the south-east of England. Under RAWP, resources were now to be allocated on various objective measures, the most important being population and morbidity (rates of illness), whereas they had previously been determined by historical accident and the location of the great teaching hospitals. Pole helped to convince the main committee that standardised mortality data would be a good proxy for morbidity, direct measures of which were unavailable at a regional level.
Though RAWP’s conclusions were initially unpopular with senior medics, Pole and the economists with him provided the analytical backbone for developing robust algorithms. According to Owen, “They made an exceptional contribution to the NHS.” The RAWP system survived hostility under Margaret Thatcher and is, broadly, still used today. The tale of RAWP provides an interesting lesson in political economy: to secure policy reform, what is needed is solid data, competent economic analysis and persistent advocacy.
When Pole arrived at the DHSS in 1970, he had already carried out pioneering research in health economics at University College, Cardiff (now Cardiff University). As a lecturer there, he had been approached by Archie Cochrane of the MRC Epidemiological Research Unit in Cardiff to look into the economics of screening for tuberculosis by mass radiography.
Two papers resulted, published by the Nuffield Provincial Hospital Trust in 1968 and 1971. Pole approached mass screening with the eye of an economist. Was prevention better than cure, when new antibiotics were becoming available to provide effective treatment of actual cases?
He was promoted to a senior lectureship in 1969 and the following year left academic economics, moving to London to join the DHSS as a senior economic adviser. His background in health research enabled him to be an authoritative advocate of the serious use of economics in formulating health policy.
After a spell at the Treasury (1977-80), as head of the public services division, where he helped to provide a convincing case for capital investment in hospitals, he returned to the DHSS as chief economist.
Pole was a little self-effacing but well-liked and effective. He was now in an excellent position to champion health economics. The Centre for Health Economics at the University of York, established in 1977, was closely associated with Pole and the economists working under him at the DHSS. Alan Williams, professor of economics at York, had developed the concept of the QALY (quality adjusted life years) as a criterion for health interventions and Pole supported further funding for its practical implementation.
The QALY is widely used in the work of the National Institute for Health and Care Excellence (Nice), for example, and has led to the EQ5D, an internationally used health-based measure of wellbeing. But by 1979 the political climate had changed in the UK so that further reforms proved difficult, though the technical work continued.
David was the son of John Pole, a schoolteacher, and Gertrude (nee Bloor), an accounts clerk. He passed an examination to go to Wyggeston grammar school for boys in Leicester, where he was a contemporary of David Attenborough. After conscription he served with the Intelligence Corps to learn written Japanese, and following VJ day in 1945 was posted to Chittagong as a sergeant.
It was there that he developed an interest in economics. In 1951 he took a BA in economics at Queens’ College, Cambridge, where he was active in the Marshall Society, the university’s economics discussion group, at the same time as Abel-Smith and John Vaizey.
From 1951 he was a lecturer and then senior lecturer at University College, Cardiff, and married Violet Woodruff, a youth employment officer and social worker, in 1956. His interest in health economics led him to the DHSS.
David took early retirement in 1983. To the surprise of many, who could not quite see him as “mine host”, he became landlord for a year of the Farmers’ Arms pub, Violet’s childhood home, at Cefn Cribwr in south Wales. He was always noted for his dry sense of humour. Into old age he continued to campaign for the Labour party, for the organisation Secular Wales and for better access to Oxbridge for state school students.
He is survived by Violet, their four daughters, Laura, Eleanor, Rachel and Elizabeth, and seven grandchildren.
• John David Pole, health economist, born 15 March 1926; died 25 May 2021
