Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health

Table 4.15.10

NUMBERS OF ADMISSIONS AND REMOVALS

England by speciality

Ordinary Day Case
6 months to:
Admitted
Removed
Admitted
Removed

Sep-1988
941,363
72,131
359,213
18,419
Mar-1989
938,864
86,256
392,646
23,871
Sep-1989
959,516
92,715
420,536
26,784
Mar-1990
934,164
109,963
454,266
31,041
Sep-1990
910,557
101,572
465,603
36,409
Mar-1991
888,291
125,408
496,554
43,510
Sep-1991
918,376
115,338
534,998
47,616
Mar-1992
938,842
157,759
601,316
67,267
Sep-1992
901,687
124,675
638,905
67,044
Mar-1993
879,834
139,707
691,201
80,873
Sep-1993
829,580
131,708
712,016
85,040
Mar-1994
800,632
137,604
768,249
97,207
Sep-1994
796,780
136,907
849,379
111,295
Mar-1995
804,411
143,757
925,446
129,361
Sep-1995
763,117
128,408
943,405
131,830
Mar-1996
767,412
139,901
1,026,419
147,724
Sep-1996
761,967
132,833
1,056,084
154,879
Mar-1997
683,421
117,203
1,047,602
147,084
Sep-1997
*
*
*
*
Mar-1998
*
*
*
*
Sep-1998
687,330
134,836
1,189,074
194,417
Mar-1999
682,511
136,383
1,267,592
206,796

*In the year 1997-98, information was collected annually only
Source: KH06




Table 4.15.11
NUMBER OF SELF-DEFERRALS


Ordinary
Number at:
Ordinary
Day Case

Sep 1988
40,753
8,433
Mar 1989
37,098
8,769
Sep 1989
38,224
9,905
Mar 1990
36,441
9,735
Sep 1990
39,274
11,865
Mar 1991
36,115
11,998
Sep 1991
33,868
12,469
Mar 1992
30,965
13,151
Sep 1992
35,992
18,134
Mar 1993
35,800
19,095
Sep 1993
41,550
24,142
Mar 1994
39,189
25,185
Sep 1994
43,538
34,946
Mar 1995
42,188
37,152
Sep 1995
45,004
42,650
Mar 1996
45,112
44,908
Sep 1996
46,876
49,632
Mar 1997
46,022
49,390
Sep 1997
(2)
(2)
Mar 1998
56,633
64,522
Sep 1998
42,330
52,928
Mar 1999
40,098
50,667

Footnotes:

  1. The numbers above relate to the position on the last day of the six month period and do not represent the total number throughout the period.

  2. In the year 1997-98, information was collected annually only.

Source: KH07A

Table 4.15.12

TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY AND WAITING LISTS


Quarter ended:
Non Emergency
Activity
Emergency
Activity
Waiting
Lists

30 Jun 92
100
100
100
30 Sep 92
103.94
101.26
100.29
31 Dec 92
103.64
101.33
104.28
31 Mar 93
100.36
104.00
106.18
30 Jun 93
103.87
102.48
108.78
30 Sep 93
107.13
104.27
110.14
31 Dec 93
102.66
111.95
113.74
31 Mar 94
118.60
111.18
113.69
30 Jun 94
111.38
107.74
114.99
30 Sep 94
115.74
110.03
114.31
31 Dec 94
120.20
113.04
114.24
31 Mar 95
122.31
117.28
111.42
30 Jun 95
118.41
113.58
112.37
30 Sep 95
122.71
115.46
111.00
31 Dec 95
127.20
119.76
112.58
31 Mar 96
128.88
120.29
111.84
30 Jun 96
123.51
118.32
112.71
30 Sep 96
128.10
119.24
113.29
31 Dec 96
127.72
124.10
117.92
31 Mar 97
123.87
128.70
123.58
30 Jun 97
127.89
125.23
126.99
30 Sep 97
128.14
124.26
128.86
31 Dec 97
128.58
128.58
134.67
31 Mar 98
128.46
130.19
138.48
30 Jun 98
134.60
129.48
137.40
30 Sep 98
139.02
129.27
129.54
31 Dec 98
141.41
135.62
125.24
31 Mar 99 (1)
139.70
133.12
114.49


Footnotes:

  1.  Activity figures for this quarter are provisional.





4.16  PERFORMANCE AGAINST KEY PATIENT'S CHARTER STANDARDSCOULD THE DEPARTMENT PROVIDE AN UPDATED VERSION OF TABLE 4.16 TOGETHER WITH APPROPRIATE COMMENTARY?

  1.  Overall, performance against the key Patient's Charter standards fell during 1998-99. When compared with the corresponding period in 1997-98, figures show that the number of breaches of the standard for urgent action following a cancelled operation increased from 2,326 in Quarter 4 of 1997-98 to 3,239 in Quarter 4 of 1998-99. This change in performance was also reflected in the standard relating to emergency admissions through A&E. However, these changes in performance should be balanced against the continuing growth in emergency care generally and consequent emergency admissions. For example, the total emergency admissions through A&E increased by over 5 per cent against the same quarter in 1997-98.

  2.  Since 1 April 1996, the waiting in outpatient clinics standard has been measured annually for those Health Authorities who achieve a satisfactory standard in Quarter 4 of the previous year. The remaining Health Authorities are required to submit returns quarterly on an exception basis. Figures show that performance against this standard remains unchanged showing 90 per cent achievement in Quarter 4 of 1997-98 and 1998-99.

  3.  Central monitoring on Community Nurse home visits ceased from Quarter 2 1998-99 as a result of the consistently high level of achievement against this standard. At the same time, exception reporting was introduced for the standards relating to Urgent and Routine transfers of medical records. There was very little change in performance against these standards during 1998-99.

  4.  Changes to the central collection of key standards data in 1998-99 were set out in Health Service Circular HSC1998/138. These collection arrangements will remain in place at least until the new NHS Charter is implemented.

Table 4.16

SUMMARY OF PERFORMANCE IN ENGLAND AGAINST KEY PATIENT'S CHARTER STANDARDS 1998-99


National Average
National Charter Standards
QTR1
QTR2
QTR3
QTR4

Waiting in outpatient Clinics
  (percentage seen within 30 minutes)
(1)
(1)
(1)
90
Cancellation of Operations
  (number not admitted within one
  month of cancellation)
2,174
1,495
2,472
3,239
Emergency admission through
  A&E (percentage admitted within 2 hours)
82
83
79
79
Community Nurse Home Visits
  (percentage carried out within a
  two-hour time band)
97
(2)
(2)
(2)
Medical Records transferred
  (percentage within standards)
—Urgent
88
(3)
(3)
87
—Routine
85
(3)
(3)
82
Footnotes:
1.  Monitored in Quarter 4 for all Health Authorities and in Quarter 1 to Quarter 3 by exception.
2.  Central monitoring discontinued at Quarter 2 (HSC98/138 refers).
3.  Exception reporting introduced at Quarter 2 (HSC98/138 refers). Monitored in Quarter 4 for all Health Authorities.


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)?

  Standard Spending Assessments (SSAs) for social services for 1999-2000

  1.  SSAs for social services for 1999-2000, by local authority and SSA sub-block, in cash, per capita and per capita of relevant population are shown in tables 5.1.1, 5.1.2 and 5.1.3.

  2.  Table 5.1.4 compares the change in the total SSA for social services between 1998-99 and 1999-2000 for each local authority.

  3.  Existing data sources do not provide information on the total number of clients receiving services, only on numbers in receipt of particular components of care. As some clients will receive more than one component of service (for example home care and meals) it is not possible to aggregate numbers for particular components to derive an estimate of overall numbers of clients. The new Referrals Assessments and Packages of Care (RAP) data collection now being introduced will help plug this gap in the data (see Question 5.10). RAP will collect data on the number of clients receiving services (provided or commissioned), by primary client type, service type and age group. The first full set of data from the RAP project will be for the financial year 1999-2000, and will be available in September 2000.

CHANGES TO THE CALCULATION OF SSAS

  4.  The SSA resources allocation formulae are reviewed each year, and updated to take account of the latest data. This year, a new SSA formula for children's services was introduced, together with changes to the SSAs for residential and non-residential services for the elderly. These changes are described below.

THE SSA FOR CHILDREN'S SERVICES

  5.  The origins of the previous SSA formula pre-dated the Children's Act. It was based on an analysis of children looked after or on the child protection register and so excluded many children in need who were receiving support but who did not fall into either of these categories. This formula has been subject to a major review over the last four years. In 1995, a consortium of researchers was commissioned to devise a new SSA formula for children's services. The consortium comprised MORI (responsible for survey evidence), the University of York (responsible for statistical analysis) and Ruth Sinclair from the National Children's Bureau (responsible for policy advice). The consortium's approach involved looking at the case files of all children in touch with social services in about 25 authorities.

  6.  The consortium reported in 1996 and further work has been undertaken since then to try to remove any technical objections to its use. Local authorities and other interested parties were involved throughout, and were allowed to make recommendations and representations about the new formula. As a result of this research and consultation, the Government decided to use the new SSA formula to distribute resources for children's services for 1999-2000.

  7.  The formula is in two parts. The first part attempts to estimate the relative number of children requiring services, while the second part estimates the comparative cost of providing children's services in different authorities. The factors included in the first part of the SSA calculation are:

    (i)  the proportion of children from lone parent families;

    (ii)  the proportion of children living in flats;

    (iii)  the proportion of children with a limiting longstanding illness;

    (vi)  the proportion of children dependent on an Income Support claimant;

    (v)  the population density of the authority (measured in persons per hectare).

  8.  The factors included in the second part of the calculation, relating to the comparative costs of providing services, are:

    (i)  The Area Cost Adjustment. This is a factor applied throughout SSAs to reflect the fact that services are usually more expensive to provide in the South East, mainly because of labour costs;

    (ii)  A foster care adjustment. This factor allows for variations in the demand and supply of foster care, which can affect the price of foster care placements. For a given supply of foster carers, areas with high need would have to pay more to attract suitable foster carers. Equally, for a given level of need for foster care, areas with a low supply of foster carers would have to pay more to attract sufficient numbers of suitable carers. The result of the calculation in the preceding paragraph is taken as a proxy for the need for foster care. The number of women in full time employment is used as an indicator of the supply of foster care.

THE SSA FOR RESIDENTIAL SERVICES FOR THE ELDERLY

  9.  There were two changes to this formula. First, it was decided to include in the formula a factor that reflects the number of people aged over 65 years in receipt of Disability Living Allowance. The existing formula already took account of people aged over 65 years who were receiving Attendance Allowance. As the middle and higher rates of Attendance Allowance and Disability Living Allowance have the same eligibility criteria, and therefore include people who have potentially similar needs for social services, this was an uncontentious change. The second change was to exclude from the calculation the number of people living in institutions. This change was made for a number of reasons. First, the research that led to this formula was based on the characteristics of people living in the community and at the point of entry to care, and did not consider people living in institutions per se. Second, if the SSA calculation reflects the total number of people in institutional care in an area, it will be giving the wrong amount of financial credit to each authority. Some people in residential care in an authority will be paying in full for their own care; others will have been placed by another authority, and will therefore be the financial responsibility of that authority.

THE SSA FOR NON-RESIDENTIAL SERVICES FOR THE ELDERLY

  10.  In the previous SSA calculation, there was no recognition of the fact that authorities with less affluent residents could not be expected to recoup as much in charge income as other authorities. The new formula recognises this through the inclusion of a factor reflecting the numbers of older people on Income Support in each authority. In addition, an adjustment was made to reflect the higher costs of delivering non-residential services in sparsely populated areas.

FUTURE PLANS FOR PSS-SSAS

  11.  The Department of Environment, Transport and the Regions is carrying out a three-year review of local government finance. This review will be carried out in partnership with the Local Government Association, and will consider many aspects of how local government is financed. During the period of this review, there are no plans to make any changes made to the SSA formula (the formulae applying in 1999-2000 will be applied throughout). Where data that are more recent become available however, they will be incorporated in the SSA calculations.

  12.  The main objective of the review is to investigate whether there is a better way of determining the distribution of resources for local government, which is simpler, more stable, more robust and fairer than the present arrangements for SSAs. There will be two strands to the review. The first will explore radical options. The second will look at options for improving the current method of calculating spending needs.

  13.  There is a parallel review of resource allocation for the NHS.


 
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Prepared 18 October 1999