Select Committee on Health Memoranda


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




 
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