2. GENERAL EXPENDITURE ISSUES
2.3 Programme Budgets
2.3.1 Could the Department update the
information on expenditure on Programme Budgets provided in Tables
2.3.1? [2.3.1]
INTRODUCTION
1. The response to this question is in two
parts. The first part deals with the Hospital & Community
Health Services (HCHS) programme budget for 2001-02 presented
in the format introduced five years ago. (see paragraphs 3 to
7 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 2001-02.
(see paragraphs 8 to 10 below).
SECTION 1—HCHS
PROGRAMME BUDGET:
A "NEW" METHOD
3. Traditionally, detailed HCHS analysis
has been carried out using provider data from directly managed
units. Since NHS Trusts were created in 1991-92, provider data
has become an increasingly poor proxy for healthcare commissioned
by Health Authorities and more recently, Primary Care Trusts.
The fundamental problem is that there are increasing differences
between activity reported by Health Authorities and NHS providers.
Figure 2.3.1 shows the relationship between the two sets
of data.
Figure 2.3.1.
ACTIVITY COVERED BY NHS PROVIDERS AND HEALTH
CARE TRUSTS IN ENGLAND
4. As can be seen from Figure 2.3.1
the common ground between Primary Care Trusts and NHS providers
is activity that has been both commissioned and provided by the
NHS in England. The traditional presentation of HCHS expenditure
blurs the distinction between Primary Care Trusts and NHS providers
by fitting the provider profile of expenditure to the commissioners'
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 Primary Care Trusts and present that data in a more easily
readable format. The results are shown in Table 2.3.1.
5. There are major differences between the
new HCHS programme budget format and the traditional format:
(i) 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.
(ii) A clear distinction has been drawn
between programmes of care (columns) and methods of care (rows).
KEY MESSAGES
6. In 2001-02 overall HCHS expenditure rose
by 6% to £31,977 million. This is equivalent to 1% growth
in volume terms and almost 4% in real terms.
— Over 70% of HCHS expenditure is in
the hospital sector, with community taking over 17%, the remainder
being other spending, including ambulance journeys and local administration.
— The largest programme in both the
hospital and community sectors is for G&A elderly patients
with 42% and 27% of spend respectively.
(See Figure 2.3.2 and Figure 2.3.3
for a graphical representation of the proportions of expenditure
each programme makes up in the hospital and community sectors).
Table 2.3.1
HCHS PROGRAMME BUDGET EXPENDITURE
(£ million at 2001-02
cash prices)
|
| | Programme of care
| General and Acute
|
| Service Type | Total
| Maternity | Mental
Illness
| Learning
Disability |
Children | Adults
| Elderly |
|
| Total Hospital, of which: | 22,642
| 1,222 | 2,979
| 561 | 1,320
| 6,968 | 9,593
|
| Ordinary admissions; (1) | 16,183
| 1,058 | 2,341
| 467 | 763
| 3,610 | 7,944
|
| Day cases; | 1,559
| — | —
| — | 119
| 922 | 535
|
| Outpatients; | 3,532
| 164 | 292
| 17 | 349
| 1,904 | 807
|
| Day care; | 580
| — | 346
| 78 | —
| 53 | 104
|
| Accident & emergency | 772
| — | —
| — | 88
| 480 | 203
|
| Total Community, of which: | 5,528
| 242 | 965
| 1,047 | 834
| 952 | 1,488
|
| Community nursing; | 2,291
| 225 | 521
| 139 | 35
| 443 | 928
|
| Health visiting; | 452
| — | —
| — | 294
| 142 | 16
|
| Professional staff groups; | 705
| 18 | 11
| 1 | 53
| 311 | 311
|
| Immunisation, surveillance and screening |
508 | —
| — | —
| 452 | 55
| 1 |
| Residential care | 1,572
| — | 432
| 908 | —
| — | 232
|
| Ambulance journeys | 597
| 32 | 79
| 15 | 35
| 184 | 253
|
| Other Patient Related | 954
| 50 | 134
| 54 | 73
| 268 | 375
|
| Non Patient Related | 2,256
| 117 | 316
| 129 | 172
| 634 | 888
|
|
| Total HCHS(2) | 31,977
| 1,663 | 4,472
| 1,807 | 2,434
| 9,005 | 12,597
|
|
Footnotes:
1. Includes regular day/night attenders.
2. Figures may not sum due to rounding.
7. Table 2.3.2 shows a summary of Table 2.3.1
by service sector over the last five years for which data
has been available in this form.
Table 2.3.2
HCHS PROGRAMME BUDGET EXPENDITURE CASH PRICES
|
| All prices | 1997-98
| 1998-99 | 1999-00
| 2000-01 | 2001-02
|
|
| Total Hospital | 17,294
| 19,204 | 19,328
| 21,313 | 22,642
|
| Ordinary admissions | 12,433
| 13,618 | 13,877
| 15,233 | 16,183
|
| Day cases | 1,126
| 1,397 | 1,308
| 1,483 | 1,559
|
| Outpatients | 2,687
| 3,001 | 2,970
| 3,325 | 3,532
|
| Day care | 437
| 513 | 500
| 546 | 580
|
| Accident & emergency | 610
| 675 | 675
| 726 | 772
|
| Total community | 4,259
| 4,888 | 4,788
| 5,203 | 5,528
|
| Community nursing | 1,791
| 2,113 | 2,057
| 2,156 | 2,291
|
| Health visiting | 339
| 381 | 407
| 425 | 452
|
| Professional staff groups | 608
| 679 | 608
| 663 | 705
|
| Immunisation, surveillance and Screening |
381 | 429
| 457 | 479
| 508 |
| Residential care | 1,140
| 1,285 | 1,259
| 1,480 | 1,572
|
| Ambulance journeys | 478
| 511 | 505
| 562 | 597
|
| Other Patient related | 631
| 815 | 953
| 898 | 954
|
| Non-Patient related | 1,043
| 77 | 2,058
| 2,124 | 2,256
|
|
| Total HCHS | 23,704
| 25,494 | 27,633
| 30,099 | 31,977
|
|
SECTION 2—TRADITIONAL
PROGRAMME BUDGET
METHODOLOGY
8. This section of the reply discusses trends in Hospital
and Community Health Services (HCHS) gross current expenditure
over the period 1991-92 to 1995-96, and 1997-98 to 2001-02.
9. 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 1996-97
make long term comparisons difficult.
10. Expenditure on HCHS is shown in Table 2.3.3.
The corresponding annual growth rates are also given. These rates
are for the period 1991-92 to 1995-96 and 1997-98 to 2001-02.
Figures 2.3.4 to 2.3.6 illustrate the breakdown
of expenditure between the main programmes and how this has changed
for 1991-92, 1995-96, 1997-98 and 2001-02.
Abbreviations used in Table 2.3.3
CHS = community health services;
DP = day patient;
HCHS = Hospital and Community Health Services;
IP = inpatient;
JF = joint finance;
OP = outpatient;
YPD = younger people with physical and/or sensory disabilities.
Figure 2.3.2
Figure 2.3.3
|
