House of Commons - Health

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 figures—calendar 2001—as well as the already published 1997 to 2000 figures—in February 2003.

1.3 oncordat Activity

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. 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. 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 April—September 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. 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. 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

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.