4. As can be seen from figure 2.2.1, the
common ground between Health Authorities and trusts/DMUs is activity
which has been both purchased and provided by the NHS in England.
The traditional presentation of HCHS expenditure blurs the distinction
between Health Authorities and trusts/DMUs by fitting the provider
profile of expenditure to the Health Authority total of expenditure.
A new method of constructing the programme budget information
has therefore been devised. The new programme budget aims to capture
the most recent year's expenditure made by Health Authorities
and present that data in a more easily readable. The results are
shown in Table 2.2.1.
5. There are major differences between the
new HCHS programme budget format and the traditional format:
(i) The new format covers Health Authority
expenditure regardless of whether it was provided by NHS or non-NHS
providers. Conversely, private patients at NHS providers do not
affect the figures>
(ii) The programmes are more logically structured
and presentation is easier to follow. For example, all general
and acute expenditure on the elderly is presented as one programme,
whereas previously the geriatric programme (ie care led by a consultant
geriatrician) was frequently, and wrongly, taken to mean all general
care for the elderly.
(iii) A clear distinction has been drawn
between programmes of care (columns) and method of care (rows).
COMPARISONS WITH
LAST YEAR
6. In order to gain the maximum value and
usefulness from the programme budget it is necessary to compare
expenditure trends over a comparative period. Unfortunately, for
the most recent years (due to a number of changes to data and
accounting systems) this has not been possible and so in the following
text we have adjusted the 1995-96 and 1996-97 date in order to
give estimates of comparable totals.
7. In 1996-97 overall HCHS expenditure (excluding
joint finance) was £21,987m compared to the adjusted 1995-96
figure of £21,672m. Therefore HCHS expenditure rose by 1.5
per cent in volume terms, ie after allowing for HCHS pay and prices
increases, and by 1.4 per cent in real terms.
8. The pattern of spend between programmes
differs for hospital services and those in the community (see
Figures 2.2.2 and 2.2.3). The largest programmes in both sectors
are elderly (general & acute) and adults (general
& acute) although the proportion of total budget spent
differs considerably. These two areas account for two thirds of
hospital expenditure but less than half of the community sector's
expenditure. Spending on learning disabilities in the community
sector account for 17 per cent of this sector's expenditure, whereas
only 3 per cent of hospital expenditure is spent on this programme.
The proportion of expenditure spent on mental illness is
similar in both sectors, as it is in both children (general
& acute) and maternity.
