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?
1. The response to this question is in two
parts. The first part deals with the Hospital & Community
Health Services (HCHS) programme budget for 1999-2000 presented
in the format introduced three years ago. The Department feels
that this format more accurately reflects expenditure by the NHS
in the latest year for which data is available (see paragraphs
3 to 8 below).
2. The second part deals with longer-term
trends in expenditure within the programme budget. Unfortunately,
due to major discontinuities in the data, figures for 1996-97
are not comparable with those in earlier years and trends are
reported on the period 1991-92 to 1995-96 and 1997-98 to 1999-2000
(see paras 10 to 13).
A "NEW" METHOD
3. Traditionally, detailed HCHS analysis
has been carried out using provider data from directly managed
units. Since trusts were created in 1991-92, provider data has
become an increasingly poor proxy for healthcare commissioned
by Health Authorities. The fundamental problem is that there are
increasing differences between activity reported by Health Authorities
and NHS providers. Figure 2.2.1 shows the relationship between
the two sets of data.
4. As can be seen from Figure 2.2.1. the
common ground between Health Authorities and NHS providers is
activity which has been both commissioned and provided by the
NHS in England. The traditional presentation of HCHS expenditure
blurs the distinction between Health Authorities and NHS providers
by fitting the provider profile of expenditure to the Health Authority
total of expenditure. An alternative method of constructing the
programme budget information has, therefore, been devised. This
programme budget aims to capture the most recent year's expenditure
by Health Authorities and present that data in a more easily readable
format. The results are shown in Table 2.2.1.
5. There are major differences between the
new HCHS programme budget format and the traditional format:
i. The new format covers Health Authority
expenditure regardless of whether it was provided by NHS or non-NHS
providers. Conversely, private patients at NHS providers do not
affect the figures.
ii. The programmes are more logically structured
and the presentation is easier to follow. For example, all general
and acute expenditure on the elderly is presented as one programme,
whereas previously the geriatric programme (ie care led by a consultant
geriatrician) was frequently, and wrongly, taken to mean all general
care for the elderly.
iii. A clear distinction has been drawn between
programmes of care (columns) and method of care (rows).
6. In 1999-2000 overall HCHS expenditure
rose by 12% to £28,463m. This is equivalent to 6.8% growth
in volume terms and 9.6% in real terms.
Over three quarters of HCHS expenditure
is in the hospital sector, with community taking a further 19%,
the remainder being other spending (6%).
The largest programme in both the
hospital and community sectors is for G&A elderly patients
with 44% and 27% of spend
(See Figures 2.2.2 and 2.2.3 for a graphical
representation of the proportions of expenditure each programme
makes up in the hospital and community sectors).
HCHS PROGRAMME BUDGET EXPENDITURE, 1999-2000
1 Includes regular day/night attenders.
2 Figures may not sum due to rounding.
3 Expenditure on RHA Direct spending including
SIFT, R&D etc is now allocated centrally.
7. Table 2.2.2 shows a summary of Table
2.2.1 by service sector over the period for which data has been
available in this form.
8. Figures on health promotion, although
available in the traditional method Programme Budget, are not
available from the data sources that are used in this format.
HCHS PROGRAMME BUDGET EXPENDITURE At 1998-99
9. This section of the reply discusses trends
in Hospital and Community Health Services (HCHS) gross current
expenditure over the period 1989-90 to 1995-96, and 1996-97 to
10. In order to gain the maximum value and
usefulness from the programme budget it is necessary to compare
expenditure trends over a comparative period. Major discontinuities
in several years make long term comparisons difficult. The most
recent changes occurred in 1991-92 and 1996-97. Therefore, although
this section covers the period from 1989-90, trends are only shown
for growth between 1991-92 and 1995-96. The change between 1998-99
and 1999-2000, the latest years available, are also shown.
11. Expenditure on HCHS is shown in Table
2.2.3. The corresponding annual growth rates are also given. These
rates are for the period 1991-92 to 1995-96 and 1998-99 to 1999-2000.
Figures 2.2.4 to 2.2.7 illustrate the breakdown of expenditure
between the main programmes and how this has changed for 1991-92,
1995-96, 1998-99 and 1999-2000.
12. The information collected to produce
Table 2.2.3 does not allow for the expenditure on health visiting
and district nursing to be separately identified. Health Visiting
is included within Professional Advice & Support. Although
Health Visiting will consist of a significant part of this expenditure
other areas, such as school nurses and community medicine, are
included in this category which means that we are unable to identify
expenditure within the separate areas. Similarly, with District
Nursing details on expenditure in this area are included within
General Patient Care. General Patient Care consists of all community
nursing, excluding Community Mental Health and Community Learning
Abbreviations used in Tables 2.2.6: IP = inpatient;
OP = outpatient; DP = day patient; CHS = community health services;
JF = joint finance; HCHS = Hospital and Community Health Services;
Res = residential; YPD = younger people with physical and/or sensory
disabilities; LD = learning disabilities; MH = mental health (previously
mental illness); PSS = Personal Social Services; MI = mental illness;
LA = Local Authority.