Health Select Committee Public Expenditure
Inquiry 2002
RESPONSES
1. 10 years worth of EU Average, EU countries
and UK expenditure figures as a proportion of GDP.
The information requested is contained in the
attached table at Annex A.
2. Confirmation of the Department's assumption
that private sector expenditure on healthcare will remain broadly
static.
The forecasts for Health Care Expenditure as
a percentage of GDP are consistent with those used in the independant
Wanless Report. The report used a figure of 1.15 per cent for
private healthcare expenditure (rounded to one decimal place for
publication to 1.2 per cent). Also, due to the difficulties in
forecasting this expenditure, Wanless assumed that it would remain
constant across the period. This could be considered a prudent
assessment but for consistency we have decided to continue to
use the figures published by Wanless.
The Health Select Committee may be interested to
know that another independent body—The European Observatory
on Healthcare Systems also used the same assumptions in their
study "European Healthcare systems in Eight Countries".
3. Information on progress around tele-health/medicine
The Chairman of the committee had a detailed
query on the delivery of tele-health. As such the response is
also detailed and has been attached as a separate paper titled
"Tele-health"
4. Confirmation that the apparent reduction
in spending on the geriatric sector was due to the transfer of
patients with specific ailments to specialists rather than a reduction
in care for older people.
The recent fall in spending on geriatric care
as a proportion of total hospital expenditure is primarily because
it is becoming more common for elderly patients—those aged
65 and over—to be seen by specialists according to their
medical condition. This is consistent with the explanation given
the committee by Richard Douglas.
5. A copy of the letter referred to by Giles
Denham in respect of the suggestion that standards of care for
older people are falling—(Ian Philps response to article
in HSJ 19 September Page 6).
The letter referred to is attached at Annex
B.
6. An assessment of the cost of agency nurses
to the hospital sector as a whole—to be drawn from annual
accounts when ready.
The information requested is not currently available
and will follow under separate cover.
7. Examples of "quality" to be measured
for the NHS efficiency index.
The indicators of quality we aim to use are
those that relate most closely to outcomes of care, such as the
number of deaths following surgery and strokes. Other indicators
that can potentially indicate changes in the quality of care includes:
the proportion of people returning home following treatment, the
readmission rates and the information we are collecting through
the patient survey.
We have taken care to identify measures that
provide a robust indication of quality. The relatively small numbers
involved can mean that purely random year on year variation produces
fairly large proportionate changes. We also need to ensure that
apparent changes in performance are not due to improved data collection.
This could occur, for example, if we become better at tracking
patients that have been readmitted to hospital following an earlier
discharge.
8. Note on the proportion of consultant to
consultant referrals.
Attached at Annex C is a table and chart showing
GP and "other" referrals. The "other" referrals
include consultant to consultant, as well as referrals from A&E,
and other sources—separate figures are not available.
The table shows that these and other referrals
have recently been growing generally at a faster rate than GP
referrals, but these are not necessarily "new" referrals
into the system.
9. Proposals for allocating money in respect
of populations transferring between social services/local authority
areas.
There are three potential measures of the elderly
population included in the consultation paper. These are resident
population; household population (total population minus those
in institutions); and household population plus the number of
clients supported by local authorities. In recent years the older
people formulae have been based on either resident population
or household population. If we were to move to a single older
people's formula then we would have to adopt a single population
measure.
The residential population includes all people
living in an area including those in institutions. As some authorities
place clients in other boroughs, there is a risk with using this
population measure, as the authority in which the client is placed
will gain even though a different authority is responsible for
financing their care. On the other hand those authorities that
place extensively outside of their boundaries will not be compensated
and may suffer from an under-allocation of resources.
The household population excludes all those
living in institutions. This population measure overcomes the
problem of out of borough placements, but it does not compensate
an authority who may have to support a larger number of older
people in residential care, as they will receive no support for
those already in care. In the extreme case, if an authority placed
all its clients in residential care, they would receive no funding
at all.
The third option includes the local authority
household population plus the number of local authority supported
residents in residential /nursing placements. The advantage of
this option is that it does not count any people in the wrong
area as total resident population does, and it includes most care
home residents rather than omit them, as household population
does.
Julia Drown MP asked for the justification for
not adopting the third option. The main argument authorities have
used on why the resident population should be adopted is that
neither of the other options include self funders in care homes.
The authorities have argued that these clients, who have placed
themselves in an area, are likely at some stage to become the
responsibility of the host authority, and therefore should be
included in the population count. The other argument for using
the resident population is that households population is based
on census information about the proportion of people resident
in households, which is not updateable between censuses and can
quickly become out of date.
The Government is still considering the responses
to the consultation and has not yet reached a decision on which
population to use in the elderly formula.
10. How much of "other spend" under
the Programme Budget breakdown is "litigation" and how
much of that is maternity related?
Of the "other" spend, £91 million
is litigation (clinical negligence) but it is not possible to
break that down to say how much is maternity related. This does
not reflect the full cost of clinical negligence to the NHS. This
is because the Programme Budget is derived from an analysis of
Health Authority expenditure. In 2000-01 the majority of expenditure
on Clinical Negligence was incurred by NHS trusts.
11. What steps is the Dept taking to collect
data from units which do not submit "maternity tails"
data. What is being done to collect data from the private sector
and improve data collection outside hospitals?
Units that find it difficult to submit maternity
tails have the option of submitting separate "flat-file"
data through a service offered by the NHS Wide Clearing Service.
The Department will continue to press for complete and accurate
data and to provide feedback to trusts through the data quality
indicator. In particular, the Department will approach these trusts
to draw attention to their situation in relation to other trusts,
to stress the importance of the data and to alert trusts to the
"flat-file" service. HES collects "other maternity",
which should cover home births and those in private hospitals,
but there are limited resources to improve the generally poor
coverage.
12. What progress has been made since March
2001 with the Maternity Care Data Project? Is it on course to
achieve its aim by April 2003—to have standardised and consistent
recording of data related to maternity and childbirth, for women
and infants, within Electronic Patient Record systems in all affected
NHS organisations?
The Committee is referred to the answer provided
in the memorandum at question 1.5.2.[1]
The Department believes this covers the points raised. DoH is
of course happy to supply further information should it be required.
13. Check on whether information is centrally
held on mothers-to-be choosing to have caesarean sections.
14. Forecast over 30 years of interest and
capital costs of PFI schemes excluding the services element.
The forecast table shows known and estimated
cumulative expenditure on the part of PFI unitary payments representing
building maintenance costs ("Hard" FM), the cost of
the asset and repaying debt on existing and planned PFI projects
(called here the "tariff"). The planned schemes are:
(i) all the medium (£10-£20 million)
and major (£20 million+) schemes currently approved to go
ahead and counting towards the NHS Plan target of "100 new
hospital schemes by 2010" not yet reached financial close;
and
(ii) a reasonable assumption that the number
of small schemes (£1-£10 million) reaching financial
close from now until 2010 will be about the same as have already
signed contracts.
All PFI schemes are different and contain different
levels of support services; there is no mathematical formula for
calculating precisely what the final unitary payment will be.
However, the tariff is certainly a function of capital value and
forecasts can therefore be reasonably accurately extrapolated
from data for schemes,which have already reached financial close.
The spreadsheet shows forecast tariff figures
for scheme yet to sign alongside the existing tariffs already
submitted to the committee so that the relative proportions and
totals for all schemes counting towards the NHS Plan target can
be clearly seen.
The supporting table is attached as a separate
file titled Annex D—Revenue Forecasts.
1 See Public Expenditure and Health and Personal Social
Services 2002 [HC 1210] Back
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