Public Expenditure Questionnaire 2001[1]
CHANGES TO LAST YEAR'S QUESTIONNAIRE ARE
IN BOLD
Unless otherwise stated, table numbers refer to
those in the 2000 PEQ (HC 882).
1. CURRENT ISSUES
1.1 NHS Financial Balance
Based on current forecasts, what will be
the likely financial performance of the NHS in 2001-02 in terms
of financial balance, "deficit" organisations and performance?
1.2 Social Services Waiting Times
Could the Department provide a table showing
the waiting times for receipt of care packages in each social
services department for 2001-02 to 2002-03?
1.3 NHS Lift
Could the Department explain the finance,
funding and accountability processes of NHS Lift? In particular
could the Department clarify the relation between NHS LIFT, the
Minister and parliament and also the relation between NHS LIFT
and Partnerships UK (PUK)?[2]
1.4 NHS Estates
Could the Department describe how NHS Estate
will be disposed of. Could the Department list the directors of
the new company Inventures and their connection with NHS Estates?
Could the Department explain the process of dividing the proceeds
from the disposal of NHS assets and the accountability for public
funds.
1.5 Breast Feeding
Could the Department describe what data it
keeps on breast feeding rates and provide a table showing breast
feeding rates for the last 10 years for which figures are available?
2. NHS AND PSS
EXPENDITURE ISSUES
2.1 Overall Expenditures
2.1a Could the Department provide an updated
version of Table 2.1.1, and of the Department's commentary which
accompanied it? Could it also show this data in graphical form?
Could the Department provide a brief commentary, explaining what
expenditure is included under each section of the table? Can the
footnote to table 2.1.1 explain the measures and their applications
for lines D to G?
2.1b Could the Department identify significant
changes between forecast and actual outturn for 1999-2000 and
between the planned level of spending and forecast outturn for
2000-01, by comparing figures in Table 2.1.1 with current figures.
For each programme the planned level of spending in 1999-2000
and actual outturn expenditure should be shown in tabular form.
2.1c Please identify and explain differences
between the 2001 Departmental Report and the figures in Table
2.1.1.
2.1d What is the Department's assessment
of each programme's performance in 1999-2000 against plans for
that year, and anticipated performance in 2000-01 against plans
for that year and outturn in 1999-2000?
2.1e The supply estimates are now presented
in a simplified form which does not disaggregate the different
sources for appropriations in aid. This is now presented only
in an annex to the Departmental Report (Annex D, Information formerly
in Supply Estimates). For the sake of clarity, could the Department
give a detailed reconciliation between table 2.1.1 and appropriations
in aid for each year since 1995-96 by sub-programme and source
(ie miscellaneous, charges, sales of assets, capital repayments,
trust debt remuneration).
2.1f Any commentary which the Department
wishes to append would be welcome, including information about
efficiency gains and a table showing changes in the Hospital and
Community Health Services cost-weighted index of activity for
the latest 10 years for which figures are available.
2.2 Programme Budgets
Could the Department update the information
on expenditure on Programme Budgets provided in Tables 2.2? Could
the Department ensure that some information is provided for expenditures
on district nursing and health visiting in table 2.2.5?
2.3 Expenditure on Community Care
Could the Department provide a table showing,
by service, net expenditure in real terms by central and local
government on community care, broken down by residential and non-residential
care (taking into account relevant service pay and price increases),
over the most recent five year period for which such data are
available? Could this data include Social Security and Housing
expenditures contributing to Community Care objectives? Could
it also show this data in graphical form?
2.4 Care of Mental Health and Learning Disability
Patients
2.4a Could the Department update the information
given in Tables 2.4, on patients under the care of a learning
disability or mental illness consultant, discharges by length
of stay, ages and destination, and residential and other places
available? Could the Department identify the number of individual
concerned, and hence the number of repeat discharges?
2.4b Could the Department provide a table
showing:
(i) number of people sectioned, by trust
and by type of section?
(ii) number of people sectioned in proportion
to HA population? If the data are not available, will the Department
consider obtaining it from the HES?
(iii) number of people sectioned in proportion
to number of admissions?
(iv) proportion of people who appeal against
being sectioned and the outcomes of the appeals?
2.4c Could the Department provide a table
showing, over the last four years, the numbers of people with
mental health problems and with learning disabilities who have
been in special hospitals, prisons and regional secure units?
2.5 (was 2.6) Special Allocations
Could the Department list any special allocations
and likely allocations in 2001-02, and indicate any likely allocations
in 2002-03?
3. PUBLIC HEALTH
3.1 Saving lives: our healthier nation
set targets in four areas: cancer, CHD and stroke, accidents and
mental health.
3.1a 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 those targets?
3.1b 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.
3.1c How much funding has been made available
for methodological research to underpin the application of Health
Impact Assessments in 2001-02? How will the Health Impact Assessment
process be evaluated?
3.1d Can the Department update the information
given in tables 3.1.1 and 3.1.2?
4. NHS: RESOURCES
AND ACTIVITY
Resources
4.1 Hospital and Community Health Services
current and capital resources
4.1a 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?
4.1b Could the Department provide a table
showing planned capital spending from 2000-01 to 2001-02?
4.2 Family Health Services current resources
Could the Department provide a table showing
gross expenditure on Family Health Services in 1999-2000?
4.3 General Medical Services resources
4.3a Could the Department give an account
of the funding streams for the General Medical Services budget
and provide a trend analysis?
4.3b Could the Department provide an account
of capital allocations for primary care investment and the sources
of funding (both HCHS capital and revenue and Family Health Services
budgets) over the last eight years for England and by health authority?
Can they reconcile the General Medical Services budgets against
the HCHS and Family Health Services budgets?
4.3c 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?
4.3d 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?
4.3e Could the Department provide an account
of estimates of backlog in repairs and maintenance for primary
care nationally and by health authority?
4.3f Could the Department provide data on
the sources of finance for primary care premises and debts outstanding?
4.3g Could the Department provide baseline
data on the changing ownership of primary care premises and provide
details of the top 10 new provider companies?
4.3h 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?
4.4 Inflation
4.4a Could the Department give an explanation
as to the level of funding set aside for inflation in 2001-02?
In particular, can it give the average inflation funding allocation
to each health authority, the average pay awards to each (subjective)
staff group and the inflation assumptions for non pay including
capital charges?
4.4b Could the Department provide a breakdown
of the components of the health specific inflation indices for
revenue spending on HCHS and Family Health Services respectively,
together with capital spending on HCHS, for 1998-99 and 1999-2000,
together with estimates for 2000-01? The tables for the HCHS should
show separate inflation indices for Review Body staff and non-Review
Body staff pay, and whatever other breakdowns of staff are available.
4.4c 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)?
4.4d 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?
4.5 Hospital and Community Health Services
Allocations and Distance from Targets
4.5a Could the Department provide a table
showing for each health authority:
(i) allocations for resident populations
for 2000-01 (cash) and 2001-02 (cash and at 2000-01 prices);
(ii) 2001-02 Distance From Targets (DFT)
in cash and percentage terms;
(iii) growth for each HA in percentage terms;
(iv) net adjustment (cash) for Primary Care
Groups and Primary Care Trusts;
(v) net adjustment for out of area treatments.
4.5b Could the Department include a commentary
explaining the key factors that determined those percentage growth
increases shown in the table?
4.5c Could the Department update the Committee
on recent developments in allocations of HCHS resources and provide
the timetable for any planned changes?
4.6 Capital charges
Could the Department give an account of the
funding system for capital charges, including the basis on which
funding is allocated, whether by formula or otherwise? Could the
Department explain the reasons for and the significance of the
reclassification of Trust Debt Remuneration as an appropriation
in aid in 2000-01?
4.7 Hospital and Community Health Services
capital prioritisation
Could the Department list the criteria used
by the Capital Prioritisation Advisory Group in its assessment
of which projects to prioritise for major investment? Which schemes
were assessed last year, and which were prioritised for investment?
Of these, which have been allocated public and private funding?
Could the Department give examples of schemes which have been
turned down, and explain why?
4.8 Long Term Capital Projects and PFI
4.8a Could the Department provide a table
showing all publicly funded capital projects with a total cost
above £10 million which are under construction during 2001-02?
Could this also show the original and current estimated completion
dates along with a percentage figure for any additional time overrun/saving?
Likewise, the original total cost and current estimated outturn
cost should be provided along with a percentage cost performance
figure.
Could the Department provide a commentary on
cases where there are significant discrepancies between original
estimates of completion dates and/or expenditures and current
estimates?
4.8b Could the Department provide details
of PFI projects with a capital value of £10 million or over
approved since 1992, including their current status?
4.8c Could the Department provide tables
showing the planned and actual annual contribution to capital
from PFI, and the forecast level of investment generated by schemes
over £10 million plus an aggregate of those below £10
million, since 1997-98? What revenue or transitional support is
being given to support the scheme? Could the Department provide
further details of locally agreed arrangements to provide revenue
or transitional support to schemes?
4.8d Could the Department provide a table
showing the increases to the capital cost of schemes since the
last expenditure questionnaire and provide a commentary on changes
of more than 10 per cent? In addition, could the Department provide
the initial costs of PFI schemes at outline business case (baseline
year) for those schemes reported in last year's questionnaire
and comment on increases?
4.8e Could the Department provide data on
the revenue consequences of schemes which have reached financial
close and represent long term contractual commitment over the
next 25 years? Could the Department provide an update of the Departmental
Report table showing the source and applications of HCHS capital,
giving the outturn position for 2000-01?
4.8f For major projects (currently defined
as those greater than £25 million in value), could the Department
please provide a comparison between the PFI price and the publicly
financed option. The publicly financed comparator's costings should
be broken down as follows:
Basic construction contract, broken down between
pre-implementation and post implementation costs;
The value of risk adjustment, again broken down
between pre-implementation and post implementation costs, in both
pounds and percentage terms, and
The final total real full life cost of both options.
Where adjustments have been made to the PFI
costs (to bring prices to a like for like basis), these should
be broken down on the same basis as the publicly funded option.
Could the Department also provide a brief commentary
on any apparent differences between the reported schemes.
4.8g Could the Department update the information
given in Table 4.8g on donated capital additions by region only?
4.8h Could the Department list, by scheme,
how much has been spent on developing business cases for a sample
of schemes worth over £1 million, identifying which schemes
are publicly financed and which financial through the PFI? Where
schemes have reached completion, could the estimated development
costs be compared with actual costs?
4.8i Could the Department detail for every
NHS trust with a hospital development, whether publicly or privately
financed, worth over £25 million (i) the number of NHS beds—general
and acute—currently provided by the trust and (ii) the number
of NHS beds—general and acute—to be provided when
the development is completed?
4.8j For each PFI scheme could the Department
provide the estimates of the unitary fee and split between the
availability and facilities management fee at outline business
case (baseline year) and the actual cost of the unitary fee split
as above on signing off the FBC? Could the Department comment
on how any increases were funded?
4.8k For each PFI scheme signed or given
approval in principle, could the Department provide income and
capital charges of Trusts which make up each PFI scheme prior
to signing and income, availability fee and capital charges on
retained estate for each scheme having signed, or estimates for
those schemes which have not yet signed?
4.9 Capital investment in primary care.
4.9a Could the Department please provide
data on all grants, public loans and capital receipts used to
fund or finance primary care facilities since 1997. Data should
be provided on an annual basis from 1997 and by health authority.
4.9b Could the department please provide
a list of primary care premises which have signed or in the process
of signing up for the use of PFI, together with their total capital
cost, the length of contract, the annual unitary charge and availability
fee and FM fee. Where projects are bundled with non-NHS facilities.
Could they also provide details of the other income streams eg
from commercial and retail, local authority.
4.9c Could the Department please provide
a full account of the revenue implications of using private finance
for all primary care schemes annually for the next 10 years.
4.9d Could the Department please provide
an account of all loans outstanding on primary care premises and
the ownership of these premises.
4.9e Could the Department please provide
a list of the top 20 companies involved in primary care PPPS,
together with the value of their asset base, their turnover and
profits, the value of NHS contracts signed, the loans outstanding
and the NHS revenue streams.
4.9f Could the Department please provide
an account of the value of NHS primary care facilities, the total
value of primary care estate and the backlog in maintenance and
repairs on primary care facilities.
4.10 (was 4.9) Family Health Services Expenditure
on Prescribing
4.10a Could the Department provide information
on total NHS expenditure on pharmaceuticals, including a breakdown
by sector and by generic/branded drugs? Could the Department please
state what data are available on pharmaceuticals in the non primary
care sector, and how they are monitoring drug spending and cost
pressures in the acute hospital and community sectors?
4.10b Could the Department provide information
on (i) total Family Health Services expenditure on prescribing
for each year from 1992-93 to 2000-01, (ii) the average expenditure
per capita, (iii) the total number of items prescribed and average
number per capita, and (iv) the average cost per prescription?
Any commentary which the Department would wish to append would
be welcome, including an assessment of progress in meeting its
stated target of restraining "the growth in the drugs bill
to sustainable and affordable limits".
4.10c Could the Department explain the
measures being taken to control NHS expenditure on generic drugs
in primary care following the price increases in 1999-2000?
4.10d What progress has been made in
getting the pharmaceutical industry to reduce drug costs by 4.5
per cent (as agreed in the PPRS)? Could the Department comment
on issues such as volume, price and substitution? Has the lack
of reliable data to monitor spending led to a breakdown in cost
control?
4.11 (was 4.10) Allocations to National Specialist
Services
What was the total allocation in 1999-2000 and
2000-01 to each of the supra regional services and what is the
planned allocation for 2001-02; and what significant changes have
there been in the overall pattern of expenditure?
4.12 (was 4.11) Management and Administration
Costs
Could the Department provide a commentary on
the progress it has made in defining management costs in PCGs,
Health Authorities and NHS trusts? Could the Department update
Table 4.11.1? Does the Department intend to develop a definition
of NHS administration costs?
Activity
4.13 (was 4.12) Activity Data
Could the Department update the information
given in Tables 4.12 showing activity data by region for 1999-2000
and 2000-01, including: total activity, with trends; activity
by In, Day-Case and Outpatient; maternity and simple access data?
Could the Department provide figures for the ratio of Finished
Consultant Episodes (FCEs) to hospital spells by Region for the
same period? To what extent do a relatively small number of providers
depart from the overall pattern? Could the Department report on
the progress made by the NHS Information Authority in reviewing
clinical information, including the use of the FCE as a measure
of activity?
4.14 (was 4.13) Average Daily Number of Beds
4.14a Could the Department provide information
on 10 year trends in bed availability and patient throughput for
each major hospital sector and for each Region? Could information
on bed occupancy (collected for the first time in 1996-97) and
occupancy rates also be included?
4.14b Could the Department provide figures
for the number of delayed discharges of patients from acute settings
and a commentary on how these delays are being addressed?
4.15 (was 4.14) Maternity Hospital Episode
System
4.15a How many maternities were registered
in each NHS region in 1999-2000 and how many records in the Maternity
Hospital Episode System had (i) maternity tails and, (ii) maternity
tails containing data? Could the Department also update the information
given in Tables 4.14.3-4.14.7?
4.15b Could the Department provide a commentary
on, and show evidence of, the progress Trusts and Regions are
making in improving data quality and on the steps the Department
has taken to ensure improvement?
4.16 (was 4.15) Waiting Lists and Times
4.16a Could the Department provide information
about waiting lists, both distribution by waiting time as well
as mean and median average time, on a district of residence basis
and on a provider unit basis? Could the Department show graphically
changes in mean and median waiting times since March 1988 and
include a table of figures?
4.16b Could the Department provide an update
of Tables 4.15.4 to 4.15.8 on outpatient waiting times?
4.16c Could the Department provide figures
on how many people were removed from waiting lists for day case
treatment and for in-patient treatment (i) because of admission
for treatment and (ii) for reasons other than treatment? How many
people were self-deferred in each six-month period since September
1988? What rules apply to ensure consistent interpretation of
these figures? Has the Department made any assessment of the extent
to which people removed for reasons other than treatment in that
hospital had either been admitted, died, treated in another hospital,
or no longer required treatment?
4.16d Could the Department provide charts
and figures showing how trends in emergency and waiting list,
booked and planned activity have moved with waiting lists sizes
since June 1991? Could the Department provide a both indices and
actual numbers in each case?
4.16e Can the Department provide a comparison
of total numbers of people waiting for outpatient appointments
for each year for which figures are available, separately identifying
trends in the average wait for an outpatient appointment?
4.16f Can the Department estimate the number
of people at each access point of the elective care system broken
down to show:
(a) numbers of GP consultations
(b) numbers of referrals to specialist outpatient
clinics
(c) numbers of attendances at specialist
outpatient clinics
(d) numbers of placements on waiting lists
(differentiated by (i) "waiting list", (ii) "booked"
and (iii) "planned", and
(e) numbers of elective episodes of care,
for each year since 1991-92.
Would the Department provide a commentary on
changes over time in numbers waiting at each stage, and the conversion
rates between each stage?
4.16g What additional mechanisms have been
put in place since last year's response to deal with waiting lists?
How is the success of each of these measured? What assessment
have you made of the effectiveness of each? What has been the
cost of each of these?
4.17 (was 4.16) Performance against Key Patient's
Charter Standards
Could the Department provide an updated version
of Table 4.16 together with appropriate commentary?
5. PERSONAL SOCIAL
SERVICES
5.1 PROVISION
THROUGH PSS SSAS
FOR YEAR
AHEAD
Could the Department set out the Standard Spending
Assessments (SSAs) for social services in the latest year, by
local authority, and SSA sub-block, in cash, per capita, per capita
of relevant population and per client? Could the Department also
provide a table comparing the change in the total PSS SSA between
the last two years for each local authority? Could the Department
describe any changes to the SS formulae introduced in this year
and provide details of any plans the Department has to review
PSS SSAs further? Could the tables include sub-totals for type
of authority and averages (so that individual authorities figures
can be seen in context)?
5.2 Comparison of Budgets with SSAs
Could the Department provide a table comparing
PSS SSAs with the corresponding budget for each local authority
for the latest two years for which comparable information is available?
Could the Department illustrate how the total of PSS SSAs and
budgeted expenditure in PSS have compared at the national level
over the latest five years? Could the Department provide a commentary
on any trends shown by these figures?
5.3 Variations between authorities in unit
costs
Could the Department set out in a table how
the unit costs of the main social services for children and adults
have changed over time? Could the Department quantify the degree
of variation in these unit costs between authorities? Could the
Department provide a commentary on these figures?
5.4 Independent sector provision
Could the Department provide a table showing
for each authority the latest information on the proportion of
social services for adults which are purchased from the independent
sector rather than being provided directly? Could the Department
supply a commentary on these figures?
5.5 Care for children
Could the Department provide a table, by local
authority, comparing the number of children fostered, with the
number of children placed in community homes?
Could the Department provide data on the number
of children involved in schemes which are specifically designed
to support families?
5.6 Variations in service delivery
Could the Department provide figures showing
how the delivery of non-residential social services has changed
over the last five years and comment on these trends?
5.7 PSS demographic pressures
Could the Department provide details of the
specific inflation index calculated for social services, and an
assessment of the financial effect of demographic pressures on
social services?
5.8 PSS Programme Budgets
Could the Department provide a breakdown by
client group of gross expenditure for the latest available two
years on the main items of social services activity? Could the
Department also update Tables 5.8?
5.9 Capital spending on social services
5.9a Could the Department provide figures
on the acquisition, upgrade and sale of personal social services
assets, for the years 1995-96 to 2000-01?
5.9b Could the Department comment on the
outcome for personal social services of the Capital Challenge
Pilot Fund scheme?
5.9c Could the Department provide an
update on PFI projects currently supported, or being considered
by the Departments, and state its criteria for supporting such
projects?
5.9d Could the Department compare actual
capital spend by social services departments with the funding
provided through credit approvals and capital grants?
5.10 Changes to PSS Statistical Information
Could the Department provide details of any
forthcoming changes to statistical information the Department
collects on personal social services?
5.11 Research on outcomes and effectiveness
of social care
Could the Department provide details of any
research work currently being sponsored by the Department on the
outcomes and effectiveness of social care?
5.12 Fees and Charges
Could the Department update Tables 5.12 providing
separate figures on residential care for each client group? Could
the Department quantify the degree of variation in domiciliary
charges between authorities? Could the Department provide a commentary?
Could the Department provide an analysis, to
include chart, tables and commentary, of (i) the recent national
trend in the percentage of gross expenditure on residential accommodation
for older people recouped through fees and charges and (ii) the
recent national trend in the percentage of gross expenditure on
home care/home help for all client groups recouped through fees
and charges?
Could the Department provide an analysis, to
include chart, tables and commentary, of (i) the local authority
variations in the latest year in the percentage of gross expenditure
on residential accommodation for older people recouped through
fees and charges and (ii) the local authority variations in the
latest year in the percentage of gross expenditure on home care/home
help for all client groups recouped through fees and charges?
5.13 Volume, Purpose and Monitoring of Grants
Could the Department provide details of the
volume of specific or special grants made available, by the Department,
to social services departments for the years 1997-98 to 2001-02?
Could the Department provide a full explanation of any changes,
introduced this year, to the volume, the purpose or the monitoring
arrangements for any of the grants?
1 Covers outturn period: 2000-01. Back
2
Partnerships UK (PUK) was announced on 22 July 1999 by the then
Chief Secretary to the Treasury, Alan Milburn. PUK will be a private
sector body to help the public sector get the best deals from
the Private Finance Initiative (PFI) and other forms of public-private
partnerships (PPP). Back
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