title: Has NHS reorganisation saved lives? A CuSum study using 65 years of data.
abstract: OBJECTIVE
  To determine if NHS reforms affect population mortality.
  
  
  METHODS
  Retrospective study using routinely published data.
  
  
  METHODS
  Resident population of England and Wales 1948 to 2012 MAIN OUTCOME MEASURE: All cause age sex directly standardised mortality England and Wales 1948 to 2012.
  
  
  METHODS
  Using the CuSum technique and Change-Point Analysis to identify sustained changes in the improving age-standardised mortality rates for the period 1948-2012, and comparing the time of these changes with periods of NHS reform. Where observed changes did not fit with NHS reform, changes external to the NHS were sought as a possible explanation of changes observed.
  
  
  RESULTS
  CuSum plotting and CPA showed no significant changes in female mortality trend between 1948 and 2012. However, this analysis identified a sustained improvement in the male mortality trend, occurring in the mid-1970s. A further change in the rate of male mortality decline was found around the Millennium.
  
  
  CONCLUSIONS
  The 1974 NHS reorganisation, changing service arrangements predominantly for women and children, is considered an unlikely explanation of the improved rate of male mortality decline. Thus, centrally led NHS reorganisation has never had any detectable effect on either male or female mortality and must be considered ineffective for this purpose. But some evidence supporting the view that increased funding improves outcomes is found.
authors.affiliation: School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Lale
authors.affiliation: Department of Public Health Medicine, Communicable Disease Surveillance Centre, Public Health Wales, Temple of Peace and Health, Cathays, Cardiff, CF10 3NW, UK Mark.temple@wales.nhs.uk.
authors.forename: Jonathan M F
authors.initials: JM
authors.lastname: Temple
mesh_terms: D004739:England; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D012189:Retrospective Studies; D013222:State Medicine / Q000458:organization & administration*; D014852:Wales
keywords: health care reform; mortality; statistical process control; statistics