Public Expenditure on
Health and Personal Social Services 1998
Memorandum received from the Department of
Health in June 1998 containing Replies to a Written Questionnaire
sent by the Health Committee.
Questionnaire from the Health Committee
to the Department of Health
PUBLIC EXPENDITURE 1998 (EX98/4)
[NB New material and questions are indicated
by bold type.]
1. INTRODUCTION
Key
Issues and Initiatives:
1.1 Expenditure
Would the Department list the special monies
set aside since May 1997, together with the purposes for which
they are intended and details of how their use for these specific
purposes is being audited? Would the Department provide a commentary
detailing the impact these allocations have had? Would the Department
indicate how such allocations, and in particular those earmarked
to reduce waiting lists, are justified in the light of efforts
to allocate resources in an equitable manner across England? (p
7)
1.2 Research and Development
What redistribution of R&D resources
between NHS providers, if any, has resulted from the first bidding
round for "R&D support for NHS providers"? (p 10)
1.3 Resource Accounting and Budgeting
Could the Department provide a commentary,
including its current timetable, on the implementation of Resource
Accounting and Budgeting within the wider Department? What will
be the cost of implementation? What progress has been made in
developing agreed performance measures and valuing fixed assets?
Could the Department provide a commentary on the conclusions and
recommendations of the report of the House of Commons Procedure
Committee (see Second Report from the Procedure Committee,
Session 1997-98, Resource Accounting and Budgeting, HC 438), and
in particular comment on the accounting issues raised in paras
14-17 and the feasibility of the timetable as discussed in paras
18-25. (p 10)
2. NHS AND PSS
EXPENDITURE ISSUES
2.1 Overall Expenditure (formerly A1)
Will the Department provide an updated version
of table A1.1 of HC 297 [Trends in Actual and Planned Expenditure
on the Health and Personal Social Services 1993-94 to 1998-99
by Area of Expenditure], and of the Department's commentary
which accompanied it? Can the Department provide a brief commentary,
explaining what expenditure is included under each section of
the Table? (p 12)
Significant changes between forecast and actual
outturn for 1996-97 and between the planned level of spending
and forecast outturn for 1997-98 should be identified, by comparing
figures in HC 297 with current figures. For each programme the
planned level of spending in 1996-97 and actual outturn expenditure
should be shown in tabular form.
Please identify differences between the 1998
Departmental Report and the figures in the new table 2.1.1, and
explain these differences.
Any commentary which the Department wishes to
append would be welcome, including information about efficiency
gains and a table showing changes in the HCHS cost-weighted index
of activity for the latest 10 years for which figures are available.
What is the Department's assessment of each
programme's performance in 1996-97 against plans for that year
and anticipated performance in 1997-98 against plans for that
year and outturn in 1996-97? (p 12)
Can the Department provide a table showing for
each health authority: the planned Purchaser Efficiency Indicator
(PEI) for 1997-98 and the latest estimated PEI Outturn for 1997-98.
Could the Department provide a commentary on any progress towards
a replacement measure? (p 12)
2.2 Programme Budgets (formerly A3)
Can the Department update the information on
expenditure on Programme Budgets provided in tables A3.1 of HC
297. (p 24)
2.3 Expenditure on Community Care (formerly
A4)
Can the Department provide a table showing,
by service, net expenditure in real terms by central and local
government on community care, broken down by residential and non-residential
care (taking into account relevant service pay and price increases),
over the most recent five year period for which such data are
available? Could this data include Social Security and Housing
expenditures contributing to Community Care objectives? (p 32)
2.4 Care of Mental Health and Learning Disability
Patients (formerly C5)
2.4a Would the Department update the information
provided in HC 297, tables C5.1 to C5.8, on patients under the
care of a learning disability or mental illness consultant, discharges
by length of stay, ages and destination, and residential and other
places available. (p 34)
2.4b Would the Department provide a table
showing:
(i) number of people sectioned, by HA;
(ii) number of people sectioned in proportion
to HA population;
(iii) number of people sectioned in proportion
to number of admissions;
(iv) proportion of people who appeal
against being sectioned and the outcomes of the appeals. (p 41)
2.4c Could the Department provide a table
showing, over the last four years, the numbers of people with
mental health problems and with learning disabilities who have
been in special hospitals, prisons and regional secure units?
(p 47)
2.5 Payments to voluntary organisations
How much has the Department allocated to
voluntary organisations each year for the past five years? (p
47)
3. PUBLIC HEALTH
3.1 "Our Healthier Nation" Green
Paper
3.1a What are the specific public health
targets, how will they be monitored and what are the current baselines?
How does the Department intend to monitor local target setting
and achievement? How will it make information on local targets
available to Parliament? (p 49)
3.1b Does the Government intend to estimate
the costs to other Departments of implementing the proposals in
Our Healthier Nation? (p 51)
3.1c Could the Department provide information
about former Health of the Nation key areas which have been set
as local targets and give the baseline performance figures for
the new Health Action Zones? (p 51)
4. NHS: RESOURCES
AND ACTIVITY
Resources:
4.1 HCHS Current Resources (formerly A1)
Could the Department provide tables showing
Health Authority gross expenditure on HCHS by service sector and
age group for the latest year for which data are available? (p
53)
4.2 Capital Resources (formerly A1)
Could the Department provide a table showing
planned capital spending from 1997-98 to 1998-99? (p 54)
4.3 FHS Current Resources (formerly A1)
Could the Department provide a table showing
gross expenditure on Family Health Services (including spending
by GP fundholders on drugs) in 1996-97? What fundholder surpluses
have been used for capital development in primary care? Could
the Department provide information on the arrangements for the
provision and payment of GP premises, including the "notional
rent" scheme? (p 54)
4.4 Inflation (formerly A2)
Can the Department provide a breakdown of the
components of the health specific inflation indices for revenue
spending on HCHS and FHS respectively, together with capital spending
on HCHS, for 1995-96 and 1996-97, together with estimates for
1997-98? The tables for the HCHS should show separate inflation
indices for Review Body staff and non-Review Body staff pay, and
whatever other breakdowns of staff are available. (p 57)
4.5 HCHS HA Allocations and Distance from
Targets (formerly B1 and B2)
Can the Department provide a table showing 1998-99
Distance from Targets (DFT) in cash and percentage terms and the
percentage growth increases for each HA? Can the Department include
a commentary explaining the key factors that determined those
percentage growth increases shown in the table? (p 58)
Can the Department provide a table showing for
each health authority allocations for resident populations for
1997-98 (cash) and 1998-99 (cash and at 1997-98 prices)? (p 58)
4.6 Developments in HCHS Allocations (formerly
B3)
Can the Department update the Committee on recent
developments in the allocation of HCHS resources and provide the
timetable for any planned changes? (p 62)
4.7 Steering Group on HCHS Capital—CPAG
(formerly B4)
Can the Department notify the Committee of
progress with the current review of the capital allocation system?
(p 62)
4.8 Long-Term Capital Projects and PFI (formerly
C4)
4.8a Would the Department provide a table
showing all publicly funded capital projects with a total cost
above £10 million which are under construction during
1998-99. Could this also show the original and current estimated
completion dates along with a percentage figure for any additional
time overrun/saving. Likewise, the original total cost and
current estimated out-turn cost should be provided along with
a percentage cost performance figure. (p 64)
Would the Department provide a commentary on
cases where there are significant discrepancies between original
estimates of completion dates and/or expenditures and current
estimates? (p 64)
4.8b Would the Department provide details
of PFI projects with a capital value of £10 million or over
approved since 1992, including their current status. (p 66)
4.8c Could the Department provide tables
showing the planned and actual annual contribution to capital
from PFI, and the forecast level of investment generated by schemes
over £10 million plus an aggregate of those below £10
million, between 1996-97 and 2000-01? (p 67)
4.8d Could the Department provide a table
showing the increases to the capital cost of schemes since the
last expenditure questionnaire and provide a commentary on changes
of more than 10 per cent? (p 72)
4.8e Could the Department provide data
on the revenue consequences of schemes which have reached financial
close and represent long-term contractual commitment over the
next 25 years? Could the Department provide an update of the Departmental
Report table showing the source and applications of HCHS capital,
giving the out-turn position for 1997-98? (p 72)
4.8f Would the Department provide a breakdown
of the net present value calculations upon which decisions about
the private finance option are based? Would the Department indicate
the sensitivity of these estimates to assumptions on factors such
as risk, rate of interest, length of contract? (p 76)
4.8g Where benefits of the PFI option
are indicated, for some schemes it appears that like-with-like
comparisons are not being made. How is the "comparable"
public sector option arrived at? (p 79)
4.8h What information does the Department
have about the amount of money raised each year by Leagues of
Friends, or similar groups, for capital spend in the NHS? (p 79)
4.9 FHS Expenditure on Prescribing (formerly
D2)
The Committee would like to receive information
on total FHS expenditure on prescribing for each year from 1991-92
to 1997-98, on the average expenditure per capita, on the total
number of items prescribed and average number per capita, and
the average cost per prescription. The Committee would also like
to receive this information, for appropriate years, by non-fundholders
and fundholders. Any commentary which the Department would wish
to append would be welcome, including an assessment of progress
in meeting its stated target of restraining "the growth in
the drugs bill to sustainable and affordable limits"? What
information will the Department hold on prescribing expenditure
data for Primary Care Groups and Trusts? What level of reserve
funds does the Department intend to hold so that where Primary
Care Groups and Trusts go over their prescribing budgets their
GPs will be able to continue to prescribe drugs to their patients?
(pp 85-86)
4.10 Allocations to National Specialist Services
(formerly B5)
What was the total allocation in 1996-97 and
1997-98 to each of the supra regional services and what is the
planned allocation for 1998-99; and what significant changes have
their been in the overall pattern of expenditure? (p 87)
4.11 Management Costs
What action is the Department taking to improve
the way NHS management costs are measured and what progress is
being made to reduce these costs in line with the commitment in
"The New NHS" White Paper? Could the Department provide
data relating to trends in management costs, including the current
expenditure on management costs and the baseline figure which
is to be used for future comparisons? How will the proposals in
the New NHS White Paper help reduce management costs? Have there
been any changes to the definition of management costs? How does
the Department define the difference between management and treatment?
(p 90)
Activity:
4.12 Activity Data (formerly C1)
The Committee would like to receive tables showing
activity data by region for 1996-97 and 1997-98, including: total
activity, with trends; activity by In, Day-Case and Outpatient;
maternity and simple access data (formerly table C1.5). Can the
Department provide figures for the ratio of Finished Consultant
Episodes (FCEs) to hospital spells by Region for the same period?
To what extent do a relatively small number of providers depart
from the overall pattern? What value does the Department place
on the collection of data on FCEs? (p 92)
4.13 Average Daily Number of Beds (formerly
C3)
Could the Department provide information on
10 year trends in bed availability and patient throughout for
each major hospital sector and for each Trust? Could information
on bed occupancy (collected for the first time in 1996-97) and
occupancy rates also be included? (p 99)
Could the Department provide figures for the
number of delayed discharges of patients from acute settings and
a commentary on how these delays are being addressed. (p 99)
4.14 Maternity Hospital Episode System (formerly
C2)
How many maternities were registered in each
NHS region in 1996-97 and how many records in the Maternity Hospital
Episode System had (i) maternity tails and (ii) maternity tails
containing data? (p 101)
Could the Department also provide tabulations
for 1996-97 in the same format as those provided to the Committee
for 1989-90, which were published on pages 372-378 of HC29-II
and which were subsequently provided for the years 1990-91 to
1995-96? What action is being taken to improve quality and completeness
of the data? (p 101)
4.15 Waiting Lists and Times (formerly D4)
Could the Department provide information about
waiting lists, both distribution by waiting time as well as mean
and median average time, on a district of residence basis and
on a provider unit basis? Could the Department show graphically
changes in mean and median waiting times since March 1988 and
include a table of figures? (p 104)
Would the Department provide an update of Tables
D4.4? to D4.8? on outpatient waiting times? (p 104)
How many people were removed from waiting lists
for day case treatment and for in-patient treatment (a) because
of admission for treatment (b) for reasons other than treatment,
and how many people were self-deferred in each six-month period
since September 1988? Has the Department made any assessment of
the extent to which people removed for reasons other than treatment
in that hospital had either been admitted, died, treated in another
hospital, or no longer required treatment? (p 104)
Can the Department provide charts and figures
showing how trends in emergency and non-emergency activity have
moved with waiting lists sizes in the 1990s? (p 104)
4.16 Performance against Key Patient's Charter
Standards (formerly D3)
The Committee would like to receive an updated
version of Table D3.1 together with appropriate commentary. (p
114)
5. PERSONAL SOCIAL
SERVICES
5.1 Provision through PSS SSAs for year ahead
Can the Department set out the Standard Spending
Assessments (SSAs) for social services in the latest year, by
local authority, and SSA sub-block, both in cash and per capita,
and per capita of relevant population? Can the Department
also provide a table comparing the change in the total PSS SSA
between the last two years for each local authority? Would the
Department describe any changes to the SSA formulae introduced
in this year and provide details of any plans the Department has
to review PSS SSAs further? (p 127)
5.2 Comparison of Budgets with SSAs (formerly
A5)
Can the Department provide a table comparing
PSS SSAs with the corresponding budget for each local authority
for the latest two years for which comparable information is available?
Would the Department illustrate how the total of PSS SSAs and
budgeted expenditure in PSS have compared at the national level
over the latest five years? Would the Department provide a commentary
on any trends shown by these figures? (p 127)
5.3 Variations between authorities in unit
costs
Would the Department set out in a table how
the unit costs of the main social services for children and adults
have changed over time? Would the Department quantify the degree
of variation in these unit costs between authorities? Would the
Department provide a commentary on these figures? (p 131)
5.4 Independent sector provision
Can the department provide a table showing for
each authority the latest information on the proportion of social
services for adults which are purchased from the independent sector
rather than being provided directly? Could the Department supply
a commentary on these figures? (p 137)
5.5 Care for children
Could the Department provide a table, by Local
Authority, comparing the number of children fostered, with the
number of children placed in community homes. (p 141)
5.6 Variations in service delivery (formerly
C6)
Can the Department provide figures showing how
the delivery of non-residential social services has changed over
the last five years and comment on these trends? (p 144)
5.7 PSS demographic pressures (formerly B7/A2)
Can the Department provide details of the specific
inflation index calculated for social services, and an assessment
of the financial effect of demographic pressures on social services.
(p 146)
5.8 PSS Programme Budgets (formerly A3.2/A3.4)
Can the Department provide a breakdown by client
group of gross expenditure for the latest available two years
on the main items of social services activity. Can the Department
also update table A3.5 of last year's response? (p 146)
5.9 Capital spending on social services
5.9a Can the Department provide figures
on the acquisition, upgrade and sale of personal social services
assets, for the years 1993-94 to 1997-98? (p 149)
5.9b Can the Department comment on the outcome
for personal social services of the Capital Challenge Pilot Fund
scheme? (p 149)
5.9c What are the Department's criteria
for supporting PFI projects in personal social services? (p 149)
5.9d Can the Department comment on the use
of PFI to date? (p 149)
5.10 Changes to PSS Statistical Information
Can the Department provide details of any forthcoming
changes to statistical information the Department collects on
personal social services? (p 150)
5.11 Research on outcomes and effectiveness
of social care
Can the Department provide details of any research
work currently being sponsored by the Department on the outcomes
and effectiveness of social care? (p 151)
5.12 Fees and Charges (formerly A6)
Can the Department update table A6.1 of HC 297
providing separate figures on residential care for each client
group? Would the Department quantify the degree of variation in
domiciliary charges between authorities. Would the Department
provide a commentary? (p 153)
Will the Department provide an analysis,
to include chart, tables and commentary, of (i) the recent national
trend in the percentage of gross expenditure on residential accommodation
for older people recouped through fees and charges and (ii) the
recent national trend in the percentage of gross expenditure on
home care/home help for all client groups recouped through fees
and charges. (p 153)
Will the Department provide an analysis,
to include chart, tables and commentary of (i) the local authority
variations in the latest year in the percentage of gross expenditure
on residential accommodation for older people recouped through
fees and charges and (ii) the local authority variations in the
latest year in the percentage of gross expenditure on home care/home
help for all client groups recouped through fees and charges.
(p 153)
5.13 Volume, Purpose and Monitoring of Grants
(formerly B6)
Can the Department provide the Committee with
details of the volume of specific or special grants made available
by the Department of Health to social services departments for
the years 1994-95 to 1998-99? Can the Department provide a full
explanation of any changes, introduced this year, to the volume,
the purpose or the monitoring arrangements for any of the grants?
(p 161)
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