Oyinlola Oyebode presents a personal view on the importance of the Health Survey for England and encourages participation in the Office for National Statistics / Department of Health and Social Care questionnaire on the future of population health surveys.
The need for reliable statistics as part of the evidence base for policy making
In June 2024, the Financial Times reported that “in Broken Britain, even the statistics don’t work” stating that “the government spends more than £1200bn a year, nearly £18,000 per person in the country and without solid statistics, that money is being spent with eyes shut.”
In June 2025, we heard the latest in a list of acts that is weakening the UK’s evidence base for policy-making: The Health Survey for England, which has been running since 1991 will be discontinued after 2025.
Without it, the trends we have been able to monitor for more than three decades, in obesity rates, blood pressure, second hand smoke exposure and more, may be obscured.
Reliable health data and statistics are the foundation of health policies.
National health surveys, like the Health Survey for England, gather uniquely important information. This includes data from health examinations (such as measured height and weight, blood pressure, or lung function, and laboratory analysis of biological samples such as blood, urine or saliva). These data complement data collected from participants in an interview survey.
These surveys have high external validity because they are designed to be representative of the national population.
The history of the Health Survey for England
In 1988 the Chief Medical Officer Donald Acheson wrote a “command paper” called “Public Health in England” which highlighted a “lack of specific focus at the centre with the capacity to monitor the health of the population and to feed the results of any analysis into the development of health policy, strategy and management”.
The recommendations he made in this command paper led to the set-up of the Health Survey for England in 1991.
Since then, the Health Survey for England has been funded by the Department of Health and Social Care to allow the government to plan health services and make important policy decisions.
The importance of the Health Survey for England to stakeholders
In 2012, I interviewed health policy and information stakeholders, and reviewed dozens of Department of Health and Social Care documents to identify how the Health Survey for England had been used in policy-making and monitoring.
In 2023, I was part of a team who examined examples of how similar surveys across Europe and the Americas had contributed to policy around the world.
The many examples of how the Health Survey for England has been useful are summarised in three published papers:
- National health examination surveys; a source of critical data
- A review of the use of health examination data from the Health Survey for England in government policy development and implementation
- Use of data from the Health Survey for England in obesity policy making and monitoring
The Health Survey for England has been used to identify when a health policy is needed, to support policy implementation, and to monitor and evaluate intended and unintended effects of policy.
Re-visiting the unpublished interview data has also been enlightening. In 2012, stakeholders in the Department of Health and Social Care told me:
“At the Department of Health, evidence-based policy is what we do… Health data drives what DH does.”
“The basic answer to the question ‘How is Health Survey for England data used in policy making?’ is that it is indispensable.”
The strengths of the Health Survey for England
A key feature of the Health Survey for England is the national sampling frame and random sample. This means the non-response rates can be estimated by population group, and weights can be made so that it is possible to produce nationally representative findings with external validity.
This is not the case for many other large datasets, like Biobank for example, which rely on volunteers who are not necessarily typical of the general population.
Also, the national sampling frame is important because it captures the health burden for those not seeking care, so we can explore access to health services and estimate under diagnosis. It also captures those who might seek care outside the NHS (for example private healthcare, alternative or faith-based services).
Relying on health service records means these people, and the conditions affecting them, are missed.
In 2012 a DHSC stakeholder told me
“[primary care data] only measures diagnosed prevalence, which greatly underestimates true prevalence”.
Another benefit is that the Health Survey for England collects objective measures.
This allows us to examine undiagnosed conditions, as well as understanding whether someone with a diagnosed condition has it under control. This provides us with an external quality control for the health system.
The objective measurements are collected using standardised methods.
This makes the data comparable across locations- unlike health service data where a particular practice might have different equipment or a different process for diagnosis. It is also well known that the investigations a patient’s GP might order in response to similar symptoms can vary based on the patient’s personal characteristics. This can lead to patterns of diagnosed disease that belie the true epidemiology (and burden) of an illness.
The standardised methods also make the data comparable across years.
In 2012, stakeholders told me:
“Inadequately trained staff doing spirometry is a problem nationally… We ensured that spirometry was good quality to ensure that data collected are robust. This attention to how the data is collected gives credibility to what is reported and consequently what the team says.”
“The fact it has been going for almost 20 years make it especially useful.”
“Continuity is so valuable.”
“It became easier to argue the case for the HSE after a few years of data collection, when the data could be used to show trends, demonstrating the use in monitoring.”
The future
A future without the Health Survey for England, or a suitable alternative, is a future where we cannot track the trends we have been able to monitor since 1991.
We do not know the health status of the population, whether the health service is reaching and treating people appropriately or who might be being missed.
We cannot set appropriate health targets or hold the government to account.
We cannot examine intended and unintended consequences of health policies and other policies that may affect health.
Whatever follows the Health Survey for England, it’s important that we have a say in maintaining a robust approach to measuring and recording the health of people in England, to continue to maintain the standards and features that have made this so valuable as an evidence base for policy making.
The Office for National Statistics and the Department for Health and Social Care are running a consultation which is open until midday on Friday 25 July 2025.
If this matters to you, please participate in the consultation.
About the author
Oyinlola Oyebode is a Professor of Public Health at Queen Mary University of London where she leads the Centre for Public Health and Policy.
In 2012, during her specialty training in public health, she spent 9 months with the Health and Social Surveys Research Group at UCL where she was introduced to the Health Survey for England which has been important to her work since.
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