Select Committee on Health Memoranda


Public Expenditure Questionnaire 1999

CHANGES TO LAST YEAR ARE IN BOLD

Unless otherwise stated, table numbers refer to those in the 1998 PEQ (HC 959).

1. Current Issues

1.1  Comprehensive Spending Review

  Could the Department explain the outcome of the Comprehensive Spending Review and its impact on the NHS and PSS? In particular, would it give a clear indication of:

    (i)  the size of the settlement and its impact on annual growth assumptions for the NHS;

    (ii)  the net annual cash and real terms increase year on year and not compounded;

    (iii)  a reconciliation of these figures to the headline £21 billion published at the time of the review.

1.2  Modernisation Fund

  Could the Department list the monies set aside in the Modernisation Fund for the NHS and PSS (including expenditure on NHS Direct), the gains expected from each element of the fund, and the means by which results and achievements will be monitored and assessed?

1.3  Winter Pressures

  Could the Department give a list of the allocations made to alleviate winter pressures in 1989-99, and an indication of funds likely to be so allocated in 1999-2000 and when they will be allocated?

1.4  Special Allocations

  Could the Department list any other special allocations and likely allocations in 1999-2000 not covered above, and indicate any likely allocations in 2000-01?

1.5  "Change Programme"

  Could the Department identify the sums allocated to the many "change programmes" started by this government, for example PCGs? What are the additional costs to the NHS of having the Commission for Health Improvement and other inspectors and regulators? What is the expected "regulatory burden"? Could the Department give an estimate of expected costs and benefits of IT investment?

1.6  Millennium Bug

  Could the Department explain how the "Year 2000" issue is likely to cost the NHS in terms of modification or replacement of:

    (i)  computer and information technology;

    (ii)  medical and scientific equipment;

    (iii)  engineering plant and associated systems; and,

    (iv)  cost of staffing arrangements to cover the interim period.

1.7  Staffing

  Could the Department provide a commentary on any work which is being undertaken, or which will be undertaken, on assessing the impact of policy changes on future demand for NHS staff?

  Also, what work has been done, or will be done, to assess the impact of recent pay awards on the recruitment and retention of health and social services staff?

2.  NHS AND PSS EXPENDITURE ISSUES

2.1  Overall Expenditure

  2.1a  Could the Department provide an updated version of Table 2.1.1, and of the Department's commentary which accompanied it? Could it also show this data in graphical form? Could the Department provide a brief commentary, explaining what expenditure is included under each section of the table?

  2.1b  Could the Department identify significant changes between forecast and actual outturn for 1997-98 and between the planned level of spending and forecast outturn for 1998-99, by comparing figures in Table 2.1 with current figures. For each programme the planned level of spending in 1997-98 and actual outturn expenditure should be shown in tabular form.

  2.1c  Please identify and explain differences between the 1999 Departmental Report and the figures in Table 2.1.1.

  2.1d  What is the Department's assessment of each programme's performance in 1997-98 against plans for that year, and anticipated performance in 1998-99 against plans for that year and outturn in 1997-98?

  2.1e  Could the Department explain how it has modified the Purchaser Efficiency Indicator (PEI) for 1999-2000? How is this to be measured? What is the range of Efficiency Index imposed on regional offices and, within regions, the range imposed on health authorities? Has the Reference Cost Index made any impact on the calculation of the Index?

  2.1f  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 ten years for which figures are available. What underlying assumptions have been made over the past 10 years about efficiency gains?

2.2  Programme Budgets

  Could the Department update the information on expenditure on Programme Budgets provided in Tables 2.2?

  2.3  Expenditure on Community Care

  Could 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? Could it also show this data in graphical form?

2.4  Care of Mental Health and Learning Disability Patients

  2.4a  Could the Department update the information given in Tables 2.4, on patients under the care of a learning disability or mental illness consultant, discharges by lengths of stay, ages and destination, and residential and others places available?

  2.4b  Could the Department provide a table showing:

    (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.

  Could the Department provide a commentary on the introduction of the new sections (45a and 45b)?

  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?

  2.4d  Could the Department provide any useful data and knowledge on the survey of the incidence of mental health problems in the prisons population (as referred to on p47 of last year's evidence)?

2.5  Payments to voluntary organisations

  How much has the Department allocated to voluntary organisations each year for the past five years?

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?

  3.1b  Could the Department update the information given in Table 3.1c on baseline performance figures for the new Health Action Zones? Could the Department provide information on the resources made available to each HAZ over the next three years? Could the Department provide a commentary on the strategy and targets of each HAZ and on how their performance will be evaluated?

4.  NHS:  RESOURCES AND ACTIVITY

Resources:

4.1  HCHS Current Resources

  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?

4.2  Capital Resources

  Could the Department provide a table showing planned capital spending from 1998-99 to 1999-2000?

  4.3  FHS Current Resources

  Could the Department provide a table showing gross expenditure on Family Health Services (including spending by GP fundholders on drugs) in 1997-98? Could the Department detail the accumulated surplus that arose on fundholding at the end of 1999-2000 (actual or best estimate), compare this to the position on 31 March 1998 and explain the differences and funds? What will happen to these funds when fundholding is abolished? How do the arrangements in place for 1999-2000 deal with the accumulated position?

4.4  Inflation

  4.4a  Could the Department give an explanation as to the level of funding set aside for inflation in 1999-2000? In particular, can it give the average inflation funding allocated to each health authority, the average pay awards to each (subjective) staff group and the inflation assumptions for non pay including capital charges?

  4.4b  Could 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 1996-97 and 1997-98, together with estimates for 1998-99? 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.

4.5  HCHS HA Allocations and Distance from Targets

  4.5a  Could the Department provide a table showing for each health authority:

    (ii)  1999-2000 Distance From Targets (DFT) in cash and percentage terms;

    (iii)  growth for each HA in percentage terms;

    (iv)  net adjustment (cash) for Primary Care Groups;

    (v)  net adjustment for out of area treatments.

  4.5b  Could the Department include a commentary explaining the key factors that determined those percentage growth increases shown in the table?

4.6  Developments in HCHS Allocations

  Could the Department update the Committee on recent developments in the allocation of HCHS resources and provide the timetable for any planned changes?

4.7  Steering Group on HCHS Capital—CPAG

  Could the Department provide a commentary on the review of the capital allocation system? Could the Department comment on the progress made by the Capital Prioritisation Advisory Group with prioritisation exercises?

4.8  Long Term Capital Projects and PFI

  4.8a  Could the Department provide a table showing all publicly funded capital projects with a total cost above £10 million which are under construction during 1999-2000? 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.

  Could the Department provide a commentary on cases where there are significant discrepancies between original estimates of completion dates and/or expenditures and current estimates?

  4.8b  Could the Department provide details of PFI projects with a capital value of £10 million or over approved since 1992, including their current status.

  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 1997-98 and 2001-02? What revenue or transitional support is being given to support the scheme?

  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?

  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 outturn position for 1998-99? Could the Department identify the real savings behind PFI and other schemes, broken down by category, for example, reduced staffing costs due to redesign of buildings, reduced maintenance costs, transfer of risk, for all or a sample schemes?

  4.8f  Could the Department provide a breakdown of the net present value calculations upon which decisions about the private finance option are based? Could the Department indicate the sensitivity of these estimates to assumptions on factors such as risk, rate of interest, length of contract?

  4.8g  Could the Department update the information given in Table 4.8h on donated capital additions by NHS Trusts and provide regional summaries?

  4.8h  Could the Department list, by scheme, the amounts of monies allocated for the payment of external advisors to PFI schemes?

4.9  FHS Expenditure on Prescribing

  Could the Department provide information on (i) total FHS expenditure on prescribing for each year from 1992-93 to 1998-99, (ii) the average expenditure per capita, (iii) the total number of items prescribed and average number per capita, and (iv) 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".

  Could the Department identify the expenditure on drugs described by the BNF as a doubtful value?

4.10  Allocations to National Specialist Services

  What was the total allocation in 1997-98 and 1998-99 to each of the supra regional services and what is the planned allocation for 1990-2000; and what significant changes have there been in the overall pattern of expenditure?

4.11  Management and Administration Costs

  Could the Department report on work to develop a single measurement of management costs for PCGS and health authorities? Has the Department finished its review of the basis for measuring NHS trust management costs? Could the Department provide a commentary on this? Could the Department update Table 4.11.1? What progress is being made to reduce management/administration costs in line with the Government's commitment?

 Activity:

4.12  Activity Data

  Could the Department update the information given in Tables 4.12 showing activity data by region for 1997-98 and 1998-99, including: total activity, with trends; activity by In, Day-Case and Outpatient; maternity and simple access data? Could the Department provide figures for the ratio of Finished Consultant Episodes (FCEs) to hospital spells by Region for the same period? To what extent to a relatively small number of providers depart from the overall pattern? What value does the Department place on the collection of data on FCEs?

4.13  Average Daily Number of Beds

  4.13a  Could the Department provide information on 10 year trends in bed availability and patient throughput for each major hospital sector and for each Region? Could information on bed occupancy (collected for the first time in 1996-97) and occupancy rates also be included?

  4.13b  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?

  4.13c  Could the Department give an indication of the work undertaken on the National Bed Inquiry, including the terms of reference? In particular, what assumptions have been made and what conclusions have been reached?

4.14  Maternity Hospital Episode System

  4.14a  How many maternities were registered in each NHS region in 1997-98 and how many records in the Maternity Hospital Episode System had (i) maternity tails and, (ii) maternity tails containing data? Could the Department also update the information given in Tables 4.14.3-4.14.7?

  4.14b  Could the Department provide a commentary on, and show evidence of, the progress Trusts and Regions are making in improving data quality and on the steps the Department has taken to ensure improvement?

4.15  Waiting Lists and Times

  4.15a  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?

  4.15b  Could the Department provide an update of Tables 4.15.4 to 4.15.8 on outpatient waiting times?

  4.15c  Could the Department provide figures on how many people were removed from waiting lists for day case treatment and for in-patient treatment (i) because of admission for treatment and (ii) for reasons other than treatment? How many people were self-deferred in each six-month period since September 1988? What rules apply to ensure consistent interpretation of these figures? 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?

  4.15d  Could the Department provide charts and figures showing how trends in emergency and non emergency activity have moved with waiting lists sizes in the 1990s?

4.16  Performance against Key Patient's Charter Standards

  Could the Department provide an updated version of Table 4.16 together with appropriate commentary?

5.  PERSONAL SOCIAL SERVICES

5.1  Provision through PSS SSAs for year ahead

  Could the Department set out the Standard Spending Assessments (SSAs) for social services in the latest year, by local authority, and SSA sub-block, in cash, per capita, per capita of relevant population and per client? Could the Department also provide a table comparing the change in the total PSS SSA between the last two years for each local authority? Could 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? Could the tables include sub-totals for type of authority and averages (so that individual authorities figures can be seen in context)?

5.2  Comparison of Budgets with SSAs

  Could 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? Could 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? Could the Department provide a commentary on any trends shown by these figures?

5.3  Variations between authorities in unit costs

  Could the Department set out in a table how the unit costs of the main social services for children and adults have changed over time? Could the Department quantify the degree of variation in these unit costs between authorities? Could the Department provide a commentary on these figures?

5.4  Independent sector provision

  Could 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 and the amount spent in the independent sector? Could the Department supply a commentary on these figures?

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?

  Could the Department provide data on the number of children involved in schemes which are specifically designed to support families?

  Could the Department provide data on the number of children placed with foster carers or in local authority residential care which are outside their home authority?

 5.6  Variations in service delivery

  Could 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?

5.7  PSS Demographic Pressures

  Could 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?

5.8  PSS Programme Budgets

  Could 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? Could the Department also update Table 5.8?

5.9  Capital spending on social services

  5.9a  Could the Department provide figures on the acquisition, upgrade and sale of personal social services assets, for the years 1994-95 to 1998-99?

  5.9b  Could the Department comment on the outcome for personal social services of the Capital Challenge Pilot Fund scheme?

  5.9c  What are the Department's criteria for supporting PFI projects in personal social services?

  5.9d  Could the Department comment on the use of PFI to date?

  5.9e  Could the Department compare actual spend with credit approvals?

5.10  Changes to PSS Statistical Information

  Could the Department provide details of any forthcoming changes to statistical information the Department collects on personal social services?

5.11  Research on Outcomes and Effectiveness of Social Care

  Could the Department provide details of any research work currently being sponsored by the Department on the outcomes and effectiveness of social care?

5.12  Fees and Charges

  Could the Department update Table 5.12 providing separate figures on residential care for each client group? Could the Department quantify the degree of variation in domiciliary charges between authorities? Could the Department provide a commentary?

  Could 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/help for all client groups recouped through fees and charges?

  Could 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?

5.13  Volume, Purpose and Monitoring of Grants

  Could the Department provide details of the volume of specific or special grants made available, by the Department, to social services departments for the years 1995-96 to 1999-2000? Could 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?


 
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Prepared 18 October 1999