Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health

Table 5.13.1

GRANTS AVAILABLE FOR PERSONAL SOCIAL SERVICES 1995-96 TO 1999-2000



£ million

1995-96
1996-97
1997-98
1998-99
1999-00

Specific Grants
AIDS Support Grant
13.4
13.7
13.7
13.7
15.5
Drugs & Alcohol Specific Grant
2.5
2.5
2.5
2.5
4.5
Guardians Ad Litem & Reporting Officer
services
6.2
6.3
6.3
Mental Health Grant
47.3
58.3
67.3
73.3
116.5
Training Support Programme
34.6
35.5
35.5
35.5
39.0
Secure Accommodation (Capital)
20.8
27.2
13.2
8.2
6.2
    
Special Grants
Community Care Special Transitional Grant
647.6
418.0
325.0
350.0
Capital Disregard Increase
64.5
Drugs & Alcohol Special Grant
0.2
Asylum-Seekers' Grants
28.0
69.6
208.2
3.0
Promoting Independence: Partnership Grant
253.0
Promoting Independence: Prevention Grant
20.0
Promoting Independence: Carers Grant
20.0
Children's Services (Quality Protects) Grant
5.0
75.0
TOTAL
772.4
654.0
533.1
696.4
550


Aids Support Grant

  2.  Volume: The only change in 1999-2000 is that £15.5 million is being made available to authorities, an increase of 13 per cent on the 1998-99 amount of £13.7 million.

Drugs and Alcohol Grant

  3.  Legislation: In 1999-2000, grant of £4.5 million will continue to be paid as a specific grant under Section 7E of the Local Authorities and Social Services Act 1970, as inserted by Section 50 of the National Health Service and Community Care Act 1990. However, £0.2 million will be paid as a special grant under the powers contained in Section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of schedule 10 to the Local Government Finance Act 1992.

  4.  Volume: On 1 April 1999, £0.7 million of the existing grant was transferred to the new London Rough Sleepers Unit, set up by the Department of the Environment, Transport and the Regions. Overall however, the value of the total grant has increased to £4.8 million.

  5.  Purpose: The grant now has three component parts, two of which are new. Specific grant of £1.8 million will be paid in accordance with the existing aims and conditions. The additional £3 million is available to help authorities develop more co-ordinated and flexible service provision and improve access to services for substance misusers. £2.8 million of the £3 million will be paid as a specific grant to develop new drug services in approximately a quarter of local authority areas. The balance of £0.2 million is available as a special grant to those authorities that have agreed to develop better approaches to service commissioning. They will be expected to disseminate the lessons learned to other authorities. The £0.2 million has to be paid as a special grant under Section 88B(5) legislation because the powers in Section 7E of the Local Authorities and Social Services Act 1970 state authorities must pay over any grant received to those voluntary organisations which provide drug and alcohol services. The money transferred to the London Rough Sleepers Unit will be used to develop drug and alcohol services for rough sleepers in London.

  6.  Monitoring: Additional targets have been set for 1999-2000 for the new funding of £2.8 million and £0.2 million: a 10 per cent increase in the number of problem substance misusers participating in effective treatment, a reduction in the time spent by problem misusers in waiting for an assessment of their needs, and a 10 per cent increase in the proportion of decisions to approve funding, made within two weeks of a misuser having been formally assessed as needing it. Performance against these targets will be monitored through Drug Action Teams' annual reports. The Teams in the Social Care Regions have agreed plans with each authority and will monitor compliance with the agreed outcomes. The London Rough Sleepers Unit intends to monitor the money distributed for the development of drug and alcohol services using the outcome funding methodology employed on the existing Drug and Alcohol Specific Grant.

  7.  Effectiveness: The achievement of the targets set out in paragraph 6 above will be the measure of grant effectiveness.

Mental Health Grant

  8.  Volume: The 1998-99 Mental Illness Specific Grant (MISG) of £73.3 million has been replaced by the Mental Health Grant (MHG) which in 1999-2000 totals £116.5 million. Because £3.2 million has been transferred to the new London Rough Sleepers Unit set up by the Department of the Environment, Transport and the Regions (see paragraph 10 below) the £116.5 million represents an increase of £46.4 million over the 1998-99 MISG.

   9.  Purpose: The purpose remains the same. MHG is for social care services for people with mental illness. It has five strands, the core grant, the CAMHS (Children and Adolescent Mental Health Services), the Partnership and Target Funds and the Homeless Mentally Ill Initiative (HMII).

  10.  The CAMHS Fund has increased from £2 million in 1998-99 to £10 million in 1999-2000. Some of this increase will provide full-year funding for 24 innovative projects initially funded for six months in 1998-99. The remainder will be distributed amongst all local authorities with agreed joint CAMHS development strategies. Support for Partnership Fund projects, also initially funded for six months in 1998-99, has increased from £4 million to £7.1 million in 1999-2000. Grant for the HMII (which assists reintegration into the community of people with mental health problems sleeping rough) had been £4.2 million in 1998-99. £3.2 million of the £4.2 million has been transferred to the London Rough Sleepers Unit because it had funded mental health services for rough sleepers in London. The new Unit is now co-ordinating all services for rough sleepers in the capital. Grant for HMII services outside London is being increased from £1 million to £1.5 million a year from 1999-2000. This increase is in proportion to the increase in the overall MHG and will contribute towards achieving the Government's aim, set out in the Social Exclusion Unit's report on rough sleeping, of reducing the number of rough sleepers by two thirds by 2002.

  11.  The remainder of the MHG increase is being paid as an addition to the core grant to address key issues in the Government's mental health strategy "Modernising Mental Health Services" published in December 1998; and in preparation for the implementation of the Mental Health National Service Framework. These issues include staff training, needs-based planning, costed mental health strategies; the strengthening of senior management for mental health; also, new or expanded investment in social services support for assertive outreach; 24-hour NHS care arrangements and rehabilitation and support services, a sufficient supply of approved social workers to meet statutory requirements, developing links between community mental health teams and agencies responsible for housing, employment and welfare benefits and improving standards of risk assessment, risk management, record keeping and information sharing.

  12.  Monitoring: Core grant monitoring in 1999-2000 will be strengthened to ensure that local authorities are investing their additional funds against the specified strategic objectives. They have been asked to submit documentary evidence of progress when they claim the first instalment of their core grant in September 1999. They have also been advised that the Department will ask for evidence of further progress during 2000-01. The Department is also designing a detailed performance management and reporting framework for the "National Priorities Guidance" for CAMHS. Authorities allocated HMII funding have been asked to provide regular reports on the work of the post holders being supported by the grant.

  13.  Effectiveness: The achievement of the targets set out in paragraph 11 will be the measure of grant effectiveness.

Training Support Programme

  14.  Volume: The Training Support Programme (TSP) grant for 1999-2000 was increased from £35.5 million to £39 million.

  15.  Purpose: The purpose of the grant remains the same. The additional funding is available for training residential child care staff in NVQ Level 3 and training qualified social workers in the new Post Qualifying Award in Child Care.

  16.  Monitoring: Each local authority has to submit an annual training targets plan plus an application form for each of the sub-programmes within TSP, at the beginning of the financial year. The application forms require authorities to state the number of people that they intend to train during that financial year and to set targets for the achievement of qualifications for that year and the following two years. From 1999-2000, authorities will also have to provide a mid year report in October, giving details of the training that has been provided over the first half of the year. Authorities have to submit a comprehensive annual report in May of the following year, giving details of the training that has been undertaken, the qualifications that have been obtained and the total financial expenditure on training that was incurred during the previous year.

  17.  Effectiveness: The achievement of qualifications will be the indicator for the level of effectiveness of TSP in the future. Authorities are required to set targets for the achievement of qualifications and these targets will be monitored closely. To ensure that the grant is being used to target training in priority areas, amounts of TSP have been ring-fenced for specific training such as NVQ Level 3 for residential child care staff, training for foster carers, sensory impairment training. This ring-fencing helps to highlight how effective the use of TSP has been.

Secure Accommodation (Capital) Grant

  18.  Volume: The grant has reduced to £6.2 million in 1999-2000. The Secure Accommodation Development Programme (SADP)—which provided an additional 170 secure places—is now complete and the majority of local authority secure accommodation is now provided at a very high standard. Continuing grant aid is required to assist authorities in the upgrade and refurbishment of units not within the SADP and to ensure that the safety and security of all units is maintained to the standard required by the Secretary of State. There are no changes other than in volume to report.

Community Care Special Transitional Grant

  19.  Volume: The grant ended on 31 March 1999 because it had achieved its objective of providing the transitional support authorities needed in order to implement the requirements of the NHS and Community Care Act 1990.

Special Grant for Asylum-Seekers (Adults, Families of Asylum-Seekers and Unaccompanied Asylum-Seeking Children)

  20.  Legislation: Special Grant Report No. 38 was laid under the powers contained in Section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of Schedule 10 to the Local Government Finance Act 1992. The 1998-99 grant was divided into three parts: Adults, Families and Unaccompanied Children.

Adult Asylum-Seekers' Accommodation

  21.  Purpose: To re-imburse local authorities for certain expenditure in 1998-99 following a High Court judgement on 8 October 1996. This judgement stated that authorities have a duty under section 21 of the National Assistance Act 1948 to provide accommodation and board to certain adult asylum-seekers unaccompanied by dependent children.

  22.  Monitoring: Claims were made by any authority which provided accommodation and board. Up to a maximum of £165 per week per asylum-seeker could be claimed. Authorities were able to claim an additional £10 per week per person accommodated in premises specially commissioned for the provision of accommodation for asylum-seekers. A claim form showing actual and estimated expenditure had to be submitted to the Department, detailing the number of adults accommodated and supported each week during the relevant period. All claims and expenditure are subject to audit by the Audit Commission.

  23.  Effectiveness: Responsibility for adult asylum-seekers falls on a large number of authorities but London authorities face a particularly heavy burden. In 1997-98 the grant was reduced to a level of £140 per person per week but in recognition of the increased numbers of asylum-seekers supported and the difficulties in securing sufficient accommodation, the unit cost was restored to £165 for 1998-99. Payments were made to 121 authorities.

Families of Asylum Seekers

  24.  Purpose: To reimburse local authorities in 1998-99 for certain expenditure incurred in providing services for children in need, under sections 17 and 18 of the Children Act 1989. The duty to provide those services arose in consequence of changes to the entitlement of certain persons from abroad to certain social security and housing benefits.

  25.  Monitoring: Grant was available to any authority which provided services to these families. Where a family was already being provided with services by an inner London authority prior to 23 November 1998, up to a maximum of £240 per family, per week could be claimed. On 23 November 1998, the Government reached agreement with local authority representatives on the 1998-99 grant provision for all asylum-seeker support. One aspect of that agreement was that where an authority began supporting a family on 23 November 1998 or later, the maximum which could be claimed was £230 per family, per week. A claim form showing actual and estimated expenditure and detailing the number of families supported each week during the relevant period (whether or not housing benefit was involved) had to be submitted to the Department. All claims and expenditure are subject to audit by the Audit Commission.

  26.  Effectiveness: The terms of the grant were substantially improved in 1998-99 and allowed all local authorities who incurred costs in supporting asylum-seeking families to receive grant monies, up to the designated limits set out above, for each family supported. The grant provides a substantial contribution to authorities' costs of accommodating and supporting these families in 1998-99. Payments were made to 112 authorities.

Unaccompanied Asylum-Seeking Children

  27.  Purpose: The grant targets resources to local authorities affected by the costs of providing services for unaccompanied asylum-seeking children. Authorities have duties under the Children Act to provide services for these children but the standard spending assessment distribution mechanism does not take full account of the burdens involved. The grant provides a substantial contribution to authorities' costs.

  28.  Monitoring: Authorities seeking grant support had to submit a claim to the Department detailing their actual and estimated expenditure and the numbers of children supported during each week for which the claim is made. Payments were limited to a maximum of £400 per week for each child of 15 years and under and £200 per week for each child of 16 or 17. All claims and expenditure are subject to audit by the Audit Commission.

  29.  Effectiveness: The terms of the grant were substantially improved in 1998-99 and allowed all local authorities who incurred costs in supporting these children to receive grant monies, up to the designated limits for each child supported. This was effective in meeting most of the costs of accommodating and supporting these children in 1998-99. Payments were made to 75 authorities.

Promoting Independence: Partnership Grant

  30.  Legislation: Special Grant Report No. 42 was laid under the powers contained in section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of Schedule 10 to the Local Government Finance Act 1992.

  31.  Purpose: The purpose of the new grant is to foster partnerships between health and social services in promoting the independence of adults needing community care services in order to achieve the objectives for adult services set out in the White Paper "Modernising Social Services" and the objective on promoting independence in the "National Priorities Guidance 1999-2000 to 2001-02."

  32.  Monitoring: Grant allocations are based on standard spending assessments with conditions attached. By 31 May 1999 each local authority has to provide the Secretary of State with a written plan setting out the measures it will take to meet the grant conditions. The plan must be agreed with partner health authorities. As part of the new performance assessment function of the Social Care Regional offices (as set out in the White Paper "Modernising Social Services") implementation of the plans will be checked in the summer and there will be a further check in the autumn. By 31 May 2000, authorities have to provide a year-end report. An audit certificate of expenditure has to be completed by the authority, certified by the auditor and sent to the Department.

  33.  Effectiveness: This is a new grant, payable from April 1999. The Department will be assessing its effectiveness by measuring the performance of local authorities against the joint health and social services objective in the "National Priorities Guidance 1999-2000 to 2001-02". The objective is to "reduce the risk of loss of independence following unplanned and avoidable admission to hospital by reducing nationally the per capita rate of growth in emergency admissions of people aged over 75 to an annual average of 3 per cent over the five years up to 2002-03". One of the grant conditions is that recipient authorities should agree local targets with their health authority partners to help meet this national objective and set out in their plans how the grant will be used to achieve it. The over 75s emergency admissions target features in both the NHS and social services performance assessment frameworks and will be monitored through performance management and assessment processes carried out by the NHS Executive and the Social Care Regional offices.

Promoting Independence: Prevention Grant

  34.  Legislation: Special Grant Report No. 43 was laid under the powers contained in section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of Schedule 10 to the Local Government Finance Act 1992.

  35.  Purpose: The purpose of the new grant is to help local authorities develop with other relevant agencies, particularly health authorities, preventative strategies aimed at slowing down or preventing deterioration in individuals who have been assessed as at risk of losing independence and who are able to benefit from lower level interventions which will prevent or significantly delay admission to residential or nursing care or to hospital and/or will improve their quality of life. The grant will help to achieve the objectives set out in the White Paper "Modernising Social Services" and meet the objective on promoting independence in the "National Priorities Guidance 1999-2000 to 2001-02."

  36.  Monitoring: Grant allocations are based on standard spending assessments with conditions attached. Monitoring of the grant will be undertaken by the Social Care Regional Offices, in partnership with NHS Executive Offices. By 29 October 1999, each local authority has to provide the Secretary of State with a written plan, agreed jointly with each health authority in their area, setting out how the objectives will be met. Also, by 31 May 2000 each authority has to provide a report setting out the progress made on its preventative strategy and the amount spent on additional services. An audit certificate of expenditure has to be completed by the authority, certified by the auditor and sent to the Department.

  37.  Effectiveness: This is a new grant payable from April 1999. Local authorities should set indicators against which progress in implementing the strategy can be measured. In doing so they will want to take note of the proposed indicators for performance assessment framework for social services contained in the document "A New Approach to Social Services Performance". The consultation period for this has recently closed.

Promoting Independence: Carers Grant

  38.  Legislation: Special Grant Report No. 44 was laid under the powers contained in section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of Schedule 10 to the Local Government Finance Act 1992.

  39.  Purpose: The carers' strategy "Caring about Carers" sets out the Government's intention to stimulate greater diversity and flexibility of provision to enable carers to take a break from caring, to encourage a greater awareness by local authorities of the need for services which are more responsive to the needs of carers and to enable carers and carers' organisations to get involved in authorities' work on the appropriateness of current provision and the possibility of greater diversity. This new grant is intended to help authorities to enhance their community care services in carrying out these objectives.

  40.  Monitoring: Grant allocations are based on adjusted standard spending assessments with conditions attached. In the first year each local authority has to provide a programme of change and development in a written plan agreed with partner health authorities and submitted to the Secretary of State by 29 October 1999. The plan will set out how the authority intends to diversify and improve the range of relevant community care services it provides, the indicators the authority intends to apply to monitor its progress between 1 April 1999 and 31 March 2002 and how it is intended that the values of those indicators should change during that period. General monitoring of progress towards implementation of the programme of change and development will be via a report to the Secretary of State which, for the first year, must be provided by 31 May 2000. An audit certificate of expenditure has to be completed by the authority, certified by the auditor and sent to the Department.

  41.  Effectiveness: This is a new grant payable from April 1999. Effectiveness will be measured through the achievement of the objectives and targets set each year in local authority plans.

Children's Services (Quality Protects) Grant

  42.  Legislation: In 1998-99, Special Grant Report No. 40 was laid under the powers contained in Section 88B(5) of the Local Government Finance Act 1988, as substituted by paragraph 18 of Schedule 10 to the Local Government Finance Act 1992. In 1999-2000 the same powers are being used.

  43.  Purpose: This new grant supports a major three-year Quality Protects programme, starting in 1999-2000, which aims to transform the management and delivery of children's social services. It will help local authorities deliver the targets set and the outcomes to be achieved for children. There are six priority areas: increasing the choice of adoption, foster and residential care placements for looked after children, increasing the support provided for care leavers, including steps to prevent inappropriate discharge of young people at 16 and 17, enhancing the development and use of management information systems, improving assessment, care planning and record keeping, improving quality assurance systems so services are delivered according to requirements and meet local and national objectives, listening to the views and wishes of young people.

  44.  In 1998-99, £5 million was made available to help authorities with the costs associated with preparing for the programme. Paragraph 13 of LAC(98)28 set out eligible areas for expenditure.

  45.  Monitoring: All authorities have prepared Quality Protects Management Action Plans (MAPS) which include local project plans for modernising children's services. MAPS provide the basis for the authorities' assessment, and the Department's monitoring, of progress in implementing the three-year Quality Protects programme. The Social Services Inspectorate's (SSI) regional offices evaluated the initial MAPS and subsequently recommended to Ministers that payment of the special grant for Year 1 (1999-00) should be made. As well as formally monitoring progress, regional SSIs will continue to work closely with authorities in taking forward the Government's objectives. Payments of grant in 2000-01 and 2001-02 will depend on satisfactory progress reports for preceding years, in addition to acceptable action plans being received. An audit certificate of expenditure has to be completed by the authority, certified by the auditor and sent into the Department.

  46.  Effectiveness: The MAPs format was designed by the Department to ensure that the eight key objectives and the sub-objectives for children's services were covered in the individual action plans. Those sub-objectives include five targets from the Department's "National Priorities Guidance 1999-00 to 2001-02". For example "Improve the educational achievement of children looked after, by increasing to at least 50 per cent by 2001 the proportion of children leaving care at 16 or later with a GCSE or GNVQ qualification; and to 75 per cent by 2003"; and "Demonstrate that the level of employment, training or education amongst young people aged 19 in 2001-02 who were looked after by Local Authorities in their 17th year on 1 April 1999, is at least 60 per cent of the level amongst all young people of the same age in their area". The Department is developing plans to evaluate Quality Protects—this will enable it to make any necessary changes during the course of the programme, as well as provide an evaluation of the effectiveness of the entire programme. Effectiveness will be measured against authorities' success in achieving the objectives, sub-objectives and targets set, through regular reports from authorities, through surveys and research and through inspection by SSI.

PUBLIC EXPENDITURE QUESTIONNAIRE 1999: FURTHER QUESTIONS

WAITING LISTS

    a.  Can the Department provide a comparison of total numbers of people waiting for outpatient appointments for each year for which figures are available, separately identifying trends in the average wait for an outpatient appointment?

    b.  If the Department will estimate the number of people at each access point of the elective care system broken down to show:

      (a)  numbers of GP consultations,

      (b)  numbers of referrals to specialist outpatient clinics,

      (c)  numbers of attendances at specialist outpatient clinics,

      (d)  numbers of placements on waiting lists (differentiated by (i) "waiting list, (ii) "booked" and (iii) "planned"), and

      (e)  numbers of elective episodes of care, for each year since 1991-92.

    Would the Department provide a commentary on changes over time in numbers waiting at each stage, and the conversion rates between each stage?

    c.  If the Department will conduct a survey of a random sample of 10 trusts to establish the arrangements made to compensate NHS staff for the contribution they have made to the waiting list initiative in (a) 1997-98 and (b) 1998-99?

    d.  What additional mechanisms have been put in place since May 1997 to deal with waiting lists? How is the success of each of these measured? What assessment have you made of the effectiveness of each? What has been the cost of each of these? Have there been additional costs incurred as a result of administering the "special" waiting list monies in this way?

    e.  Is the Department able to give an estimate of the average contribution from special waiting list funds to each trust, the resulting increase in activity, and the unit cost per case of this additional work?

MODERNISATION FUND

    f.  How many successful bids went to health authorities which were already over their target allocation? How will these modernisation fund allocations impact on future funding formulas and capitation positions?

Long term care of the elderly

    g.  Could the Department give a detailed breakdown of the costs of implementing the Royal Commission report proposals?

    h.  Could the Department provide figures on the proportion of home helps/home carers(wte) per 1,000 people aged 75 and over for each of the last 10 years?

DEFLATORS AND NHS EXPENDITURE

    i.  Would the Department state what the increase in expenditure on the NHS has been since 1992 in cash terms, real terms (GDP deflator), and real terms (NHS deflator)? Can the Department break down the year-on-year absolute increases in cash expenditure into the part that covers general inflation, the additional part for NHS inflation, and finally the remainder as an uplift in expenditure to cover changes in the level and structure of activities? Would the Department use estimated values for both general and NHS inflation for years where these are not yet known?

    j.  Would the Department provide a table showing the construction of the NHS inflation index from main sub-indices of pay and other factor costs since 1992, and comment on the assumptions underlying this construct?

    k.  The Government has set a target to achieve efficiency and other value-for-money gains in the NHS equivalent to 3 per cent of Health Authority Unified Allocations a year for the next three years (Cm 4203, para 4.145). Can the Department of Health explain how efficiency is measured in this context?

    l.  What proportion of the total pay settlement by value is yet to be finalised? Can the Department give an estimate of what pay inflation in the NHS is likely to be in 1999-2000?

    m.  What changes in the terms of reference of the NHS staff review bodies have there been since 1997, what factors underlay such changes?

    n.  What information do quarterly monitoring returns give about local NHS inflation?

    o.  If the Department will conduct a survey of a random sample of 10 trusts to give brief details of their assumptions about the level of inflation in input prices that they will face in 1999-2000 and 2000-01?

WAITING LISTS

    (a)   Can the Department provide a comparison of total numbers of people waiting for outpatient appointments for each year for which figures are available, separately identifying trends on the average wait for an outpatient appointment?

  1.  The Department collects information on the time between referral by a GP and the patient seeing a consultant for a first outpatient appointment split into time bands: zero to four weeks, four to 13 weeks, 13 to 26 weeks and 26 weeks and over. In addition, the number of patients who are still waiting to be seen at the end of each quarter and have been waiting for over 13 weeks are collected (13-26 weeks and 26 weeks or more). The total number of patients waiting for outpatient appointments is not collected.

  2.  The table below shows the number of patients who had been waiting more than 13 weeks for their first outpatient appointment following referral by their GP at the end of each year from 1994-95.


Date
Number of patients who had been waiting >13 weeks

June 19951
301,648
March 1996
216,137
March 1997
247,510
March 1998
333,982
March 1999
456,033

Footnote:
1. Data not collected before June 1995.


  3.  The average (median) waiting time from GP referral to first outpatient attendance is shown in the table below. This information is not collected directly and has been estimated from the information collected on the waiting time of those patients seen (by broad time band).



Year
Median waiting time (weeks)

1995-96
6.10
1996-97
6.10
1997-98
6.26
1998-99
6.79


    (b)   If the department will estimate the number of people at each access point of the elective care system broken down to show: (a)  numbers of GP consultations; (b)  numbers of referrals to specialist outpatient clinics; (c)  numbers of attendances at specialist outpatient clinics; (d)  numbers of placements on waiting lists (differentiated by (i) "waiting list", (ii) "booked" and (iii) "planned"); and (e)  numbers of elective episodes of care, for each year since 1991-92.

  See attached Annex. (P 214)

Would the Department provide a commentary on changes over time in numbers waiting at each stage, and the conversion rates at each stage?

  1.  The Department collects information on the number of patients waiting after referral by their GP for a first outpatient appointment (only after they have been waiting for more than 13 weeks) and after a decision to admit the patient for inpatient treatment.

  2.  The number of patients who had been waiting more than 13 weeks for their first outpatient appointment has increased every year since March 1996 [see answer to question (a)] after falling between June 1995 (when they were first collected) and March 1996.

  3.  Since March 1992 the number of patients waiting to be admitted to NHS hospitals has risen in all but two years: when it fell by 21,000 between March 1994 and March 1995 and by 225,000 between March 1998 and March 1999.

  4.  The rough conversion rate from GP consultation to referral to an outpatient clinic has remained fairly steady between 1992-93 to 1996-97, rising from 2.7 per cent of all GP consultations in 1992-93 to 2.9 per cent in 1996-97.

  5.  It is not possible to estimate the conversion rate from GP referral to outpatient first attendance as the number of outpatient attendances contains referrals from other sources.

  6.  The conversion rate from outpatients to inpatients (as measured by additions to the inpatient waiting list as a proportion of all outpatient first attendances) fell slightly from 41 per cent of all outpatient first attendances in 1991-92 and 39 per cent in 1995-96 and has remained fairly steady each year since.

  7.  It is not possible to make a valid conversion from additions to the waiting list to elective episodes as the number of elective episodes contains planned admissions which are exclude from the count of additions to waiting lists.

 (c)   If the Department will conduct a survey of a random sample of 10 trusts to establish the arrangements made to compensate NHS staff for the contribution they have made to the waiting list initiative in (a) 1997-98 and (b) 1998-99?

  1.  The Government has provided significant additional resources to the NHS in 1998-99, linked to specific targets for reductions in waiting lists. It is a matter for local NHS bodies how best to deploy these resources, including the levels of remuneration payable to staff for the additional work carried out in meeting these targets.

  2.  Payments to doctors to undertake extra work are governed by the National Health Service Hospital, Medical and Dental staff terms and conditions of service except where doctors are employed on a NHS Trust contract where it is up to the individual NHS Trusts to negotiate the rates of payment for work outside of the individual doctor's normal duties.

  3.  It is not feasible to conduct a survey of NHS Trusts within the timescales set, particularly as to ensure statistically valid results, would require a larger sample size than that proposed.

 (d)   What additional mechanisms have been put in place since May 1997 to deal with waiting lists? How is the success of each of these measured? What assessment have you made of the effectiveness of each? What has been the cost of each of these? Have there been additional costs incurred as a result of administering the "special" waiting list monies in this way?

  1.  The Government has made additional resources available to the NHS, linked to the achievement of clear targets to reduce waiting lists and times:

    in 1998-99:

    —  £320 million was invested directly on elective activity—to deliver record increases in the number of operations and surgical and medical sessions;

    —  £65 million was targeted for investments in primary care, community, mental health and social services so that people who didn't need to go to hospital could get better care in their communities;

    —  £5 million was made available to establish 24 pilot sites as part of the National Booked Admissions Programme. The new system helps to take away patients' uncertainty and stress about waiting for a hospital appointment and enables patients to agree dates which suit them, and take into account their family and work responsibilities.

    in 1999-2000:

    —  a further £320 million was announced for waiting lists from the NHS Modernisation Fund. This money will make sure we continue the excellent progress towards delivering our Manifesto pledge to cut NHS waiting lists to at least 100,000 below the figure we inherited;

    —  as part of this we will invest a further £20 million to extend the National Booked Admissions Programme and increase the number of patients who agree a booked date for their operation when they see the consultant in the outpatient clinic.

  2.  To support the NHS in developing and delivering a sustainable reduction in waiting lists and waiting times, management arrangements have been strengthened by:

    —  the establishment of:

      (i)  a national Waiting List Action Team, consisting of senior managers and clinicians to help develop and secure effective implementation of national policies for the NHS on outpatient and inpatient waiting lists, and;

      (ii)  eight Regional Task Forces, to help drive up standards and spread best practice across the NHS.

    —  The appointment of Peter Homa, Chief Executive of Leicester Royal Infirmary, as the national List-Buster to tackle bottlenecks in the system and modernise the approach to waiting lists.

  3.  The combination of additional resources, linked to clear targets and strengthened management arrangements have delivered record reductions in waiting lists, down by 225,000 between March 1998 and March 1999. As waiting lists have fallen so have waiting times: the number of over 12 month waiters has fallen by 33 per cent (24,000) since the peak in June 1998 and average waiting times for treatment are now lower than the position inherited.

  4.  Administration costs have been kept to a minimum by integrating arrangements for the use of these additional monies into existing NHS plans and accountability systems, in line with our commitment to free up resources for patient care by reducing unnecessary bureaucracy.

 (e)   Is the Department able to give an estimate of the average contribution from special waiting list funds to each trust, the resulting increase in activity, and the unit cost per case of this additional work?

  1.  The additional finds given to the NHS in 1998-99 to tackle waiting lists were allocated to Health Authorities. This resulted in an increase in elective activity of 9.2 per cent (448,000 extra cases) compared to the previous year.

  2.  It is not possible to calculate the unit cost per case of the additional work delivered. The average unit cost of all General and Acute elective cases in 1998-99 was estimated to be £1,100.


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries

© Parliamentary copyright 1999
Prepared 18 October 1999