MEMORANDUM BY THE DEPARTMENT OF HEALTH
(CONT.)
(ii) How many successful Modernisation Fund
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 position?
4. The table below lists, for each strand
of the Modernisation Fund that was allocated following a bidding
process, the number of recipient Health Authorities who were over
their capitation target and the total amount issued to those authorities.
Table 2.5.2
SUCCESSFUL BIDS FROM THE 1999-2000 MODERNISATION
FUND TO HEALTH AUTHORITIES WHO WERE OVER THE CAPITATION TARGETS
| Modernisation Fund Strand
| Number of over-target Health Authorities who received allocations
| Total amount to these Health Authorities (£m)
|
| Waiting lists—Booked admissions programme
| 30 | 10 |
| Waiting lists—cancer outpatient waits
| 50 | 4 |
| Calman Cancer | 51 | 5
|
| Paediatric Intensive Care | 21
| 9 |
| Nurse Prescribing | 50 |
4 |
| Diana's Nurses | 3 | 0.5
|
| Health Action Zones | 12 |
22 |
| Mental Health (Child and Adolescent Mental Health Services
| 52 | 5 |
| Mental Health (non-recurrent) | 34
| 9 |
| Mental Health (recurrent) | 2
| 0.5 |
| Primary Care Groups | 52 |
11 |
| Primary Care Groups IT | 52
| 10 |
| Improving Primary Care | 52
| 1 |
| Primary Care Acts Pilots | 48
| 3 |
| Out of hours | 22 | 1
|
| NHS Direct | 4 | 2
|
| Health Informatics Services | 30
| 5 |
| Smoking cessation | 14 |
4 |
| Public Health Development Fund | 22
| 1 |
| Total | | 107
|
5. The distribution of funds by non-recurrent allocations
has no impact on distance from target. Where Modernisation Funds
are made recurrent they become part of the health authorities'
baselines and this affects the health authorities' distances from
target. This means that they will be taken into account in deciding
what increases HAs receive in line with decisions about pace of
change policy.
2.6 Special Allocations
Could the Department list any other special allocations and
likely allocations in 2000-01 not covered above, and indicate
any likely allocations in 2001-02?
1. At this time there no plans to award any other special
allocations in either 2000-01 or 2001-02 (the extra funding announced
in Budget 2000 is covered in the answer to Q1.8).
3. PUBLIC HEALTH
3.1 PUBLIC HEALTH—Saving
lives: our healthier nation set targets in four areas:
cancer, CHD and stroke, accidents and mental health.
(i) How does the Department intend to monitor individual
health authorities progress towards the targets set in Saving
Lives? What assessment is being made of the effectiveness
of any additional spending committed in response to these targets?
(ii) Could the Department provide summary details
of the investment plans of all HAZs, as they relate to the four
main targets in Saving lives? Please provide details of
spending, targets and evaluation.
(iii) How much funding has been made available for
Health Impact Assessments? Has any assessment been made of their
usefulness to date?
(iv) Can the Department update the information given
in tables 3.1.1, 3.1.2 and 3.1.3?
(i) How does the Department intend to monitor individual
HA's progress towards the targets set in Saving Lives? What
assessment is being made of the effectiveness of any additional
spending committed in response to these targets?
1. Local health strategies developed by Health and Local
Authorities are set out in Health Improvement Programmes (HImPs).
HImPs combine a range of nationally and locally set targets. The
national targets are set in the National Priorities Guidance (NPGs)
which includes "Saving lives: Our Healthier Nation"
(ie Coronary Heart Disease and Stroke, Accidents, Mental Health
and Cancer) and the goals of the NHS Modernisation Fund and in
the National Service Framework (NSFs).
2. Local targets will be set to address issues and problems
which are judged important locally by the partner organisations,
with particular emphasis on addressing areas of major health inequality
in local communities.
3. It is for local health communities, led by Health
Authorities to determine how best to use their funds to meet national
and local priorities for improving health, tackling health inequalities
and modernising services.
4. Performance management of HImPs, including the HImP
Performance Scheme, is undertaken by the NHS Executive Regional
Offices in their formal annual review of HAs, and continuous monitoring
and development work throughtout the year.
(ii) Could the Department provide summary details
of the investment plans of all HAZs as they relate to the four
main targets in Saving Lives? Please provide details of spending,
targets and evaluation. NB: it has been agreed that this response
will relate to the DH key priorities.
OVERVIEW
5. Health Action Zones (HAZs) are seven year multi-agency
programmes between the NHS, local government, the voluntary and
private sectors and community groups. The principal aim of HAZs
is to tackle inequalities in health in the most deprived areas
of England through health and social care service modernisation
programmes with opportunities to address other interdependent
and wider determinants of health such as housing, education and
employment.
6. Twenty-six HAZs were selected across England having
passed a needs threshold based on a basket of health, healthcare
and deprivation indicators. Table 3.1.1 presents HAZs' age standardised
mortality rates for Our Healthier Nation Indicators. HAZs cover
more than 50 per cent of the population living in deprived areas
in England and over 13 million people. Within each HAZ different
health as well as service priorities are addressed. The first
wavers started implementing their programmes at the beginning
of 1999 and the second wavers later in the year.
7. HAZs are acting as trailblazers for new ways of working
and integrating the services and approaches being developed into
mainstream activity, including the use of flexibilities such as
pooled budgets between health and local authorities. HAZs are
expected to be the leading edge of the Health Improvement Programme
for the local area, trying out new approaches, using the additional
resources to change the way services are delivered, and contributing
to the overall performance of the local health economy.
8. HAZs have a strong focus on prevention and working
with partners to address the wider determinants of health. This
work, alongside improving services, is also crucial to achieving
Saving Lives: Our Healthier Nation targets. HAZs' involvement
in leading edge partnership work also leaves them well placed
to take forward the Social Exclusion Unit's neighbourhood strategy.
HAZ STRATEGY AND
TARGETS
9. As noted in last year's evidence, Ministers told HAZs
that their programmes should address the major health and service
issues they face. This was a bottom up process recognising that
each of the HAZs have different problems that need to be addressed.
HAZ targets should address their major health and service issues.
The Department did not specify what these should be but did specify
the approach be taken: HAZs have built their programmes on the
following seven principles:
— equity: in resource, allocation, in reducing health
inequalities and promoting equality of access to services;
— person centred services;
— an evidence based approach to service planning
and delivery;
— partnerships/multi agency working;
— a whole systems approach to taking forward change
engaging stakeholders across the local health and social care
system.
10. During 1999-2000, this bottom up approach has been
supplemented by Ministers' wish to see the HAZs concentrate on
the 13 DH programme areas, particularly on the top three priorities
of CHD, Cancer and Mental Health, the Prime Minister's five Ps
of partnership, patients, performance and productivity, professions
and prevention, and supporting work on tackling winter pressures
and to reduce waiting. HAZs are adding value across all areas
of treatment, prevention and care, and in delivering the priority
areas of the Health Improvement Programme. Table 1 shows the number
of HAZs working on each programme area in 1999-2000.
Table 1
REPORTED EXPENDITURE AND HAZs WORKING ON 13 DH PROGRAMME
AREAS
| Programme | £m (note A)
| Number of HAZs (note A) |
| CHD (see note B) | 4.5 |
22 |
| Cancer (see note B) | 1.2 |
22 |
| Mental Health (see note B) | 4.5
| 26 |
| Smoking Cessation | 5.2 |
26 |
| Drugs Prevention | 1.5 |
12 |
| Teenage Pregnancy | 1.0 |
20 |
| Waiting Lists and Times | 1.8
| 13 |
| Modern Primary Care | 1.5 |
26 |
| Older People's services | 6.9
| 21 |
| Children's services | 4.9 |
21 |
| Quality | 4.3 | 26
|
| Staff Involvement | 0.8 |
26 |
| Information Technology | 1.6
| 18 |
| HAZ Expenditure on 13 DH programmes |
39.9 | |
| Other Expenditure including carry forward |
46.3 | |
| Total HAZ Allocations (note C) | 86.2
| |
Notes to Table 1.
|
| |
A. Preliminary expenditure figures from End of Year reports.
Number of HAZs working on areas as at January 2000.
B. £15.4m was spent directly on the top priorities
of cancer, mental health and CHD, with a further £7.6m being
spent on these areas but being listed on other priority areas
(ie children, elderly, etc).
C. Other expenditure relates to a range of work in support
of key programmes areas such as learning disabilities, physical
disabilities, ethnic minority health as well as wider public health
programmes such as health and housing.
HAZ PROGRESS AND
EARLY OUTCOMES
11. For the 1999-2000 end of year process, the NHS Executive
adopted a four pronged approach that contributes to the End of
Year report for Ministers:
— self assessment of progress by the HAZ;
— high level statement of what the HAZ is aiming
to achieve on each of their workstreams;
— categorisation of Financial data and outturn report
to support the above;
— Report for Ministers by Regional Offices of the
NHS Exective (involving Government Offices of the Regions and
Social Services Inspectorate Regional Offices).
12. This data has only recently been received and is
being analysed. The self assessments will be summarised and placed
on the HAZ Website (www.Haznet.org.uk). This information will
be made available to the committee in due course.
13. The key issues that have emerged so far in implementing
HAZ programmes are:
— HAZs are already starting to have an impact on
health inequalities for people in deprived areas and are on course
to meet most milestones in individual programmes;
— There has been enormous progress in developing
partnership working and relationships have been transformed particularly
between the NHS and local government. There is local enthusiasm
to develop partnership working further. This partnership is now
translating into action on the ground;
— HAZs have involved communities in decision making,
developing new ways of involving local people in making decisions;
— It is a challenge to change the way mainstream
services are delivered although most HAZs are starting to do this.
14. Examples of typical targets from HAZ work addressing
one major area: Coronary Heart Disease are set out as follows.
These are all part of comprehensive programmes addressing both
prevention and treatment. The national objective for CHD is to
reduce deaths by 40 per cent over 10 years.
— Reduce CHD deaths in people aged under 65 by at
least 50 per cent in the five wards with highest rates by March
2007 (Wolverhampton).
— As a partnership to work towards reductions in
deaths from CHD by at least 40 per cent by the year 2010: a reduction
from 486 lives lost (1995-97 baseline) to 292 lives lost by the
year 2010 (Walsall).
— To reduce deaths from heart disease by targeting
primary prevention activities on groups at increased risk of developing
heart disease (including unemployed people and those from ethnic
minority communites): intermediate outcome targets include Child
(11-15) smoking prevalence down from 11 per cent to 6 per cent
in 2005. Number of mothers who quit before or during pregnancy
to increase to 205 by 2005 (Sandwell).
— To reduce death rate from heart disease, stroke
and related conditions in under 75s by at least 40 per cent by
year 2010, 25 per cent reduction by 2005 (Manchester, Salford
and Trafford).
— 40 per cent reduction in CHD in under 75s by 2010
(Sheffield and Nottingham).
15. Examples of outcomes from HAZ work on CHD include:
A. The Edinburgh Heart manual is an evidence based six
week home based cardiac rehabilitation programme that is being
used in Tyne and Wear HAZ following acute mycocardial infarction.
It is encouraging lifestyle changes beneficial to health. Forty
new patients suffering recent heart attack have been referred
to date but with a 50 per cent acceptance rate, 240 patients per
annum will have improved survival and substantial improved quality
of life. Following the first year of introduction, a 3 per cent
reduction in deaths is expected (50 cases) rising to 10 per cent
by year five (180 cases).
B. In Northumberland the HAZ programmes of work have
a direct impact on reducing mortailty, reducing admissions to
hospital for heart attack and stroke (which together with heart
failure represents 40 per cent of emergency admissions over the
winter period), and reducing demand, and therefore potentially
impacting on waiting lists, for revascularisation. The combined
disease register for Northumberland now includes over 15,000 people
known to suffer from ischaemic heart disease, either to have had
a previous heart attack or suffer from angina. The target is to
reduce cholesterol in these patients and evidence over the last
12 months suggests that 1,500 additional people have received
the maximum possible benefit. This means that between 100 and
250 strokes or heart attacks will be prevented over the next five
years.
C. As a result of the CHD prevention programme in East
London:
— 83 per cent of people on the CHD register are
taking prophylactic aspirin (reducing the risk of heart attack)
as compared to 60 per cent in 1998;
— 400,000 people (54 per cent of the ELCHA population)
are covered by a Raised Blood Pressure data set, audit and quality/performance
review as compared to 250,000 in 1998;
— Participation of 60 per cent of GP practices in
a coherent CHD management programme and 50 per cent in a Raised
Blood pressure management programme—increasing at 10 per
cent per annum with a target of over 80 per cent within current
HAZ programme.
— It is estimated that this programme has prevented
heart attacks in at least 200 people and saved at least 50 lives
and had a comparable impact on stroke since 1998.
D. 18,000 people in Sandwell have been trained on the
Bystander CPR Training Programme. This consists of emergency first
aid training for members of the public. Known as "Heartstart",
this course teaches members of the general public what to do if
someone complains of chest pain or collapses. The evidence for
benefits of this training comes from the USA where the chances
of surviving cardiac arrest are four times higher than in Britain.
HAZ EVALUATION
16. An initiative such as HAZ is challenging to evaluate.
Comprehensive community initiatives like HAZs have broad goals
that depend on achieving "synergistic" change. Furthermore,
their goals tend to change over time. Evaluation problems are
compounded by the fact that many of the activities and their intended
outcomes, such as investing in capacity building, generating social
capital and promoting leadership development, are difficult to
measure with conventional research instruments. Finally, the disadvantaged
communities where interventions are focused are complex, open
systems in which it is difficult to disentangle the many forces
that can influence the conduct and outcomes of initiatives.
17. Given these complexities, traditional evaluation
approaches are inappropriate. The fundamental problem is one of
attribution. So many interacting factors impact on the programmes
and activities that HAZs are undertaking that it is almost impossible
to focus attention solely on the mechanisms or interventions of
interest and to assume that contextual factors can be "controlled
for" in some way. New approaches to evaluation are needed.
18. The HAZ evaluation is based on the theories of change
approach in which the partnership set out the long-term outcomes
and strategies that are intended to produce change. The original
problem which the programme is seeking to address is set out with
the activities planned to address the problem and the medium and
longer-term outcomes intended (see diagram). HAZs are asked to
specify targets for each programme of work that satisfy two requirements.
First, they should be articulated in advance of the expected consequences
of actions. Second, these actions and their associated milestones
or targets should form part of a logical pathway that leads towards
strategic goals or outcomes. HAZs have generally found this challenging
but the benefits of this approach are starting to show.
19. A national evaluation of the HAZ initiative began
in January 1999. The evaluation is being carried out by a team
led by Professor Ken Judge of the Personal Social Services Research
Unit. Following an initial scoping exercise, the national evaluation
will take place over a further three years, ending in December
2002. The evaluation aims to identify and review how HAZ agendas
for change are developed and implemented, and to assess achievements.
It will involve an overview of developments in all 26 HAZs in
England, including a more detailed investigation of developments
in eight of those HAZs. In addition to the national evaluation,
HAZs are required to evaluate their programmes locally.
INTERNAL ARRANGEMENTS
WITHIN HAZS
20. The Committee asked for an update on paragraph 10
of last year's evidence: "HAZs should establish clear arrangements
locally for internal performance management, including the local
framework, the reporting cycle and lead responsibilities for performance
management." HAZs have set up internal arrangements so that
the HAZ partnership board can be kept informed on progress on
the full range of HAZ activities. The NHS Executive recognised
that HAZs were not created as statutory bodies and that this meant
that partners would need to allocate some of their own resources
to monitor progress and the financial situation. This was also
in the context of mainstreaming the HAZ way of working. For example
Bradford HAZ created a process to ensure that HAZ project outcomes
and how they will be achieved will be clearly defined. All their
projects are required to undergo a "fitness to start"
evaluation undertaken by Bradford University. Performance management
is led by Regional Offices of the NHS Executive (involving Government
Offices of the Regions and Social Services Inspectorate Regional
Offices).
HAZ FINANCE
21. HAZ funding is helping to bring about change in the
more substantial mainstream budgets of health and local authorities.
HAZs are also expected to link up with other initiatives and help
secure other sources of funding for their areas, such as through
the New Deal Initiative. In 1999-2000 HAZs received total funding
of £86.2 million. Of this £30 million was targeted non-recurrent
funding for HAs with HAZs within their boundaries. In this current
year the resources made available to HAs within HAZs was doubled
from £30 million to £60 million, leading to HAZs receiving
over £120 million in funding in 2000-01. Table 2 below lists
the total funding each HAZ received in 2000-01 compared to 1999-2000.
Table 2
TOTAL HAZ FUNDING IN 1999-2000 AND 2000-01
| Health Action Zone Funding | 1999-2000
| 2000-2001 | % Increase
|
| Lambeth, Southwark and Lewisham | 6,148
| 7,415 | 20.6 |
| East London & The City | 5,535
| 6.339 | 14.5 |
| Plymouth | 2,043 | 2,258
| 10.5 |
| Luton | 1,300 | 2,262
| 74.0 |
| Sandwell | 2,302 | 2,794
| 21.4 |
| South Yorkshire Coalfields | 5,539
| 6,459 | 16.6 |
| Manchester, Salford & Trafford | 7,050
| 8,496 | 20.5 |
| Bradford | 3,822 | 4,705
| 23.1 |
| Tyne & Wear | 8,709 |
9,815 | 12.7 |
| Northumberland | 2,395 |
2,773 | 15.8 |
| North Cumbria | 2,298 | 2,515
| 9.5 |
| Tees | 3,232 | 5,381
| 66.5 |
| Wakefield | 1,666 | 2,620
| 57.3 |
| Leeds | 3,610 | 5,863
| 62.4 |
| Hull & East Riding | 2,824
| 4,727 | 67.4 |
| Merseyside | 7,445 | 12,246
| 64.5 |
| Bury & Rochdale | 2,004
| 3,263 | 62.8 |
| Nottingham | 3,105 | 5,047
| 62.6 |
| Sheffield | 2,923 | 4,599
| 57.3 |
| Leicester City | 1,502 |
2,510 | 67.0 |
| Wolverhampton | 1,388 | 2,320
| 67.1 |
| Walsall | 1,376 | 2,345
| 70.4 |
| North Staffordshire | 2,056
| 3,189 | 55.1 |
| Cornwall & Isles of Scilly | 2,288
| 3,641 | 59.1 |
| Camden & Islington | 2,372
| 3,734 | 57.4 |
| Brent | 1,294 | 1,996
| 54.2 |
| Total | 86,226
| 119,311 | 38.4
|
(iii) How much funding has been made available for
Health Impact Assessments? Has any assessment been made of their
usefulness to date?
20. The Department of Health does not fund health impact
assessments per se. Health Impact assessment as a discipline is
a decision-making tool, and users are not expected to incur any
additional costs through making best use of the available evidence
about the health consequences of their actions. It should therefore
enhance the existing decision-making processes rather than place
any kind of unnecessary, additional burden onto them.
21. The Department has however been centrally funding
methodological research to underpin the practical application
of HIA. This amounted to some £230k in 1999-2000, and is
expected to be around £350k in 2000-01. We also subsidise
conferences and training courses to help develop local capacity
for health impact assessment, as well as producing practical tools
and guidelines for policymakers at all levels.
22. The usefulness of health impact assessment in decision
making becomes apparent by practice. By improving people's health,
it serves to enhance the outcome of the existing decision-making
process. Clearly, of course, a health impact assessment that produced
a health gain was far outweighed by the cost of identifying it,
would be an inefficient use of resources. However, the methodology
allows for this by building in an initial screening step, which
effectively reduces the risk of work being carried out in fruitless
areas.
(iv) Can the Department update the information given
in Tables 3.1.1, 3.1.2 and 3.1.3?
HAZ FINANCE
23. Updated tables are set out below. Table 3.1.2 gives
all information previously provided in Tables 3.1.2 and 3.1.3.
Table 3.1.1
AGE STANDARDISED MORTALITY RATES FOR OUR HEALTHIER NATION
INDICATORS, 1996-98
| Rates per 100,000 Population
|
| HAZs | Circulatory Diseases aged under 75
| All Cancers aged under 75 | Accidents:all ages
|
| Suicide & undetermined injury: all ages
| | | |
London RO
| Lambeth, Southwark and Lewisham HAZ | 153.20
| 156.39 | 13.81 | 13.28
|
| East London & City HAZ | 180.58
| 157.60 | 17.23 | 9.80
|
| Camden and Islington HAZ | 137.51
| 146.35 | 21.86 | 14.05
|
| Brent & Harrow HA (Brent HAZ) | 124.18
| 121.76 | 14.04 | 9.40
|
| West Midlands RO | |
| | |
| Sandwell HAZ | 186.85 | 159.08
| 16.97 | 7.56 |
| Wolverhampton HAZ | 168.37 |
147.82 | 13.24 | 9.14
|
| Walsall HAZ | 156.01 | 147.63
| 15.89 | 5.88 |
| North Staffordshire HAZ | 167.25
| 149.19 | 15.91 | 9.74
|
| Trent RO | |
| | |
| South Yorkshire Coalfields HAZ: |
| | | |
| Doncaster HA | 157.19 | 152.58
| 16.92 | 11.39 |
| Rotherham HA | 167.24 | 148.05
| 11.24 | 7.52 |
| Barnsley HA | 167.38 | 158.27
| 13.36 | 11.36 |
| Nottingham HAZ | 141.55 |
140.81 | 18.28 | 8.63
|
| Sheffield HAZ | 148.76 |
151.69 | 12.92 | 8.28
|
| Leicestershire (Leicester City HAZ) | 130.65
| 125.55 | 17.54 | 8.28
|
| Eastern RO | |
| | |
| Bedfordshire HA (Luton HAZ) | 123.51
| 130.15 | 19.81 | 7.98
|
| North West RO | |
| | |
| Manchester, Salford & Trafford HAZ |
| | |
|
| Manchester HA | 112.81 |
190.47 | 25.03 | 14.86
|
| Salford & Trafford HA | 163.44
| 157.89 | 15.94 | 10.86
|
| Merseyside HAZ: | |
| | |
| Liverpool HA | 199.52 | 187.49
| 17.91 | 9.88 |
| St. Helens & Knowsley HA | 181.87
| 169.20 | 19.28 | 7.78
|
| Wirral HA | 145.68 | 157.36
| 16.15 | 14.57 |
| Sefton HA | 138.27 | 154.74
| 15.62 | 8.76 |
| Bury & Rochdale HAZ | 179.86
| 151.37 | 17.96 | 9.54
|
| South & West RO |
| | | |
| South and West Devon HA (Plymouth HAZ) |
123.01 | 132.33 | 13.11
| 10.79 |
| Cornwall & Isles of Scilly HAZ | 115.44
| 132.11 | 17.59 | 13.05
|
| Northern & Yorkshire RO |
| | | |
| Bradford HAZ | 168.83 | 145.81
| 19.08 | 9.36 |
| Tyne and Wear HAZ: | |
| | |
| Newcastle and North Tyneside HA | 161.54
| 172.93 | 16.73 | 11.00
|
| Gateshead and South Tyneside HA | 168.69
| 176.03 | 16.02 | 11.97
|
| Sunderland HA | 167.55 |
171.98 | 16.99 | 9.79
|
| Northumberland HAZ | 159.50
| 152.04 | 17.68 | 9.30
|
| North Cumbria HAZ | 146.08 |
143.59 | 22.04 | 11.63
|
| Tees HAZ | 171.46 | 165.52
| 14.80 | 10.26 |
| Wakefield HAZ | 159.57 |
144.06 | 18.00 | 8.06
|
| Leeds HAZ | 135.85 | 143.30
| 17.46 | 9.81 |
| Hull and East Riding HAZ | 137.90
| 148.16 | 19.85 | 9.97
|
| England | 133.78
| 136.99 | 16.36
| 9.18 |
Notes:
1. Data is available on a health authority basis rather
than a HAZ basis. Some HAZs consist of more than one HA and others
are part of a HA, where this is the case, it is indicated above.
Table 3.1.2
HAZ PROGRAMME ALLOCATIONS
| 2000-01& 2001-02
| 1999-2002 total |
| Plymouth | 1,037 | 3,111
|
| Sandwell | 1,263 | 3,789
|
| Luton | 742 | 2,226
|
| Manchester, Salford & Trafford | 3,835
| 11,505 |
| Lambeth, Southwark & Lewisham | 3,650
| 10,950 |
| East London & City | 3,189
| 9,567 |
| Bradford | 1,980 | 5,940
|
| Tyne & Wear | 4,784 |
14,352 |
| North Cumbria | 1,253 | 3,759
|
| Northumberland | 1,230 |
3,690 |
| South Yorkshire Coalfields | 3,137
| 9,411 |
| Hull & East Riding | 2,057
| 5,295 |
| Leeds | 2,622 | 6,744
|
| Tees | 2,138 | 5,507
|
| Wakefield | 1,199 | 3,108
|
| Leicester City | 1,176 |
3,047 |
| Nottingham | 2,288 | 5,587
|
| Sheffield | 2,047 | 5,278
|
| Brent | 984 | 2,559
|
| Camden & Islington | 1,874
| 4,836 |
| Cornwall & Isles of Scilly | 1,748
| 4,505 |
| North Staffordshire | 1,470
| 3,801 |
| Walsall | 1,007 | 2,619
|
| Wolverhampton | 996 | 2,589
|
| Bury & Rochdale | 1,484
| 3,836 |
| Merseyside | 5,337 | 13,744
|
| Total | 54,617
| 151,835 |
Notes to Table 3.1.2:
(a) All figures are £'000s and include development support
monies.
(b) These figures are planned allocations as the HAZ Central
Budget for 2000-01 is in the process of being finalised and may
therefore change.
24. HAZs also receive funding for specific projects from
the HAZ Innovations Fund on a bidding basis. Monies have also
been made available for Smoking Cessation and Drugs Prevention.
In 2000-01, as in 1999-2000, HAs in HAZs received £30 million
in their Initial Cash Limits to spend in support of the HAZ programme
and in the geographical area of the HAZ. HAs in HAZs also received
£30 million to target CHD, Cancer and Mental Health in 2000-2001.
3.2 RESEARCH
The Department has recently announced a major development
programme to modernise the funding system for research and development
in the NHS. What are the research priorities for 2000-01 and subsequent
years?
1. NHS R&D Funding will in future comprise:
— NHS Priorities and Needs R&D Funding; and
— NHS Support for Science.
2. Funding will be separated into NHS Support for Science
and NHS Priorities and Needs R&D Funding from 2000-02 onwards,
with systems to manage NHS Priorities and Needs Funding introduced
in subsequent years.
3. NHS Priorities and Needs R&D Funding will support
R&D required to underpin modernisation and quality improvements
in the NHS. Research priorities for the new system and for the
current year will reflect the National Priorities Guidance, National
Service Frameworks and the National Performance Assessment Framework,
and the work of the National Institute of Clinical Excellence.
NHS needs outside service priority areas will receive due attention
and will reflect consultation with NHS users and staff.
4. NHS Support for Science will meet the NHS costs of
supporting R&D under agreed standards of strategic direction
and quality assurance by the research councils and other eligible
R&D funding partners.
4. NHS: RESOURCES AND
ACTIVITY
Resources
4.1 HCHS current and capital resources
(i) 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? Could
the Department include details of spending by age group?
(ii) Could the Department provide a table showing
planned capital spending from 1999-2000 to 2000-01?
(i) 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? Could
the Department include details of spending by age group?
1. The data requested are shown in table 4.1.1.
Table 4.1.1
HCHS EXPENDITURE BY SECTOR AND AGE GROUP 1997-98
Age (years)
| Service Sector | All Births |
0-4 | 5-15 | 16-44
| 45-64 | 65-74 | 75-84
| 85+ | TOTAL |
| Acute | — | 947
| 628 | 2,916 | 2,968
| 2,110 | 2,014 | 1,024
| 12,607 |
| Elderly | — | 16
| 33 | 186 | 227
| 414 | 868 | 662
| 2,407 |
| Mental Health | — | 4
| 38 | 1,295 | 603
| 348 | 418 | 184
| 2,891 |
| Other | 52 | 58
| 44 | 263 | 221
| 159 | 177 | 99
| 1,072 |
| Other Community | 51 | 326
| 353 | 344 | 141
| 67 | 89 | 55 |
1,426 |
| Learning Disability | —
| 35 | 138 | 750
| 309 | 61 | 23
| 7 | 1,324 |
| Maternity | 1,077 | —
| — | — | —
| — | — | —
| 1,077 |
| HQ Administration | 40 | 47
| 42 | 197 | 153
| 108 | 123 | 69
| 779 |
| TOTAL | 1,221 |
1,433 | 1,276 | 5,950
| 4,622 | 3,268 |
3,713 | 2,101 | 23,584
|
Footnotes:
1. In calculating expenditure by age it has been assumed that
all expenditure in Maternity is spent on the baby. No allocation,
from the total, has been allocated to the costs incurred by the
mother (eg hotel costs, complications, etc).
2. HQ Administration has been allocated according to the spend
already known within the relevant age groups.
3. Expenditure on those under 65 occurs in the elderly sector
due to the allocation of General Community Patient Care (which
includes district nursing) and chiropody in this sector. Both
of these initially provided services aimed at the elderly although
their role has now become more wide spread across different age
groups.
4. Prior to 1996-97 monies provided for GP Fundholders to
purchase HCHS care were exclusively allocated to General and Acute
care. A more realistic allocation of expenditure shows that community
services comprised a part of this expenditure. Hence figures may
not be directly comparable with previous years.
5. In 1996-97 several categories of the programme budget were
affected by changes to accounting practice and the changing structure
of the NHS. Included in these was the need to capitalise redundancy
payments, and recharges were no longer included.
6. Figures may not sum due to rounding.
7. Expenditure figures exclude Joint Finance.
2. The latest year for which disaggregated data are available
is 1997-98 since the allocation of programme-age related activity
data is reliant on patient level data from the Hospital Episode
System (HES).
3. The proportion of HCHS expenditure by programme of
care is as follows:
| Programme of Care | Proportion of expenditure
|
| Acute services | 53% |
| Mental health | 12% |
| Services intended primarily for the elderly
| 10% |
| Other services | 14% |
| Learning disability | 6% |
| Maternity | 5% |
4. The proportion of HCHS expenditure by age group is
as follows:
| Age band | Proportion of expenditure
|
| All births | 5% |
| Age 0-4 | 6% |
| Age 5-15 | 5% |
| Age 16-44 | 25% |
| Age 45-64 | 20% |
| Age 65-74 | 14% |
| Age 75-84 | 16% |
| Age 85+ | 9% |
5. Services aimed specifically, or mainly, at the elderly
account for 10 per cent of total HCHS expenditure. However, those
aged 65 and over accounted for 39 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 41 per cent
of acute expenditure, and significant proportions of expenditure
on services for mentally ill people being used by this age group.
(ii) Could the Department provide a table showing planned
capital spending from 1999-2000 to 2000-01?
6. The information requested is shown in table 4,1.2.
Table 4.1.2
PLANNED CAPITAL SPENDING FROM 1999-2000 TO 2000-01
| 1999-2000 | Forecast outturn 2000-01
|
| Hospital and Community Health Services |
£m | £m |
| Goverment Spending | 1,155 |
1,708 |
| Percentage Real Terms Growth |
| 44.6 |
| Receipts from Land Sales | 373
| 363 |
| Percentage Real Terms Growth |
| --4.8 |
| PFI Investment | 381 | 633
|
| Percentage Real Terms Growth |
| 62.5 |
| Other NHS Spending | 33 |
32 |
| Percentage Real Terms Growth |
| --5.2 |
| Total | 1,942
| 2,736 |
| Percentage Real Terms Growth |
| 37.8 |
Real Terms Growth calculated using 29/03/00 GDP deflators
|
4.2 FHS CURRENT RESOURCES
Could the Department provide a table showing gross expenditure
on Family Health Services in 1998-99?
1. The information requested is contained in the attached
table.
Table 4.2.1
FAMILY HEALTH SERVICES GROSS EXPENDITURE, 1998-99
| £ million |
| Service | Gross Expenditure
|
| Non discretionary General Medical Services |
2,243 |
| Non discretionary Drugs | 1,837
|
| Discretionary Drugs | 2,519
|
| Personal Medical Services (PMS) discretionary
| 37 |
| General Dental Services | 1,438
|
| Personal Dental Services (PDS) discretionary
| 4 |
| Discretionary General Medical Services |
878 |
| Dispensing Costs | 781 |
| General Ophthalmic Services | 240
|
| TOTAL | 9,977 |
| Note: PMS and PDS are Primary Care Act pilots designed to test locally managed approaches to the delivery of primary care. PDS and PMS expenditure figures exclude any related capital Investment by NHS Trusts; PDS expenditure figures are also gross of patient charge income.
|
4.3 GMS RESOURCES
(i) Could the Department give an account of the funding
streams for the GMS budget and provide a trend analysis?
(ii) Could the Department provide an account of capital
allocations for primary care investment and the sources of funding
(both HCHS capital and revenue and FHS budgets) over the last
eight years for England and by health authority? Can they reconcile
the GMS budgets against the HCHS and FHS budgets?
(iii) Could the Department provide a trend analysis
of the costs of the rental reimbursement schemes (in graphic form)
by category (eg notional, actual etc) and an explanation for any
changes?
(iv) Could the Department provide an account of the
total value ofthe asset base in primary care by category of owner,
eg HA, LA, GP, private provider?
(v) Could the Department provide an account of estimates
of backlog in repairs and maintenance for primary care nationally
and by health authority?
(vi) Could the Department provide data on the sources
of finance for prmiary care premises and debts outstanding?
(vii) Could the Department provide baseline data
on the changing ownership of primary care premises and provide
details of the top 10 new provider companies?
(viii) Could the Department provide data on practice
premise size (single handed, 1-4, 4-8, 8-12, 12 plus and average
list size) by ownership category?
(i) Could the Department give an account of the funding
streams for the GMS budget and provide a trend analysis?
1. The two funding streams that make up the GMS budget
are the discretionary—(cash-limited) and non-discretionary
(non cash-limited) budgets. Table 4.3.1 gives a trend analysis.
Table 4.3.1
TREND ANALYSIS OF FUNDING STREAMS OF THE GMS BUDGET
| £ millions | 1990-91 |
1991-92 | 1992-93 | 1993-94
| 1994-95 | 1995-96 | 1996-97
| 1997-98 | 1998-99 |
| GMS Non-Discretionary | 1,484
| 1,656 | 1,768 | 1,840
| 1,902 | 1,965 | 2,073
| 2,198 | 2,243 |
| PMS | N/A | N/A
| N/A | N/A | N/A
| N/A | N/A | N/A
| 37 |
| GMS Discretionary | 464 | 600
| 686 | 715 | 723
| 754 | 800 | 835
| 878 |
Source: GMS discretionary and non discretionary financial returns from the former 90 Family Health Service Authorities (up to 1995-96) and the 100 England Health Authorities.
PMS Pilots funding was introduced in 1998-99.
The Discretionary and non discretionary GMS figures reflect the growth over the period in GP and practice staff numbers, and the rise in pay and expenses.
|
2. GPs as a whole receive an average level of pay per
GP plus reimbursement of all expenses. Some of these expenses
eg a proportion of staff, premises and IT costs are met through
non-discretionary spending; pay and the remaining expenses are
delivered through non-discretionary spend. The data is for each
year's expenditure. Expenditure can represent more or less than
the profession's entitlement, which cannot be finalised until
a firm estimate of GMS expenses is available some two to three
years after year end. Over or underpayments are then corrected
in subsequent years.
3. The steep rise in discretionary spend in the early
years of the decade reflects the growth in funding to health authorities
for reimbursement of practice staff, particularly nurses, and
premises improvements.
4. All elements of a PMS Pilot's allocation are funded
by an appropriate transfer of money from the GMS non-discretionary
budget and by local discretionary resources from a health authority's
unified budget, (or, if PMS +, HCHS resources), as a result of
GPs moving from Part II arrangements to Part I of the 1997 NHS
Act.
(ii) Could the Department provide an account of capital
allocations for primary care investment and the sources of funding
(both HCHS capital and revenue and FHS budgets) over the last
eight years for England and by health authority. Can they reconcile
the GMS budgets against the HCHS and FHS budgets.
5. This response has been provided in the context of
the whole of 4.3, which deals with primary care in relation to
GMS only.
6. There are no capital allocations specifically for
GMS. The majority of funding for capital in GMS is made available
through revenue funding streams: HA revenue allocations which
includes GMS discretionary (cash limited) and the GMS non-discretionary
(non-cash limited). Capital related expenditure in the discretionary
element includes cost rents, improvement grants and computer purchases,
while the non discretionary element includes notional rents.
7. GMS capital is allocated as revenue because HAs do
not own the assets acquired. A transfer from HCHS capital to revenue
is made each year to fund an element of the total discretionary
GMS provision.
8. The table below shows the transfers of funds made
for years 1993-94 to 2000-01. Details of transfers for earlier
years are not available.
| TRANSFER OF HCHS CAPITAL FOR HA REVENUE ALLOCATIONS FOR 1993-94 TO 2000-01
|
|
1993-94 £21m
1994-95 £22m
1995-96 £23m
1996-97 £24m
| 1997-98 £25m
1998-99 £26m
1999-00 £26m
2000-01 £27m
|
| |
9. The non-discretionary and discretionary spend for
1991-92 is shown below. The non-discretionary and discretionary
spend for 1992-93 to 1998-99 is shown in the table provided at
question 4.3iii.
| SPEND ON GMS PREMISES (ENGLAND) 1991-92
|
|
Spend on GMS Premises (England) 1991-92
£ million
| |
| Non Discretionary |
|
| Notional Rents | 29.2 |
| Actual Rent | 17.8 |
| Actual Rent—*Health Centres | N/A
|
| Rates/water/sewage | 28.5 |
*Health centre Rates/water/sewage
Ongoing rental on vacated premises
| |
| Non Discretionary Premises total |
75.5 |
| Discretionary | |
| Cost Rents and LA Economic Rents | 97.9
|
| Improvement grants | 28.5 |
| Improvement grants—Health centres |
N/A |
| Grants to surrender lease on poor Premises |
N/A |
| Discretionary Premises total | 126.4
|
Notes to table:
(i) All data is based on FIS(FHS)4 part B and part C Health
Authority audited financial returns respectively.
At the time of responding, the last set of audited data available
is 1998-99.
(ii) GMS capital spend figures only represent a small proportion
of GMS capital spend.
(iii) Non Discretionary:
—From 1997-98 Actual rents was split to additionally
show introduction of Health Centre rents incurred.
—Health Centre rates were created in 1997-98 to identify
costs incurred.
(iv) Discretionary:
—Again, with the introduction of monitoring Health
Centre spend from 1997-98. Improvement Grants have been split
to separately identify Health Centre spend.
(v) Data up to 1995-96 is based on the returns of the former
90 FHSAs. Data from 1996 onwards is based on Health Authority
returns.
(iii) Could the Department provide a trend analysis
of the costs of the rental reimbursement schemes (in graphic form)
by category (eg notional, actual etc) and an explanation for any
changes.
10. The information is shown in table 4.3.4 below and
in figures 4.3.1 and 4.3.2.
Table 4.3.4
SPEND ON GMS PREMISES (ENGLAND) 1992-93 TO 1998-99
| | |
| | | | £ million
|
| Non-Discretionary | 1992-93
| 1993-94 | 1994-95
| 1995-96 | 1996-97
| 1997-98 | 1990-99
|
| Notional Rents | 31.8 | 38.8
| 44.2 | 48.7 | 56.4
| 68.2 | 75.9 |
| Actual rent | 19.1 | 20.4
| 21.6 | 22.5 | 23.2
| 18.2 | 24.7 |
| Actual rent—*Health centres |
| | | |
| 18.10 | 20.7 |
| Rates/water/sewage | 35.1 |
36.5 | 40.0 | 44.2
| 52.0 | 56.9 | 63.6
|
| *Health centre Rates/water/sewage |
| | | |
| 7.1 | 8.1 |
| Ongoing rental on vacated premises |
| | | |
| | 0.1 |
| Non Discretionary Premises total |
86 | 95.7 | 105.8
| 115.4 | 131.6 |
168.5 | 193.1 |
| Discretionary | |
| | | |
| |
| Cost Rents and LA Economic Rents | 104.8
| 90.1 | 90.8 | 94.5
| 96.4 | 96.3 | 98.2
|
| Improvement grants | 20.0 |
25.8 | 37.2 | 41.3
| 28.8 | 20.3 | 22.2
|
| Improvement grants—Health centres |
| | |
| | 7.1 | 5.6 |
| Grants to surrender leases on poor premises
| | | |
| | 0.2 |
| Discretionary Premises total | 134
| 116 | 128 |
136 | 125 | 124
| 126 |
Explanation of Changes:
(i) All data is based on FIS(FHS)4 part B and part C Health
Authority financial returns respectively.
(ii) Non Discretionary:
*from 1997-98 Actual rents was split to additionally show
introduction of Health Centre rents incurred.
*Health centre rates were created in 1997-98 to identify
costs incurred.
(iii) Discretionary:
Again with the introduction of monitoring Health centre spend
from 1997-98—Improvement Grants have been split to separately
identify Health Centre spend.
(iv) Data up to 1995-96 is based on the returns of the fomer
90 FHSAs. Data from 1996 onwards is based on Health Authority
returns.
Source: Financial returns from the former 90 Family Health
Service Authorities (up to 1995-96) and the 100 England Health
Authorities.
(iv) Could the Department provide an account of the total
value of the asset base in primary care by category of owner eg
HA, LA, GP, private provider.
(v) Could the Department provide an account of estimates
of backlogs in repairs and maintenance for primary care nationally
and by health authority.
11. The total value of premises occupied by GPs is around
£2.194 billion. This comprises £1.74 billion owner-occupied
premises, £247 million rented from the private sector and
£207 million for NHS-owned health centres. Financial data
on the value of backlog repair and maintenance for the GP estate
is not held centrally. However, from a total of around 11,000
premises, analysis of a sample of 3,912 rented (excluding health
centres) and notional rented premises showed the following:
(vi) Could the Department provide data on the sources of
finance for primary care premises and debts outstanding.
12. The vast majority of premises are funded through
private capital borrowed from the range of the specialist and
high street financial institutions and banks. Details of outstanding
loans are considered commercially sensitive and are not available.
(vii) Could the Department provide baseline data on the
changing ownership of primary care premises and provide details
of the top ten new provider companies.
13. The ratios for GP premises are 63 per cent owner-occupied,
21 per cent private sector owned and 16 per cent occupying NHS-owned
health centres. To date, premises built by third party developers
have mainly replaced existing premises already rented in the private
sector. It is expected therefore that the above ratios currently
remain constant.
14. The leasing of purpose built premises to GPs is still
a relatively new concept involving an increasing number of developers
with varying numbers of completed projects. A "top ten"
list of companies is not yet feasible in this maturing sector
of the GP estate. However, the Department has issued standards
of size, design, construction and lease terms that all third party
developers should give regard when building premises suitable
for modern primary care.
(viii) Could the Department provide data on practice premise
size (single handed, 1-4, 4-8, 8-12, 12 plus and average list
size) by ownership category.
15. We do not hold this information. The survey/sampling
exercise mentioned earlier (4.3v) is not robust enough yet to
indicate the proportion/numbers of different sized practices occupying
either leasehold or freehold property.
4.4 INFLATION
(i) Could the Department give an explanation as to the
level of funding set aside for inflation in 2000-01? 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?
(ii) 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 1997-98 and 1998-99, together for estimates for 1999-2000?
The tables for HCHS should show separate inflation indices for
Review Body staff and non-Review Body staff pay, and whatever
other breakdowns of staff are available.
(iii) 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)?
(iv) 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? Would the Department provide the weights used
for each sub-index, for each year?
(i) Could the Department give an explanation as to the
level of funding set aside for inflation in 2000-01? 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?
Health Authority Inflation
16. NHS funding will rise by over £4.2 billion in
2000-01—equivalent to 8 per cent real terms growth. This
funding was agreed following the outcome of both the Comprehensive
Spending Review (CSR) and the Chancellors Budget statement in
March. 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.
17. Last December, Health Authorities initially received,
on average, a 6.8 per cent increase in resources. The further
£660 million announced on 27 March will bring the average
increase in cash terms up to 8.9 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.
18. This overall allocation will help the NHS to meet
healthcare pressures reflected in local Health Improvement Plans.
However, it is for health economies, including Health Authorities,
in partnership with NHS 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.
19. It is not therefore possible to provide average "inflation"
funding allocated to each health authority. The Health Service
Cost Index (HSCI) covers England only and so a retrospective view
is also not possible. 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
20. Table 4.4.1 below shows the settlements awarded to
those staff whose pay arrangements are determined by the Review
Bodies.
Table 4.4.1
REVIEW BODY PAY SETTLEMENTS 2000
| Group | Basic Settlement %
| Additional Payments(1) % | Total %
|
| Nursing & Midwifery | 3.4
| 0.5 | 3.9 |
| Professional Allied to Medicine | 3.4
| 0.8 | 4.2 |
| Doctors & Dentists Review Body—HCHS
| 3.3 | — | 3.3
|
| Doctors & Dentists Review Body—FHS 2
| 3.3 | 0.6 | 3.9
|
Footnotes:
1. These additional payments do not include certain elements
for consultants, junior doctors and nurse consultants, which have
yet to be finalised.
2. Recommended an increase of 3.3% for the pay element of
fees for GMPs. The additional payment reflects technical adjustment
such as the GP balancing item.
Prices
21. The GDP deflator is used as a proxy for underlying
non-pay inflation in the NHS. This needs to be adjusted for assumptions
about the level of procurement and other efficiency savings that
the NHS is expected to make. This could reduce non-pay inflation
to around 1 per cent below GDP.
Capital Charges
22. At national level, the cost of capital charges paid
by the NHS is a circular flow of funds. The total of the capital
charges estimates made by NHS trusts forms part of the total cash
resources available through health authority allocations.
23. Indices for land, buildings and equipment are produced
for the Department each year by the Valuation Office, in order
that the NHS may calculate capital charges in advance of the financial
year.
The aggregate index used to uplift capital charges to 2000-01
levels was 3.0 per cent.
(ii) 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 1997-98 and 1998-99, together with estimates for 1999-2000?
The tables for HCHS should show separate inflation indices for
Review Body staff and non-Review Body staff pay, and whatever
other breakdowns of staff are available.
HCHS Pay and Prices Inflation
24. Increases in the cost of goods and services, ie the
non-pay components of inflation are measured by the Health Service
Cost Index (HSCI). The HSCI weights together price increases for
a broad range of items used by the health service—for example,
drugs, medical equipment, fuel, telephone charges—using
weights derived from expenditure on these various goods and services
reported in financial returns.
25. Table 4.4.2 gives details of the pay and non-pay
components used in calculating HCHS pay and price inflation.
Table 4.4.2
INFLATION FOR SPECIFIC ITEMS OF HCHS REVENUE EXPENDITURE
| 1997-98 | 1998-99
| 1999-2000 |
| % | % |
% |
| Total staff pay | 2.5 | 4.9
| n/a |
| Review body staff | 2.2 |
5.1 | n/a |
| Non-Review Body staff | 3.4
| 3.9 | n/a |
| Prices | 0.4 | 2.5
| 1.2 |
| HCHS Total | 1.7 | 4.0
| n/a |
26. The increase in the earnings of Review Body staff
over that of non-Review Body staff may be explained by the larger
increase in the consultant grades (6 per cent +) than that of
junior doctors (less than 2 per cent). This gives a richer skill/grade
mix for those staff covered by the Doctors and Dentist Review
Body, which when combined with the Review Body awards has led
to a higher average increase.
Components of the FHS inflation index
27. The components of the Family Health Service (FHS)
inflation index are set out in Table 4.4.3. For General Medical
Service (GMS) and General Dental Service (GDS), service specific
inflation is calculated as the increase year on year in the average
cost per practitioner. For both services the changes in unit costs
include volume and quality effects (eg Increase practice staff
numbers or the provision of a changing range of services) as well
as pure price effects. For the Pharmaceutical Service (PhS) and
General Ophthalmic Service (GOS), service inflation is assumed
equal to movements in the GDP deflator. GMS cash limited expenditure
has not been included in the calculations. The FHS inflation index
may be affected by a number of changes in primary care services,
including the provision of drug costs in unified budgets, and
will need to be reviewed in the future.
Table 4.4.3
COMPONENTS OF THE FHS INFLATION INDEX
| 1997-98 % | 1998-99 %
| 1999-2000 % |
| GMS | 5.1 | 2.3
| 10.4 |
| GDS | 0.4 | 4.6
| 1.0 |
| PhS | 2.8 | 3.3
| 2.5 |
| GOS | 2.8 | 3.3
| 2.5 |
| FHS Total | 3.0 | 3.2
| 4.2 |
Footnotes:
1. The difference in service inflation figures for the years 1997-98 and 1998-99 from those provided for last year's table is due to changes in the GDP deflator for those years.
2. The 1998-99 and 1999-2000 GMS figures do not include PMS GPs.
3. Figures for 1999-2000 are based on provisional data. This may therefore be affected by a number of changes in primary care services, including the provision of drug cost in unified budgets, and may need to be reviewed in the future.
|
(iii) 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)?
28. Between 1992-93 and 1998-99 the latest year for which
NHS specific indices are available, net NHS expenditure increased
by:
30.9 per cent in cash terms;
29. Table 4.4.4 below shows the year on year increase
in Net NHS expenditure in cash, real terms and after adjusting
for NHS specific inflation.
30. By 2003-04 Net NHS expenditure is forecast to increase
to £56.4 billion, a cash increase of 101.7 per cent from
1992-93 or 52.3 per cent in real terms.
Table 4.4.4
CHANGE IN NET NHS EXPENDITURE 1992-93 TO 2003-04
| Net NHS expenditure
| Cash change | Real terms change
| Change after adjusting for NHS specific inflation
|
| £m | %
| % | % |
| 1992-92 Outturn | 27,968 |
10.3 | 6.8 | 4.3
|
| 1993-94 Outturn | 28,942 |
3.5 | 0.8 | 0.8
|
| 1994-95 Outturn | 30,590 |
5.7 | 4.2 | 3.0
|
| 1995-96 Outturn | 31,985 |
4.6 | 1.6 | 0.8
|
| 1996-97 Outturn | 32,997 |
3.2 | --0.1 | 0.3
|
| 1997-98 Outturn | 34,664 |
5.1 | 2.2 | 2.9
|
| 1998-99 Outturn | 36,612 |
5.6 | 2.3 | 1.7
|
1999-00
Estimated Outturn | 40,066
| 9.4 | 6.8 |
|
| 2000-01 Plan | 44,234 | 10.4
| 8.0 | |
| 2001-02 Plan | 47,964 | 8.4
| 5.8 | |
| 2002-03 Plan | 52,026 | 8.5
| 5.8 | |
| 2003-04 Plan | 56,424 | 8.5
| 5.8 | |
(iv) 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? Would the Department provide the
weights used for each sub-index, for each year?
31. The NHS inflation index is constructed using 5 sub-indices.
These are:
— HCHS pay index: This measures the change
in average paybill per head of those employed within the HCHS;
— HCHS price inflation: This measures the
change in the price of goods and services supplied to the HCHS,
it is measured by the Health Service Cost Index;
— HCHS Capital Inflation Index: This reflects
the changes in prices experienced in HCHS capital projects and
is calculated using a mixture of the construction price index
and the GDP deflator;
— FHS Index: This is produced using different
assumptions for each of the main groups. For general medical services
and general dental services, inflation is calculated as the increase
in the average cost per practitioner. For both services, the change
in unit costs includes volume and quality effects as well as pure
price effects. For pharmaceutical services and general ophthalmic
services, service inflation is assumed equal to movements in the
GDP deflator;
— The "other" Index: This comprises
of the revenue and capital expenditure on Central Health Miscellaneous
Services (CHMS) and Departmental Administration (including the
Medicines Control Agency and NHS Estates). The GDP deflator is
used in the absence of service specific deflators.
Table 4.4.5
COMPOSITE NHS INFLATION INDEX
| Year | HCHS
Pay
| HCHS
Prices | HCHS
Capital
| FHS | Other |
NHS
Total |
| 1991-92 | 100.0 | 100.0
| 100.0 | 100.0 | 100.0
| 100.0 |
| 1992-93 | 107.9 | 104.7
| 97.5 | 104.8 | 103.3
| 105.8 |
| 1993-94 | 112.4 | 106.2
| 99.2 | 105.4 | 106.1
| 108.7 |
| 1994-95 | 116.3 | 107.1
| 104.1 | 107.9 | 107.6
| 115.5 |
| 1995-96 | 121.4 | 110.5
| 108.8 | 110.7 | 110.7
| 115.6 |
| 1996-97 | 125.4 | 112.2
| 112.3 | 114.2 | 114.2
| 119.0 |
| 1997-98 | 128.5 | 112.7
| 117.0 | 117.6 | 117.4
| 121.5 |
| 1998-99 | 134.8 | 115.5
| 122.5 | 121.4 | 121.3
| 126.1 |
The weights attached to each of the elements for each of
the years are shown in table 4.4.6 below.
Table 4.4.6
WEIGHTS USED FOR EACH SUB-INDEX OF THE NHS INFLATION INDEX
| Year | HCHS Pay
| HCHS Prices | HCHS Capital
| FHS | Other |
NHS Total |
| 1991-92 | 49% | 21%
| 6% | 21% | 3%
| 100% |
| 1992-93 | 49% | 21%
| 6% | 21% | 3%
| 100% |
| 1993-94 | 49% | 21%
| 5% | 22% | 3%
| 100% |
| 1994-95 | 49% | 21%
| 6% | 22% | 3%
| 100% |
| 1995-96 | 49% | 21%
| 5% | 22% | 3%
| 100% |
| 1996-97 | 50% | 21%
| 4% | 23% | 3%
| 100% |
| 1997-98 | 47% | 25%
| 3% | 23% | 2%
| 100% |
| 1998-99 | 48% | 26%
| 2% | 23% | 2%
| 100% |
32. A change in the allocation of weights for HCHS current
expenditure between pay and prices took place in 1997-98. Prior
to this HCHS current expenditure was allocated on a 70:30 pay:price
split. Following a reassessment of the spending patterns of the
HCHS it was decided to re-weight using a 65:35 pay:price split.
This will be kept under review.
4.5 HCHS ALLOCATIONS AND
DISTANCE FROM
TARGETS
(i) Could the Department provide a table showing for each
health authority:
(a) allocations for resident populations for 1999-2000
(cash) and 2000-01 (cash and at 1999-2000 prices);
(b) 2000-01 Distance From Targets (DFT) in cash and percentage
terms;
(c) growth for each HA in percentage terms;
(d) net adjustment (cash) for Primary Care Groups and Primary
Care Trusts;
(e) net adjustment for out of area treatments.
(ii) Could the Department include a commentary explaining
the key factors that determined those percentage growth increases
shown in the table?
(iii) Could the Department update the Committee on recent
developments in allocations of HCHS resources and provide the
timetable for any planned changes?
(i) Could the Department provide a table showing for each
health authority:
(a) allocations for resident populations for 1999-2000 (cash)
and 2000-01 (cash and at 1999-2000 prices);
(b) 2000-01 Distance From Targets (DFT) in cash and percentage
terms;
(c) growth for each HA in percentage terms;
(d) net adjustment (cash) for Primary Care Groups and Primary
Care Trusts;
(e) net adjustment for out of area treatments.
1. The information requested is contained in table 4.5.1
below.
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