Select Committee on Health Memoranda


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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