Memorandum by the Department of Health
PUBLIC EXPENDITURE QUESTIONNAIRE 2002
INDEX
1. CURRENT
ISSUES
1.1 NHS Medical Workforce
1.2 Comparative Health Spending Levels
1.3 Concordat Activity
1.4 Buying from Non-UK Providers
1.5 Information for Health
2. GENERAL EXPENDITURE
ISSUES
2.1 NHS Financial Balance
2.2 Overall Expenditure
2.3 Programme Budgets
2.4 Special Allocations
2.5 Expenditure on Community Care
3. NHS RESOURCES
AND ACTIVITY
3.1 General
3.2 Inflation
3.3 Hospital and Community Health Services
Allocations and Distance from Targets
3.4 Public Health
3.5 Care of Mental Health and Learning Disability
Patients
3.6 Expenditure on Prescribing
3.7 Allocations to National Specialist Services
3.8 Management and Administration Costs
3.9 Activity and Waiting Times
3.10 Commission for Health Improvement
3.11 Race Relations (Amendment) Act 2000
4. PERSONAL SOCIAL
SERVICES RESOURCES
AND ACTIVITY
4.1 Waiting times for receipt of care packages
4.2 Free nursing care
4.3 Standard Spending Assessments (SSAs)
4.4 Changes to the SSA formulae
4.5 PSS SSAs with corresponding budget
4.6 Changes in Unit Costs of the main social
services for children and adults
4.7 Proportion of social services for adults
which are purchased from the independent sector
4.8 Number of children fostered
4.9 Number of children involved in schemes
which are specifically designed to support families
4.10 How the delivery of non-residential
social services has changed over the last 5 years
4.11 Specific inflation index for social
services
4.12 Breakdown by client group of gross
expenditure on social services activity
4.13 Changes to statistical information
collected on personal social services
4.14 Details of any research work on the
outcomes and effectiveness of social care
4.15 Fees, Charges and Grants
5. CAPITAL EXPENDITURE
AND INVESTMENT
5.1 General
5.2 Primary Care Capital Investment and
Facilities
5.3 Hospital and Community Health Services
Capital Prioritisation
5.4 Long Term Capital Projects and PFI
5.5 Capital Investment in Social Services
1. CURRENT
ISSUES
1.1 NHS Medical Workforce
1.1.1 Could the Department provide information
(a) on numbers of GP trainers for each of the last five years,
(b) on current numbers of GP trainees, (c) on numbers completing
training this year ?
1.1.2 In view of the impact of the medical
workforce on future NHS costs and effectiveness, could the Department
provide an age breakdown of hospital consultants and of unrestricted
GP principals? Could the Department also provide estimates for
the period 2003 to 2010 of the numbers of: (a) newly graduating
medical school graduates; (b) registrars; (c) consultants and
(d) GPs expected to reach retirement age.
1.2 Comparative Health Spending Levels
1.2.1 Could the Department provide estimates
of how current levels of NHS spending compare with the European
average, and estimates of changes assuming planned rates of growth
in spending from now to 2007?
1.2.2 Would the Department explain how it
measures total health care spending, private as well as public,
for its estimates of spending as a percentage of GDP? Has the
definition of what is included within health care spending changed
since 2000 and, if so, in what way?
1.3 Concordat Activity
1.3.1 How much NHS expenditure has there
been on health care purchased from independent UK providers in
each of the years 1999-2000, 2000-01 and 2001-02? Can these figures
be broken down between acute and non-acute care and by specialty?
1.3.2 How do prices paid by the NHS in 2001-02
for independently provided inpatient and day case treatment compare
with NHS reference costs for the same treatments and procedures?
1.3.3 How many NHS patients were treated
in the private sector under the Concordat by doctors who also
work in the NHS, and what proportion of all patients treated under
the Concordat does this represent? How many were treated by the
same doctor or surgical team they would have been treated by in
the NHS, and what proportion of all patients treated under the
Concordat does this represent?
1.3.4 In a letter to the Committee of 9
January 2002, the Department reported briefly on a survey commissioned
in September 2001, the purpose of which was to understand the
volume, cost and nature of elective treatment provided to the
NHS by the independent sector. Would the Department give a more
detailed account of the findings of this survey, including tables
where appropriate, and in particular the type of procedures making
up the volume of cases commissioned, and the prices obtained by
the NHS, and how these vary between different regions of the country?
Does the Department intend to make the survey data available to
independent researchers? When does the Department intend to re-run
the survey, and when does it expect to make the results available
publicly?
1.4 Buying from Non-UK Providers
1.4.1 How much has the NHS spent on health
care provided outside the UK, for how many patients and for what
treatments, in each of the years 1999-2000, 2000-01 and 2001-02?
What is the likely spending on health care outside the UK for
2002-03? If possible, distinguish between emergency (E111) care,
non-emergency (E112) care and other purchases from non-UK providers.
1.5 Information for Health
1.5.1 Could the Department provide an annual
breakdown of NHS expenditure on IM&T since the launch of "Information
for Health" in 1999, for: IM&T infrastructure; Electronic
Patient Records; clinical governance system; and staff training?
1.5.2 Could the Department state what progress
has been made on the Maternity Care Data Project? Is it on track
to achieve the overall aim of having standardised and consistent
recording of data relating to maternity and childbirth, for women
and patients, within electronic patient record systems in all
affected NHS organisations by April 2003? If this is not likely,
what is the revised date for achieving this aim? What steps have
the Department and the NHS Information Authority taken to achieve
this aim? What resources will be made available to NHS Trusts
and maternity units to upgrade their IT to record data in the
ways defined, and to link their IT systems to those of other NHS
systems?
1.1 NHS Medical Workforce
1.1.1 Could the Department provide information
(a) on numbers of GP trainers for each of the last five years,
(b) on current numbers of GP trainees, (c) on numbers completing
training this year ?
(a) Numbers of GP Trainers
1. Information is available from 1999-2000
on the numbers available to provide GP training as follows:
1999-2000 | 2,111
|
2000-01 | 2,235 |
2001-02 | 2,264 |
(b) GP Trainees
2. The most recent figure for GP Registrars, qualified
doctors training to become GPs, is 1,908 on 31 March 2002. Previous
figures recorded in the annual censuses are:
1997 | 1998 |
1999 | 2000 | 2001
|
1,343 | 1,446 | 1,520
| 1,659 | 1,883 |
(c) Numbers Completing Training
3. The estimated figure based on information received
from Directors of Postgraduate General Practice Education for
the number completing GP training in 2002 is 1,950. This information
is not routinely collected centrally.
1.1 NHS Medical Workforce
1.1.2 In view of the impact of the medical workforce
on future NHS costs and effectiveness, could the Department provide
an age breakdown of hospital consultants and of unrestricted GP
principals? Could the Department also provide estimates for the
period 2003 to 2010 of the numbers of: (a) newly graduating medical
school graduates; (b) registrars; (c) consultants and (d) GPs
expected to reach retirement age.
1. The age breakdown of hospital consultants and Unrestricted
Principals and Equivalent (UPE)* GPs is as follows:
Hospital Medical Consultants by Age Band
|
Total | Under 30
| 30-34 | 35-39 |
40-44 | 45-49 | 50-54
| 55-59 | 60-64 |
65-69 |
25,074 | 7 | 810
| 4,907 | 5,953 | 5,132
| 4,206 | 2,746 | 1,128
| 185 |
Unrestricted Principals and Equivalent* GPs by Age Band
|
Total | Under 30
| 30-34 | 35-39 |
40-44 | 45-49 | 50-54
| 55-59 | 60-64 |
65-69 |
27,956 | 285 | 2,441
| 4,698 | 5,774 | 5,140
| 4,525 | 3,281 | 1,358
| 454 |
Source: Department of Health Medical and Dental Workforce
Statistics: Census on 31 March 2002 and Department of Health General
and Personal Medical Statistics: Census on 31 March 2002.
* UPEs includes Unrestricted Principals, Personal Medical
Services (PMS) contracted GPs and PMS Salaried GPs. These are
headcount figures.
Medical School Graduates
1. The projected numbers of graduates from English medical
schools rounded to the nearest 50 is as follows:
Academic Year | 2002-03
| 2003-04 | 2004-05
| 2005-06 | 2006-07
| 2007-08 | 2008-09
| 2009-10 |
No of Graduates | 3,550 | 3,750
| 4,050 | 4,400 | 4,950
| 5,300 | 5,400 | 5,500
|
Registrars
2. The NHS Plan promised to create a further 1,000 SpR
posts by 2004. In September 2001 there were 13,220 staff employed
as Specialist Registrars (SpRs), Registrars and Senior Registrars
(the Registrar Group) an increase of almost 550 over September
1999. An increase of at least 300 SpR posts in 2002-03 is currently
being implemented and a further increase of at least 400 SpR posts
is planned during 2003-04.
3. The method of planning the number of SpR posts has
recently been changed. A stronger service led element is being
introduced whereby NHS Trusts are invited to bid to create additional
SpR posts where a need is identified locally for an increase in
training capacity. We would therefore expect the increase in SpR
numbers to be significantly in excess of the NHS Plan increase.
Consultants
4. The projected number of consultants is as follows:
| Sep 2002 | Sep 2003
| Sep 2004 | Sep 2005
| Sep 2006 | Sep 2007
| Sep 2008 | Sep 2009
| Sep 2010 |
Total | 27,505 | 29,814
| 31,301 | 31,932 | 32,369
| 32,932 | 34,040 | 35,510
| 36,784 |
These projections are based on the number of doctors already
in and planned to enter SpR training schemes who will obtain their
CCSTs and become eligible to take up consultant posts by 2010.
The projections up to September 2004 also include the impact of
recruitment and retention measures being taken to ensure the NHS
Plan target is achieved.
GPs Reaching Retirement
5. The numbers of GPs projected to reach retirement age
between 2003 to 2010 is as follows:
Year | Estimated UPE retirements
|
2003 | 667 |
2004 | 725 |
2005 | 805 |
2006 | 826 |
2007 | 882 |
2008 | 918 |
2009 | 946 |
2010 | 977 |
6. The projections are based on the numbers forecast
to leave the workforce aged 55 and over. They assume that the
proportion of leavers in each age group will remain the same as
2001.
1.2 Comparative Health Spending Levels
1.2.1 Could the Department provide estimates of how current
levels of NHS spending compare with the European average, and
estimates of changes assuming planned rates of growth in spending
from now to 2007?
1. The latest available data shows that the EU (unweighted)
average spend is 8 per cent of GDPbased on data produced
by the OECD in 2002. This reflects an average of 6 per cent public
expenditure and 2 per cent private expenditure. The table below
sets out how UK expenditure will compare from this year until
2007-08.
| 2002-03
plan
£m
| 2003-04
plan
£m | 2004-05
plan
£m
| 2005-06
plan
£m | 2006-07
plan
£m
| 2007-08
plan
£m |
UK Public Expenditure as per cent of GDP |
6.6% | 6.9% | 7.2%
| 7.5% | 7.8% | 8.2%
|
Plus | | |
| | |
|
Private Healthcare Expenditure | 1.15%
| 1.15% | 1.15% | 1.15%
| 1.15% | 1.15% |
Total Health Expenditure as per cent of GDP |
7.7% | 8.0% | 8.3%
| 8.7% | 9.0% | 9.4%
|
1.2 Comparative Health Spending Levels
1.2.2 Would the Department explain how it measures total
health care spending, private as well as public, for its estimates
of spending as a percentage of GDP? Has the definition of what
is included within health care spending changed since 2000 and,
if so, in what way?
1. The forecasts for the UK are based on expected gross
NHS expenditure in cash and the historic level of private expenditure
as compiled by ONS and published by the OECD. The latest figures
take account of work by the ONS to improve the international comparability
of the UK's health expenditure figures. ONS published experimental
figures in February 2002 using methodology that accorded more
closely with the international definition. Specifically:
Health expenditure by charities and religious
organisations, and non-NHS expenditure on nursing care in nursing
homes has been added; and
Research & Development (R&D) and Education
& Training (E&T) by health administrations has been subtracted.
2. Note that the importance of both R&D and E&T
to the health system is reflected in the international definitions
by treating this as health-related expenditure. ONS continues
to work on improving the comparability of these experimental figures,
and will incorporate these improvements when they publish a further
year's figurescalendar 2001as well as the already
published 1997 to 2000 figuresin February 2003.
1.3 oncordat Activity
1.3.1 How much NHS expenditure has there been on health
care purchased from independent UK providers in each of the years
1999-2000, 2000-01 and 2001-02? Can these figures be broken down
between acute and non-acute care and by specialty?
1. The table shows expenditure by NHS bodies on the purchase
of healthcare from non-NHS bodies. The figures include expenditure
on services provided by all non-NHS bodies, including local authorities
and other statutory bodies, as well as independent healthcare
providers. The figures cannot be broken down between different
types of provider, nor between acute and non-acute care, nor by
specialty. The 2001-02 figure is a provisional figure based on
returns from all but 1.5 per cent of NHS bodies.
Table 1.3.1
EXPENDITURE ON PURCHASE OF HEALTHCARE FROM NON NHS BODIES
Year | Expenditure on Purchase of Healthcare from Non NHS Bodies
(£000's)
|
1999-2000 | 1,301,196 |
2000-01 | 1,549,172 |
2001-02 | 1,786,875 |
Source: Annual financial returns of NHS trusts, primary care
trusts and health authorities
1.3 Concordat Activity
1.3.2 How do prices paid by the NHS in 2001-02 for independently
provided inpatient and day case treatment compare with NHS reference
costs for the same treatments and procedures?
1. Please refer to the answer given to 1.3.4
1.3 Concordat Activity
1.3.3 How many NHS patients were treated in the private
sector under the Concordat by doctors who also work in the NHS,
and what proportion of all patients treated under the Concordat
does this represent? How many were treated by the same doctor
or surgical team they would have been treated by in the NHS, and
what proportion of all patients treated under the Concordat does
this represent?
1. The vast majority of consultants practising in independent
hospitals in this country also hold NHS appointments. Therefore,
the vast majority of NHS patients treated in such hospitals will
have been treated by a consultant who also works for an NHS Trust
or other NHS body. The Department has no information on how many
of those patients were seen by the same consultants they would
have seen had their treatment been carried out in an NHS hospital.
1.3 Concordat Activity
1.3.4 In a letter to the Committee of 9 January 2002,
the Department reported briefly on a survey commissioned in September
2001, the purpose of which was to understand the volume, cost
and nature of elective treatment provided to the NHS by the independent
sector. Would the Department give a more detailed account of the
findings of this survey, including tables where appropriate, and
in particular the type of procedures making up the volume of cases
commissioned, and the prices obtained by the NHS, and how these
vary between different regions of the country? Does the Department
intend to make the survey data available to independent researchers?
When does the Department intend to re-run the survey, and when
does it expect to make the results available publicly?
1. In October 2001, the Department's statisticians carried
out a survey of NHS bodies' use of the independent sector for
acute elective care. It asked about actual use from AprilSeptember
2001. (It also asked about planned use from October 2001 to March
2002, but this was before the announcement of the allocation of
an additional £40 million to help NHS bodies make use of
spare capacity in the independent sector over the winter months.)
2. The survey got a very poor response rate of less than
half of all hospital trusts, primary care trusts and health authorities,
together with a small number of primary care groups.
3. The organisations responding to the survey reported
commissioning a total of 13,226 procedures from the independent
sector between April and September 2001, at a total cost of around
£22.1 million.
4. It is estimated that this represents around 123 procedures
commissioned from the independent sector for every 10,000 NHS
elective inpatient and daycase procedures carried out (a rate
of around 1.2 per cent).
5. The poor response rate means that the survey results
are not reliable.
6. The Department will consider the best way to make
the findings publicly available once it has completed a further
survey to obtain information on activity and prices in the second
half of 2001-02. The further survey is currently in progress.
1.4 Buying from Non-UK Providers
1.4.1 How much has the NHS spent on health care provided
outside the UK, for how many patients and for what treatments,
in each of the years 1999-2000, 2000-01 and 2001-02? What is the
likely spending on health care outside the UK for 2002-03? If
possible, distinguish between emergency (E111) care, non-emergency
(E112) care and other purchases from non-UK providers.
1. There are two separate systems in operation in the
years in question. For all three years specified, Regulations
(EEC) 1408/71 and 574/72 have co-ordinated the social security
and health care systems of the member states of the European Community
and the European Economic Area. These Regulations cover, amongst
other things, emergency health care for temporary visitors (the
E111 arrangements) and referral of patients specifically for treatments
of pre-existing conditions (the E112 scheme).
2. Between January and April 2002 there was also a pilot
in south east England whereby a number of surgical procedures
were commissioned directly by the NHS from healthcare providers
in France and Germany outside the scope of the European Community
arrangements. 190 patients were treated during this pilot and
the total cost of their treatment and travel was approximately
£1.1 million.
3. The data in table 1 below shows, in resource terms,
costs of treatment provided under the terms of the Regulations
to UK insured persons. Actual treatment costs are used for both
emergency care (E111) and for patients referred specifically for
treatment (E112) as well as other categories of persons covered.
But claims do not necessarily distinguish between categories so
that no cost distribution between E111 and E112 arrangements is
available. Patient numbers are not available since claims may
cover several episodes of care for a single individual. However,
the UK approved the following number of patient referrals under
E112 arrangements as follows:-
1999-2000 | 852 |
2000-01 | 1,075 |
2001-02 | 1,167 |
4. Lump sum costs cover, in particular state pensioners
who have relocated to other member states; the costs of their
health care lie with the member state paying the pension (unless
they also have a pension from the member state of residence).
5. No precise information is available on types of treatment
covered. For E111, emergency care covers the range from minor
ambulatory care to major trauma. E112s cover maternity care, ongoing
treatment begun in the UK, specialised care not available in the
UK and care for which there is a long UK waiting time.
Table 1.4.1
EXPENDITURE UNDER REGULATIONS (EEC) 1408/71 AND 574/72
Year | Claim type |
Member States
claims against the
United Kingdom
(£000's)
|
1999-2000 | Total | 176,400
|
| Actual cost | 25,800
|
| Lump sums | 150,600
|
2000-01 | Total | 187,200
|
| Actual cost | 25,600
|
| Lump sums | 161,600
|
2001-02 | Total | 212,800
|
| Actual cost | 25,500
|
| Lump sums | 187,300
|
Notes:
1. All figures relate to the UK.
2. Figures are based on latest available information
as used in the 2001-02 Resource Accounting and Budgeting (RAB)
outturn exercise. This information is compiled in line with the
requirements of the Government Accounting 2000 and National Audit
Office (NAO);
3. Claims against UK are made in national currency and
converted in sterling by using the quarterly mean exchange rates
published by the EU commission;
4. Actual costs under Article 93 of Regulation 574/72
eg E111 (covering temporary visitors) and E112 cases (referred
patients).
5. Lump sums under Articles 94 and 95 of Regulation 574/72
eg E121 (pensioners).
6. £237million resource provision has been made
in Parliamentary Estimates for 2002-03 for treatment under Regulation
1408/71. With respect to treatment directly commissioned by the
NHS, although it is the Government's preference for the NHS to
treat patients close to home, some patients are likely to travel
to other countries in the European Economic Area, for example
in patient choice schemes. Their treatment will be paid for from
local budgets.
1.5 Information for Health
1.5.1 Could the Department provide an annual breakdown
of NHS expenditure on IM&T since the launch of "Information
for Health" in 1999, for: IM&T infrastructure; Electronic
Patient Records; clinical governance system; and staff training?
1. The Department does not separately record expenditure
by local NHS organisations on IM&T in general or on any specific
element of the IM&T programme. Targets are set through the
planning process and funding is made available via general allocations.
Local NHS organisations then plan to meet the targets and progress
is measured in terms of the operational achievement rather than
financial investment.
1.5 Information for Health
1.5.2 Could the Department state what progress has been
made on the Maternity Care Data Project? Is it on track to achieve
the overall aim of having standardised and consistent recording
of data relating to maternity and childbirth, for women and patients,
within electronic patient record systems in all affected NHS organisations
by April 2003? If this is not likely, what is the revised date
for achieving this aim? What steps have the Department and the
NHS Information Authority taken to achieve this aim? What resources
will be made available to NHS Trusts and maternity units to upgrade
their IT to record data in the ways defined, and to link their
IT systems to those of other NHS systems?
SUMMARY
1. A maternity data dictionary project has developed
definitions for maternity which can be used to populate electronic
records. As part of the Information for Health programme
basic electronic records are expected to be in place in the NHS
in 2005 with more sophisticated integrated electronic records
becoming available by 2008. Services are expected to use the definitions
in the maternity data dictionary as they develop electronic records.
Funding for the development of IM&T in maternity services
is included in general Information for Health funds (to
be announced as part of the spending review settlement). As part
of the Children's Services National Service Framework, the Department
will ensure that issues relating to the development of electronic
records using the maternity data dictionary are addressed.
DETAIL
2. The NHS Information Authority Maternity Data Dictionary
Project has developed a Maternity Data Dictionary, which contains
agreed definitions for a core of maternity data items. This standard
was developed in conjunction with the relevant professional organisations.
3. The practicality of adopting the standards was evaluated
with two maternity hospitals and three workshops involving a wide
range of maternity healthcare professionals. It was clear from
this process that adoption of the standard would not place any
significant burden on the service.
4. However, it was concluded that adoption of the standard
would only be practical with electronic information systems. IT
suppliers were therefore engaged via the Computer Suppliers and
Services Agency (merged with the Federation of Electronics Industry
in May 2002 to intellect) to seek their support with integration
of these standards within their products. This was accepted as
a principal and "would be adopted when confirmed as NHS standards".
5. Work is outstanding to obtain approval from the recently
formed NHS Information Standards Board (ISB) for the maternity
data dictionary. However, the ISB has recently agreed to approve
the addition of the maternity dictionary contents to the NHS Data
Dictionary, identified as work in progress. This should provided
limited guidance to maternity system suppliers and Trusts allowing
them to adopt the standard whilst more formal approval is sought.
|