Select Committee on Health Memoranda

Memorandum by the Department of Health


Table 2.1.7



  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).


  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).

Table 2.2.1



  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.

Table 2.2.2



  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 1999-2000.

  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 Disabilities Nursing

  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.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 17 January 2002