Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health


Table 3.1.2

FIRST WAVE HAZ ALLOCATIONS


1998-99
1999-2000
1999-2002
2 subsequent years total

Plymouth
260
1,037
3,111
Sandwell
301
1,263
3,789
Luton
209
742
2,226
Manchester, Salford & Trafford
742
3,835
11,505
Lambeth, Southwark &
Lewisham
706
3,650
10,950
East London & City
627
3,189
9,567
Bradford
422
1,980
5,940
Tyne & Wear
906
4,784
14,352
North Cumbria
297
1,253
3,759
Northumberland
292
1,230
3,690
South Yorkshire Coalfields
620
3,137
9,411
Total
4,282
26,100
78,300

Note:  All figures are £'000s and include development support monies.

Table 3.1.3

SECOND WAVE HAZ ALLOCATIONS


1999-2000
2000-01
1999-2002
& 2001-02
Total

East Riding
1,181
2,057
5,295
Leeds
1,500
2,622
6,744
Tees
1,231
2,138
5,507
Wakefield
710
1,199
3,108
Leicester City
695
1,176
3,047
Nottingham
1,311
2,288
5,587
Sheffield
1,184
2,047
5,278
Brent
591
984
2,559
Camden & Islington
1,088
1,874
4,836
Cornwall & Isles of Scilly
1,009
1,748
4,505
North Staffordshire
861
1,470
3,801
Walsall
605
1,007
2,619
Wolverhampton
597
996
2,589
Bury & Rochdale
868
1,484
3,836
Merseyside
3,070
5,337
13,744
Total
16,501
28,517
73,535



Note: All figures are £'000s and include development support monies.

HAZ Innovations Fund

  In addition to the HAZ programme allocations, HAZs will be able to bid for additional funds as part of the HAZ Innovations Fund. Broadly, the intention is that these should be innovative and more leading edge than mainstream programmes. The aim is to have some Joined Up Government pilots for example on employment, HAZ fellowships and primary care initiatives. £12 million will be available for the HAZ Innovations Fund over the three years 1999-2002.

EXTRACT FROM WAKEFIELD HAZ PLAN

Outcomes We Expect From Our HAZ Programme

  We will not set ourselves unrealistic goals, for example we do not expect that we will be able to significantly reduce unemployment in the District, over the life of the HAZ. However we do expect to bring about the following and we will evaluate our work to test this. One of the key areas we are focusing on is the development of communities and the voluntary sector. We will develop measures of social capital to assess progress and they will include such factors as, commitment to shared social values, high levels of social trust, strong social networks, people volunteering time to the common good, people taking action to bring about change and so on.

  Over the life of HAZ we expect to bring about:—

  (Related objective numbers are indicated in brackets, however our plan is a matrix of initiatives, and programmes will conspire to impact upon these outcome indicators.)

    —  A shared partnership combining public health, regeneration, Agenda 21, anti-poverty strategies, pooled budgets and synergised planning and action (5).

    —  The community and voluntary sector if strengthened and the Community Health Forum is established (1).

    —  Community development initiatives delivering improved quality of life in areas of deprivation. Greater involvement of people and communities in civic and community life in the District (1).

    —  Impact measures established by local people (5).

    —  Community and voluntary sector present on all main decision making groups with an equal voice (1).

    —  Communities running their own affairs. Community infrastructures established (1).

    —  Volunteering is extended in the District (1).

    —  More open access to services. More integrated complementary and people focused services and opportunities for marginalised groups (4).

    —  Primary Health Care developed with greater lay, community and patient involvement, more integration with Social Services, Housing and so on, and programmes of public health and community development in place (4).

    —  There is greater involvement of staff in public sector organisations (4).

    —  Services are improved to provide greater social support (4).

    —  A reconfigured service plan has been agreed and is being implemented, to establish a network of services (4).

    —  Clear evidence that root causes of ill health have been addressed (3).

    —  More uptake of benefits and therefore less poverty in vulnerable populations (3).

    —  Transport planning influenced by health concerns and improved in terms of accessibility, pollution levels and cost (3).

    —  Public health prevention approaches mainstreamed and changed culture in the statutory sector and resources shifted upstream (5).

    —  Greater understanding of public health issues are developed in the District, particularly amongst politicians, key decision makers and community leaders, front-line staff and the public (5).

    —  Occupational Health Services developed across the District (4).

    —  Increased understanding of occupational health in primary care and in secondary and tertiary care. Programmes established to enhance knowledge and action in terms of reducing workplace hazards and safety and health issues (2).

    —  A whole school approach to health promotion will be embedded in all schools across the District. This will lead to healthier and safer environments and improved reported sense of well being in students and staff, reduction in accidents in and around the school area and an increase in children walking to school (2).

    —  Better awareness amongst young people of the factors affecting their health (2).

    —  Health and social care locally are more effective at meeting young people's needs (4).

    —  More involvement of young people in decision making in the District (1).

    —  Improved sexual health awareness amongst young people and safer sex being practised by the majority (2).

    —  Improved parenting in Wakefield and District through enhanced parenting skills and access to appropriate services to support family unity and well being (2).

    —  At least three Healthy Living Centres or initiatives established (2).

    —  A greater understanding of environment and the health issues locally (3).

    —  Environment and health initiatives established such as allotments and food growing (3).

    —  Influence of partners upon Regional and National strategies are evident which impact upon health in Wakefield and District (5).

    —  The incidence of domestic violence will be reduced (1).

    —  Nutrition in public places will be improved as will school meals and food poverty will be reduced (3).

    —  Increased access to healthy foods in areas of most deprivation (2).

    —  Pathways of care are in place and improving quality and clinical governance in relation to cancer, and heart disease (4).

    —  The quality of discharge mechanisms are improved with patients and carers being provided with more support (4).

    —  An integrated core data set is agreed, established and being monitored for Public Health in the District (5).

    —  Improved understanding of needs of the most deprived communities and appropriate service responses in place (4).

    —  Public health skills and capacities of key staff improved in the District (5).

    —  Improved understanding of the needs of, and increased support provided to vulnerable people, particularly those with learning disabilities, the homeless, women suffering domestic violence, black and ethnic minorities, those with mental health problems (4).

    —  Improved access to health services for the above (4).

HAZ TARGETS

Objective 1  Build Community Participation and Capacity

    —  Each and every project agreed for HAZ funding will include objectives which are developed by and with the appropriate user community.

    —  Minority communities' health experience will mirror that of the majority: no difference in any of the health-related outcomes. (eg uptake of screening programmes, immunisation initially—morbidity and mortality are too long-term for five to seven year programme).

    —  Prevalence of domestic violence baseline developed targets set for each PCG areas. (District-wide service had contact with 400 women in 1998-99).

Objective 2  Promote Positive Health and Prevent Disease

    —  Number of young people who have become and continue to be drug free.

    —  Healthy schools initiative—all schools participating by 2002.

    —  Pre-16 pregnancy rate and 17-18 year olds below the national average.

    —  Increase the proportion of young people who understand factors which affect their health, and feel confident in their ability to protect their own health (baseline survey needed).

    —  Reduction in numbers taking risks with their health (ditto).

    —  Reduce recurrent major injuries and childhood accidents.

    —  CHD treatment protocols implemented—use of aspirin, rational prescribing etc.

    —  Reduction in smoking prevalence—local baseline needed.

    —  Reduction in accidents—baseline needed.

    —  Reduction in home accidents to under fives.

Objective 3  To Tackle the Root Cause of Ill Health

    —  Increase number of people with disabilities who are in employment (100 people in long-term employment by 2002).

    —  Increase number of employers who take on people with disabilities and mental health problems.

    —  Reduction in number/percentage of children "Looked after"

    —  Increase in average age of children "Looked after".

    —  Improve educational attainment of Looked After children.

    —  Improve uptake of immunisation and screening among Looked after children.

    —  Reduction in number of child protection referrals.

    —  Increase take up of Severe Disablement Allowance, Disability Living Allowance, Invalid Care Allowance etc—enhanced income for beneficiaries.

    —  Reduce homelessness and rough sleeping by 30-40 per cent by 2002—and aim higher for 2005.

Objective 4  To Develop Integrated Health and Social Care Services

    —  Introduction and implementation of care pathways for cancers and CHD.

    —  Reduction in readmissions following discharge from hospital.

    —  Improvement in a range of indicators for young single mothers—educational attainment, training opportunities, child protection referrals, emotional behaviour problems in their children.

    —  Increase in user and carer satisfaction.

EXAMPLE OF A PROJECT

   (NB: there are 5 projects under Wakefield's objective 2, of which this is one and Wakefield HAZ has 4 objectives).

Objective 2—Promote Positive Health and Prevent Disease

  Project = Young People's Sexual Health/Provision of Advice and Information on Sexual Health to Young Disabled People.

Purpose:

  To ensure that sexual health services, sex education and support facilities are available, provided and developed in ways that are consistent with young people's needs and preferences, in particular, for young people with physical and learning disabilities.

Aim:

  1.  Improve access and quality of services;

  2.  Multi-agency approach;

  3.  Improved awareness of sexual health issues in young people.

Initial (1st year) activities

  1.  Establish "pack" contributors;

  2.  Identify target group of young people with disabilities;

  3.  Assess current position and develop models of action.

Process targets:

  1.  Project team established;

  2.  Increased numbers of young people using sexual health services;

  3.  User & carer feedback;

  4.  Publication of needs assessments.

Lead Organisation

  1.  Health Development Unit.

 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?

  1.  The latest year for which disaggregated data area available is 1996-97 since the allocation of programme-age related activity data is reliant on patient level data from the Hospital Episode system (HES).

  2.  The proportion of HCHS expenditure by programme of care is as follows:


Programme of Care
Proportion of expenditure

Acute services
52%
Mental health
12%
Services intended primarily for the elderly
11%
Other services
15%
Learning disability
6%
Maternity
5%


  3.  The proportion of HCHS expenditure by age group is as follows:

Age band
Proportion of expenditure
All births
5%
Age 5-15
6%
Age 16-44
23%
Age 45-64
19%
Age 65-74
15%
Age 75-84
17%
Age 85+
9%


  4.  Services aimed specifically, or mainly, at the elderly account for 11 per cent of total HCHS expenditure. However, those aged 65 and over accounted for 41 per cent of total expenditure despite being only 16 per cent of the population. This is mainly due to high levels of spend in other sectors, with 43 per cent of acute expenditure, and significant proportions of expenditure on services for mentally ill people (38 per cent) being used by this age group.

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

Table 4.2.1

NHS CAPITAL SPENDING 1998-99 TO 1999-2000

£ million

Forecast Outturn
Plan
1998-99
1999-2000

Hospital and Community Health Services
—Government Spending
888
1,399
percentage real growth
53.7%
—Receipts from land sales1
561
337
percentage real growth
-41.4%
—PFI investment2
170
397
percentage real growth
127.8%
Total HCHS Capital
1,619
2,133
percentage real growth
28.5%
—Other NHS spending3
15
26
percentage real growth
69.1%
   
TOTAL
1,634
2,159
percentage real growth
28.9%


Footnotes:

1. Estimated.

2. Central Health and Miscellaneous Services and Departmental Administration.

3. Figures may not sum due to rounding.

 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?

  1.  Table 4.3.1 shows FHS Gross Expenditure in 1997-98.

Table 4.3.1

FAMILY HEALTH SERVICES GROSS EXPENDITURE, 1997-98

£ million

Service
Gross Expenditure

Non-Cash limited General Medical Services
2,198
Non-Cash limited Drugs
1,936
Cash Limited Drugs
2,171
General Dental Services
1,348
Cash Limited General Medical Services
835
Dispensing Costs
768
General Ophthalmic Services
241

TOTAL
9,497


FUNDHOLDING SURPLUSES

  2.  The 1997-98 final accounts record GP fundholding savings of £207,071. The latest 1998-99 forecast closing savings figures is £181,426 (from Q3 monitoring data). The variation between years arises from saving spend by fundholders and also additional "new" savings accrued in year. Final GPFH savings figures and spend for 1998-99 will not be available until HA final accounts have been audited.

  3.  Any remaining part of the GP fundholders allotted sum (including, for former fundholders who left the scheme on 31 March 1999, any savings balance) will be transferred to the HA under powers in the Health Bill. Once final accounts are audited and any commitments taken into account, any remaining sum will be considered as savings. Funds within the allotted sums that, at 31 March 1999, were committed for some purpose, for example to cover a bill incurred under the fundholding regulations, will not count as savings. This will include the costs of any redundancies among fundholding staff that are chargeable to the allotted sum.

  4.  The arrangements for releasing savings generated by former fundholders recognise both the legitimacy of the former GP fundholders' call on savings and the need for PCGs and HAs to plan for the consequences of this. The costs of closing down each fund will represent a call on the fundholders allotted sum (including any savings). After these costs have been met, former GP fundholders who have left the scheme at the end of 1998-99, should seek to reach agreement with their Primary Care Group on how their savings should be deployed within the Primary Care Group setting. Such agreements should be set out in the form of an agreed "savings plan" which would record what had been agreed on how and when the savings should be spent. These savings plans should form part of, and be embodied in, the PCG's Primary Care Investment Plan.

  5.  If, for whatever reason, the former fundholders and PCG are unable to agree a savings plan by the end of October 1999 the former fundholders will be guaranteed access to 25 per cent of the balance on their account after it has been closed or £25,000, whichever is the lower, in each of the next four years. Any savings balance in excess of these amounts will be available during 1999-2000 and beyond for management by the PCG in consultation with the HA. The PCG's planned use of savings in this way should also be set out in the PCIP.

  6.  Former fundholders will be able to spend their individual annual savings entitlement to benefit their practice. Allowable spend is set out in the fundholding regulations and will be repeated in the transitional provisions which will end the residual fundholding scheme. Allowable items are the same as will apply to the PCG incentive scheme. Premises investment will be allowed but only where the PCG is satisfied that the development proposals fit with the PCIP. Unlike fundholding, there will be no automatic right to roll over savings entitlements from one year to the next. Anything not spent in year one would lapse (unless there is local agreement otherwise with the PCG (if at level II) or the HA (for level I PCGs).

  Note:   The full introduction of these arrangements for savings is contingent on enactment of the Health Bill.

 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?

  1.  Information on the components of the HCHS and FHS service inflation indices is given below. Differences in methodology and presentation of these indices reflect the differences between the services to which they refer.

Health Authority Inflation

  2.  NHS funding will rise by over £2.8 billion in 1999-2000 - equivalent to 7.7 per cent growth in cash terms. This funding was agreed following the outcome of the Comprehensive Spending Review (CSR). During the CSR the Department made assumptions about the pay, price and demand increases likely over the next three years, as well as efficiency and other value for money improvements. These assumptions informed the debate on funding levels for future years.

  3.  Last November, health authorities received on average a 6.5 per cent rise in their Unified Allocations. Additional funds have also been allocated through other mechanisms, such as centrally held Modernisation monies and via Capital allocations.

  4.  This overall allocation will help the NHS to meet healthcare pressures reflected in local Health Improvement Plans. However, it is for health authorities, in partnership with Trusts, Primary Care Groups and local authorities, to determine how best to use their funds to meet national and local priorities for improving health and modernising services. The significant additional resources available will aid them in this process.

  5.  It is not, therefore, possible to provide average "inflation" funding allocated to each health authority. It should be noted that the Market Forces Factor (MFF) used in allocations will provide a level of adjustment for various factors which affect prices in each health authority.

Pay

  6.  Table 4.4.1 shows the settlements awarded to those staff whose pay arrangements are determined by the Review Bodies. Other staff groups' representatives are currently in negotiation with the Department over 1999-2000 pay increases.


 
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Prepared 18 October 1999