Select Committee on Health Memoranda

Memorandum by the Department of Health (PE 1)

PUBLIC EXPENDITURE QUESTIONNAIRE 2004

1  CURRENT ISSUES

1.1  NHS staffing

  1.1.1  Could the Department please provide time-series data on the number of nurses completing training since 1990, and estimates of the numbers leaving the profession in each year since 1990? Could these figures be provided for both headcount and Whole Time Equivalent (WTE)?

  1.1.2  Could the Department supply figures for the number of practice nurses, both in headcount and in Whole Time Equivalent, for the past four years?

  1.1.3  Could the Department provide information on the number of agency nurses employed and expenditure on agency nurses for each NHS Trust, and totals for the NHS in England? [1.2.1]

  1.1.4  How many GPs and consultants respectively have been employed by the NHS, and how many have left the NHS in each year since 1997? Could these figures be provided for both headcount and Whole Time Equivalent?

1.2  Reconfiguration of hospital services

  1.2.1  What criteria are used by the Department in determining the reconfiguration of hospital services? What role do Royal Colleges play in this process?

1.3  Treatment provided outside the NHS

  1.3.1  Could the Department please update the information provided in response to last year's questionnaire on NHS expenditure on health care purchased from independent UK providers, with figures broken down between acute and non-acute care and by specialty? [1.3.1]

  1.3.2  How do the most recent prices paid by the NHS for independently provided inpatient and day case treatment compare with NHS reference costs for the same treatments and procedures? [1.3.2]

  1.3.3  Could the Department provide us with a global figure for the cost of elective surgery provided to NHS patients in the private sector to tackle waiting lists, alongside a global figure for the cost of the same number of procedures on the NHS. Could the total private sector cost be broken down by Trust and PCT? [1.3.3]

  1.3.4  Could the Department please update the information provided in response to last year's questionnaire concerning NHS spending on health care provided outside the UK? [1.4.1]

  1.3.5  Could the Department please supply a breakdown of the costs of setting up each independent sector treatment centre? Which costs are borne by the private companies involved and which by the NHS?

1.4  Waiting list surgery

  1.4.1  Last year, in response to a question about the costs of elective surgery carried out in NHS hospitals outside of routine hours (for example waiting list initiative sessions held at weekends), the Department stated that it was not possible to separately identify the cost of carrying out elective surgery outside routine hours. Is any such information now available? Alternatively, is information available on NHS spending on extra elective surgical sessions to tackle waiting lists? If possible, this should include a global figure and trust by trust figures. [1.8.1]

  1.4.2  Could the department please state the rates of pay for surgeons, anaesthetists, nurses, ODAs and ancillary workers who work extra sessions to carry out elective surgery carried in NHS hospitals outside of routine hours [1.8.2]

1.5  Spending on patient and public involvement in healthcare

  1.5.1  How much has been spent, to date, on establishing and running the Commission for Patient and Public Involvement in Healthcare?

  1.5.2  How much has been spent, to date, on establishing and running Patient and Public Involvement Forums?

  1.5.3  How much has been spent on redundancy costs associated with the abolition of Community Health Councils?

  1.5.4  If the Commission for Patient and Public Involvement in Healthcare is abolished, could the Department estimate the redundancy costs that will be associated with this, as well as the costs that might be associated with transferring any of its functions to a different organisation?

  1.5.5  How much of the stated £500 million savings arising from the Arms Length Body Review will the abolition of the Commission for Patient and Public Involvement in Health contribute?

  1.5.6  What was the total cost of the change from the Community Health Councils to the Commission for Patient and Public Involvement in Health, what will the further total cost be of the change now proposed, and how long will it take to recover this cost from the implied savings arising from the arrangements proposed by the Arms Length Body Review?

  1.5.7  How much has the Commission for Patient and Public Involvement in Health spent on premises, and on IT and other fixed assets, and what future lease payments and fixed asset costs will be written off at a loss to taxpayers as a result of abolition?

  1.5.8  What cost does the Commission for Patient and Public Involvement in Health incur in providing administrative support and advice to Patients' Forums? What will be the cost of the arrangements that the Arms Length Body Review proposes to put in place to provide this administrative support and advice and what is the evidence for proposing that this will provide better value for taxpayers' money?

  1.5.9  What is the funding (in total and per Forum) that the Commission for Patient and Public Involvement in Health provides to each Forum to support Forums' work? What funding will be provided (in total and per Forum) as a result of the arrangements that the Arms Length Body Review proposes, how many members will each Forum have, and what is the evidence the proposals are based on?

  1.5.10  How much will the governance arrangements cost to ensure that the monies the Arms Length Body Review proposes Forums will spend directly as a result of these changes, will be spent effectively, efficiently and economically and for the purposes voted for by Parliament? How do these costs compare with those incurred by the Commission for Patient and Public Involvement in Health?

  1.5.11  What does the Commission for Patient and Public Involvement in Health budget for recruiting Forum Members now that Forums are established? What will the comparative cost of recruitment be, both in total and on a per head basis, if recruitment is undertaken by the NHS Appointments Commission?

  1.5.12  What net savings in back office costs will be made from abolishing the Commission for Patient and Public Involvement in Health after transferring continuing necessary costs to other bodies?

1.6  Maternity services

  1.6.1  What is the total annual clinical waste cost to the NHS from the use of disposable nappies on maternity wards?

  1.6.2  How many contracts do Bounty or other similar direct marketing companies have within the NHS? If such contracts exist:

(a)  what is the total annual revenue to the NHS for such contracts?

(b)  what percentage of hospitals have restrictions on them as a result of such contracts?

  1.6.3  How many NHS hospital maternity wards providing reusable nappies for new mothers?

1.7  Respiratory disease

  1.7.1  How many patients in the UK are currently being treated for chronic obstructive pulmonary disease (COPD)?

  1.7.2  How many in patient bed days were due to respiratory disease in the last year, broken down by condition?

  1.7.3  What is the average length of hospital admission for a COPD patient?

  1.7.4  What is the estimated annual cost of treating a patient with COPD?

  1.7.5  How many specialist respiratory nurses are employed by the NHS?

  1.7.6  How many emergency hospital admissions were for respiratory disease in the last year, broken down by condition?

1.1  NHS staffing

  1.1.1  Could the Department please provide time-series data on the number of nurses completing training since 1990, and estimates of the numbers leaving the profession in each year since 1990? Could these figures be provided for both headcount and Whole Time Equivalent (WTE)?

  1.  Information on the number of nurses completing training since 1990 or on the number of nurses leaving the profession each year is not collected by the Department. The tables show information on the number of training places for nurses and midwives since 1992-93, the first year for which information is available, and the number of nurses employed in the NHS since 1990.

NHS HOSPITAL-BASED AND COMMUNITY QUALIFIED NURSING, MIDWIFERY & HEALTH VISITING STAFF IN ENGLAND AS AT 30 SEPTEMBER EACH YEAR (excluding practice nurses employed by UPEs)

	whole-time equivalent	headcount
2003	291,925	364,692
2002	279,287	346,537
2001	266,171	330,535
2000	256,276	316,752
1999	250,651	310,142
1998	247,238	304,563
1997	246,011	300,467
1996	248,070	301,253
1995	246,822	298,650
1994	238,784	289,284
1993	241,851	293,379
1992	246,570	297,351
1991	243,254	293,774
1990	242,342	285,359

  Source: Department of Health Non-Medical Workforce Census

NHS PRE-REGISTRATION NURSING AND MIDWIFERY TRAINING COMMISSIONS

	Total[2]
2003-04	24,284
2002-03	22,956
2001-02	21,770
2000-01	20,021
1999-00	18,707
1998-99	17,689
1997-98	16,539
1996-97	14,984
1995-96	13,381
1994-95	12,480
1993-94	14,197
1992-93	16,338

1.1.2  Could the Department supply figures for the number of practice nurses, both in headcount and in Whole Time Equivalent, for the past four years?

  1.  As a result of the introduction of PCTs and changing employment practices in the NHS, a small but growing number of practice nurses are now directly employed by PCTs and not UPEs. These PCT employed practice nurses are included in the "other community nurses" returns in the HCHS non-medical census but can not be separately identified. There are no plans to change the census in this respect prior to the introduction of electronic staff records (ESR). ESR will enable the identification of practice nurses employed by PCTs. Such practice nurses are therefore not included in the figures shown in Table 1.1.2 and so the figures do not show the total number of practice nurses working in the NHS.

  2.  The information on the number of headcount and whole time equivalent practice nurses for the past four years is shown in Table 1.1.2.

Table 1.1.2

PRACTICE NURSES EMPLOYED BY UNRESTRICTED PRINCIPALS AND EQUIVALENTS (UPEs)[3]

			whole time equivalents
England, as at 30 September	2000	2001	2002	2003
Whole-time Equivalents	10,711	11,163	11,998	12,967
Headcount	19,200	19,846	20,983	21,677

  Source: Department of Health General and Personal Medical Services Statistics

  3.  Between 2000 and 2003 the number of practice nurses employed by unrestricted principal and equivalent increased by 2,467 (12.8%) headcount and 2,256 (21.1%) wte.

1.1.3  Could the Department provide information on the number of agency nurses employed and expenditure on agency nurses for each NHS Trust, and totals for the NHS in England? [1.2.1]

  1.  The Department does not collect information on the number of agency nursing staff used either in total or by Trust. Most agency nurses are employed to cover a shift, and there is no data on the number of shifts or the average number per agency nurse.

  2.  Information is collected from all NHS Trusts on expenditure on non-NHS staff salaries and wages, including those of nursing staff. The latest year for which this data is available is 2002-03. For England as a whole the total expenditure under the head nursing, midwifery and health visiting was about £590 million. Of this £516 million was spent by NHS Trusts, over £73 million by Primary Care Trusts and £20 thousand by Strategic Health Authorities. Expenditure on non-NHS staff salaries and wages is continuing to rise, for example the 2002-03 spend showed a 6.4% increase over the previous year.

  3.  NHS Professionals was established as a Special Health Authority in April 2004 with four specific objectives:

—  The strategic oversight of the temporary labour markets;

—  The management of agency framework contracts;

—  The setting of standards and the policy framework for NHS temporary staffing; and

—  The operational management of the NHS Professionals service in partnership with the local NHS.

  4.  The service which covers hospital doctors, nursing staff and in some areas, allied health professionals, executive, administration and clerical staff has been implemented in around one third of NHS Trusts in England and is beginning to show encouraging results in reducing reliance on agency staffing

  5.  Detailed information is provided in Table 1.1.3(a) to 1.1.3(c).

Table 1.1.3(a)

SALARIES AND WAGES NON NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2002-03 ENGLAND

Code	NHS Trust	Nursing, midwifery and health visiting (£)
RA2	Royal Surrey County Hospital NHS Trust	1,953,151
RA3	Weston Area Health NHS Trust	2,239,507
RA4	East Somerset NHS Trust	476,961
RA7	United Bristol Healthcare NHS Trust	6,985,815
RA9	South Devon Health Care NHS Trust	458,860
RAE	Bradford Teaching Hospitals NHS Trust	947,763
RAJ	Southend Hospital NHS Trust	2,064,878
RAL	Royal Free Hampstead NHS Trust	7,583,682
RAN	Royal Nat Orthopaedic Hospital NHS Trust	686,883
RAP	North Middlesex University Hospital NHS Trust	3,365,348
RAS	The Hillingdon Hospital NHS Trust	1,397,195
RAT	North East London Mental Health NHS Trust	7,520,400
RAX	Kingston Hospital NHS Trust	4,087,597
RB1	Avon Ambulance Service NHS Trust	0
RB4	Essex Ambulance Service NHS Trust	0
RB5	Gloucestershire Ambulance Services NHS Trust	0
RB6	Mersey Regional Ambulance Service Trust	0
RB7	Staffordshire Ambulance Service Trust	0
RB8	South Yorkshire Ambulance Service NHS Trust	0
RBA	Taunton and Somerset NHS Trust	608,152
RBB	Royal Nat Hospital Rheumatic Diseases NHS Trust	265,079
RBD	West Dorset General Hospitals NHS Trust	1,588,441
RBF	Nuffield Orthopaedic Centre NHS Trust	149,122
RBK	Walsall Hospitals NHS Trust	1,140,727
RBL	Wirral Hospital NHS Trust	876,860
RBN	St Helens and Knowsley Hospitals NHS Trust	766,450
RBQ	The Cardiothoracic Centre—Liverpool NHS Trust	1,155,275
RBS	Royal Liverpool Childrens NHS Trust	736,143
RBT	The Mid Cheshire Hospitals NHS Trust	868,423
RBV	Christie Hospital NHS Trust	1,242,359
RBX	Lincolnshire Ambulance NHS Trust	0
RBZ	Northern Devon Healthcare NHS Trust	130,908
RC1	Bedford Hospitals NHS Trust	1,010,509
RC3	Ealing Hospital NHS Trust	2,540,912
RC9	Luton and Dunstable Hospital NHS Trust	485,697
RCB	York Hospitals NHS Trust	803,922
RCC	Scarborough and NE Yorks NHS Trust	301,308
RCD	Harrogate Health Care NHS Trust	478,500
RCF	Airedale NHS Trust	110,924
RCS	Nottingham City Hospital NHS Trust	42,947
RCU	Sheffield Children's NHS Trust	450,837
RCX	Kings Lynn and Wisbech Hospitals NHS Trust	189,825
RD1	Royal United Hospital Bath NHS Trust	7,094,499
RD3	Poole Hospitals NHS Trust	684,463
RD7	Heatherwood and Wexham Park Hospitals Trust	3,489,707
RD8	Milton Keynes General Hospital NHS Trust	470,691
RDD	Basildon and Thurrock University Hospital NHS Trust	3,742,703
RDE	Essex Rivers Healthcare NHS Trust	2,815,287
RDH	New Possibilities NHS Trust	1,211,199
RDR	South Downs Health NHS Trust	1,013,932
RDU	Frimley Park Hospital NHS Trust	2,413,626
RDY	Dorset Health Care NHS Trust	354,670
RDZ	Royal Bournemouth and Christchurch Trust	434,018
RE6	Cumbria Ambulance Service NHS Trust	0
RE9	South Tyneside Health Care NHS Trust	69,135
REF	Royal Cornwall Hospitals NHS Trust	753,523
REM	Aintree Hospitals NHS Trust	1,078,746
REN	Clatterbridge Centre for Oncology Trust	171,016
REP	Liverpool Womens Hospital NHS Trust	113,174
RET	Walton Neurology Centre NHS Trust	570,311
REU	Burnley Health Care NHS Trust	1,083,237
RF4	Barking, Havering and Redbridge Hospitals NHS Trust	5,923,649
RFF	Barnsley District General Hospital NHS Trust	246,485
RFK	Queen's Medical Notts University Hospital NHS Trust	3,882,407
RFR	Rotherham General Hospitals NHS Trust	1,661,715
RFS	Chesterfield and N Derbyshire Hospital Trust	275,865
RFU	Beds and Herts Ambulance and Paramedic Trust	0
RFW	West Middlesex University NHS Trust	2,973,436
RG2	Queen Elizabeth Hospital NHS Trust	2,782,063
RG3	Bromley Hospitals NHS Trust	6,511,537
RGC	Whipps Cross University Hospital NHS Trust	9,550,351
RGD	Leeds Mental Health Teaching NHS Trust	493,655
RGH	West Yorkshire Ambulance Service Trust	0
RGM	Papworth Hospital NHS Trust	612,531
RGN	Peterborough Hospitals NHS Trust	444,028
RGP	James Paget Healthcare NHS Trust	695,345
RGQ	Ipswich Hospital NHS Trust	897,871
RGR	West Suffolk Hospitals NHS Trust	877,801
RGT	Addenbrooke's NHS Trust	721,835
RGZ	Queen Mary's Sidcup NHS Trust	395,215
RH1	Royal Berkshire Ambulance Service Trust	0
RH2	South Buckinghamshire NHS Trust	2,155,008
RH5	Somerset Partnership NHS and Social Care Trust	270,972
RH8	Royal Devon and Exeter Healthcare NHS Trust	483,229
RHA	Nottinghamshire Healthcare NHS Trust	853,074
RHM	Southampton University Hospitals NHS Trust	4,097,643
RHP	Dorset Ambulance NHS Trust	0
RHQ	Sheffield Teaching Hospitals NHS Trust	1,434,279
RHR	Wiltshire Ambulance Service NHS Trust	0
RHU	Portsmouth Hospitals NHS Trust	5,605,753
RHW	Royal Berkshire and Battle Hospitals NHS Trust	2,035,708
RHX	Oxford Learning Disability NHS Trust	0
RHY	Two Shires Ambulance NHS Trust	0
RJ1	Guy's and St Thomas' NHS Trust	14,262,335
RJ2	The Lewisham Hospital NHS Trust	2,132,529
RJ5	St Mary's NHS Trust	5,956,432
RJ6	Mayday Healthcare NHS Trust	2,090,425
RJ7	St George's Healthcare NHS Trust	5,756,820
RJ8	Cornwall Partnership NHS Trust	169,170
RJ9	Westcountry Ambulance Services NHS Trust	0
RJC	South Warwickshire General Hospitals NHS Trust	426,069
RJD	Mid Staffordshire General Hospitals Trust	462,769
RJE	University Hospital North Staffordshire NHS Trust	2,518,978
RJF	Burton Hospitals NHS Trust	794,386
RJH	Good Hope Hospital NHS Trust	2,113,226
RJL	North Lincolnshire and Goole Hospitals NHS Trust	743,840
RJN	East Cheshire NHS Trust	515,695
RJR	Countess of Chester Hospital NHS Trust	701,215
RJX	Calderstones NHS Trust	0
RJZ	King's College Hospital NHS Trust	8,186,546
RK5	Sherwood Forest Hospitals NHS Trust	173,482
RK7	Community Health Sheffield NHS Trust	1,641,776
RK9	Plymouth Hospitals NHS Trust	2,432,221
RKA	West Midlands Ambulance Service NHS Trust	22,764
RKB	University Hospitals Coventry & Warwickshire NHS Trust	3,001,199
RKD	Hampshire Ambulance Service NHS Trust	0
RKE	The Whittington Hospital NHS Trust	4,017,826
RKF	The Princess Royal Hospital NHS Trust	393,800
RKL	West London Mental Health NHS Trust	2,907,643
RL1	Rob Jones and A Hunt Orthopaedic NHS Trust	146,520
RL4	Royal Wolverhampton Hospital NHS Trust	2,586,112
RL5	Hereford and Worcester Ambulance NHS Trust	0
RL6	Warwickshire Ambulance Service NHS Trust	0
RLN	City Hospitals Sunderland NHS Trust	78,507
RLQ	Hereford Hospitals NHS Trust	1,495,142
RLT	George Eliot Hospital NHS Trust	1,207,607
RLU	Birmingham Women's Health Care NHS Trust	1,040,870
RLY	North Staffs Combined HC NHS Trust	403,749
RLZ	Royal Shrewsbury Hospitals NHS Trust	245,699
RM1	Norfolk and Norwich University Hospital NHS Trust	1,867,099
RM2	South Manchester University Hospital NHS Trust	3,184,676
RM3	Salford Royal Hospitals NHS Trust	3,402,693
RM4	Trafford Healthcare NHS Trust	1,314,870
RM6	Northgate and Prudhoe NHS Trust	160,625
RMA	Greater Manchester Ambulance NHS Trust	0
RMB	B'burn, H'burn & Ribble Valley NHS Trust	1,638,758
RMC	Bolton Hospitals NHS Trust	2,545,250
RMD	Lancashire Ambulance Service NHS Trust	0
RMH	Mental Health Serv of Salford NHS Trust	992,943
RMP	Tameside and Glossop Acute Services NHS Trust	1,563,655
RMY	Norfolk Mental Health Care NHS Trust	732,860
RMZ	East Anglian Ambulance NHS Trust	0
RN1	Winchester and Eastleigh Healthcare NHS Trust	765,214
RN3	Swindon and Marlborough NHS Trust	2,050,643
RN5	North Hampshire Hospitals NHS Trust	3,529,952
RN7	Dartford and Gravesham NHS Trust	781,780
RNA	Dudley Group of Hospitals NHS Trust	3,606,960
RND	South Birmingham Mental Health NHS Trust	1,063,819
RNF	Northern Birmingham Mental Health Trust	547,316
RNH	Newham Healthcare NHS Trust	4,823,018
RNJ	Barts and the London NHS Trust	8,958,711
RNK	Tavistock and Portman NHS Trust	0
RNL	North Cumbria Acute Hospitals NHS Trust	3,922
RNN	North Cumbria MH and Learning Disabilities NHS Trust	123,094
RNP	Newcastle, N Tyneside and Northumberlnd Mental Health NHS	158,746
RNQ	Kettering General Hospital NHS Trust	532,753
RNS	Northampton General Hospital NHS Trust	1,068,636
RNT	Stoke Mandeville Hospital NHS Trust	929,123
RNU	Oxfordshire Mental Healthcare NHS Trust	114,228
RNY	Oxfordshire Ambulance NHS Trust	0
RNZ	Salisbury Health Care NHS Trust	1,532,978
RP1	Northamptonshire Healthcare NHS Trust	2,580,390
RP4	Great Ormond Street Hospital NHS Trust	2,170,272
RP5	Doncaster and Bassetlaw Hospitals NHS Trust	251,769
RP6	Moorfields Eye Hospital NHS Trust	642,091
RP7	Lincolnshire Partnership NHS Trust	104,798
RPA	Medway NHS Trust	1,146,784
RPC	The Queen Victoria Hospital NHS Trust	509,637
RPG	Oxleas NHS Trust	1,754,599
RPH	Kent Ambulance NHS Trust	0
RPL	Worthing and Southlands Hospitals Trust	1,643,519
RPQ	Surrey Ambulance Service NHS Trust	0
RPR	Royal West Sussex NHS Trust	710,891
RPY	The Royal Marsden NHS Trust	1,710,052
RQ2	Sussex Ambulance Service NHS Trust	0
RQ3	Birmingham Children's Hospital NHS Trust	1,618,385
RQ4	Black Country Mental Health NHS Trust	1,170,149
RQ5	Wolverhampton Health Care NHS Trust	187,366
RQ6	Royal Liverpool Broadgreen University Hospital Trust	2,875,122
RQ8	Mid Essex Hospital Services NHS Trust	4,765,640
RQM	Chelsea and Westminster Healthcare Trust	2,650,673
RQN	Hammersmith Hospitals NHS Trust	7,991,878
RQQ	Hinchingbrooke Health Care NHS Trust	256,352
RQW	Princess Alexandra Hospital NHS Trust	3,170,556
RQX	Homerton University Hospital NHS Trust	7,025,074
RQY	SW London and St George's Mental Health Trust	6,468,807
RR1	Birmingham Heartlands and Solihull Trust	1,471,285
RR2	Isle of Wight Healthcare NHS Trust	9,569
RR7	Gateshead Health NHS Trust	871,808
RR8	Leeds Teaching Hospitals NHS Trust	2,743,311
RRD	N Essex Mental Health Partnership NHS Trust	3,459,050
RRE	South Staffordshire Healthcare NHS Trust	1,810,297
RRF	Wrightington, Wigan and Leigh NHS Trust	746,278
RRJ	Royal Orthopaedic Hospital NHS Trust	352,272
RRK	University Hospital Birmingham NHS Trust	2,077,622
RRP	Barnet, Enfield and Haringey Mental Health NHS Trust	2,013,459
RRU	London Ambulance Service NHS Trust	0
RRV	University College London Hospital NHS Trust	10,373,153
RT1	Cambs & Peterborough Mental Health Partnership Trust	2,237,493
RT2	Pennine Care NHS Trust	936,804
RT3	Royal Brompton and Harefield NHS Trust	2,121,525
RT5	Leicestershire Partnership NHS Trust	1,014,644
RT6	Local Health Partnerships NHS Trust	1,033,200
RTC	County Durham and Darlington Priority Service Trust	73,680
RTD	Newcastle upon Tyne Hospitals NHS Trust	1,584,309
RTE	Gloucestershire Hospitals NHS Trust	3,250,507
RTF	Northumbria Health Care NHS Trust	0
RTG	Southern Derbyshire Acute Hospitals NHS Trust	903,241
RTH	Oxford Radcliffe Hospitals NHS Trust	212,471
RTJ	Surrey Hampshire Borders NHS Trust	1,673,793
RTK	Ashford and St Peter's Hospitals NHS Trust	2,154,724
RTM	East Kent NHS and SC Partnership Trust	636,186
RTN	Surrey Oaklands NHS Trust	4,336,434
RTP	Surrey and Sussex Healthcare NHS Trust	6,751,264
RTQ	Gloucestershire Partnership NHS Trust	2,568,839
RTR	South Tees Hospitals NHS Trust	889,094
RTV	5 Boroughs Partnership NHS Trust	353,291
RTX	Morecambe Bay Hospitals NHS Trust	65,382
RV1	Tees East and North Yorkshre Ambulance Services NHS	0
RV3	Central and North West London Mental Health NHS Trust	2,925,714
RV5	South London and Maudsley NHS Trust	6,672,251
RV6	East Midlands Ambulance Servce NHS Trust	0
RV7	Bedfordshire and Luton Community NHS Trust	1,565,687
RV8	North West London Hospitals NHS Trust	5,341,883
RV9	Hull and East Riding Community Health NHS Trust	923,245
RVJ	North Bristol NHS Trust	10,117,444
RVK	North East Ambulance Service NHS Trust	0
RVL	Barnet and Chase Farm Hospitals NHS Trust	3,379,164
RVN	Avon and Wiltshire MHP NHS Trust	3,530,089
RVR	Epsom and St Helier University Hospitals NHS Trust	2,522,590
RVV	East Kent Hospitals NHS Trust	4,179,957
RVW	North Tees and Hartlepool NHS Trust	1,091,762
RVX	Tees and North East Yorkshire NHS Trust	0
RVY	Southport and Ormskirk Hospital NHS Trust	416,087
RW1	West Hampshire NHS Trust	2,200,004
RW3	Central Manchester/Manchester Child NHS Trust	5,462,910
RW4	Mersey Care NHS Trust	2,744,140
RW5	Lancashire Care NHS Trust	1,796,700
RW6	Pennine Acute Hospitals NHS Trust	6,287,856
RW7	North West Surrey Mental Health NHS Partnership Trust	1,230,212
RW8	West Sussex Health and Social Care NHS Trust	1,801,559
RW9	South of Tyne and Wearside Mental Health NHS Trust	6,679
RWA	Hull and East Yorkshire Hospitals NHS Trust	551,525
RWC	Doncaster and South Humber Healthcare NHS	533,864
RWD	United Lincolnshire Hospitals NHS Trust	1,392,126
RWE	University Hospitals of Leicester NHS Trust	3,878,047
RWF	Maidstone and Tunbridge Wells NHS Trust	4,358,121
RWG	West Hertfordshire Hospitals NHS Trust	6,240,487
RWH	East and North Hertfordshire NHS Trust	2,030,367
RWJ	Stockport NHS Trust	2,054,514
RWK	East London and the City Mental Health NHS Trust	1,886,990
RWN	South Essex Partnership NHS Trust	914,301
RWP	Worcestershire Acute Hospitals NHS Trust	8,704,730
RWQ	Worcestershire Mental Health Partnership NHS Trust	1,398,220
RWR	Hertfordshire Partnership NHS Trust	3,599,509
RWT	Buckinghamshire Mental Health NHS Trust	1,477,546
RWV	Devon Partnership NHS Trust	980,925
RWW	North Cheshire Hospitals NHS Trust	4,431,330
RWX	Berkshire Healthcare NHS Trust	4,628,191
RWY	Calderdale and Huddersfield NHS Trust	266,403
RXA	Cheshire and Wirral Partnership NHS Trust	1,026,553
RXC	East Sussex Hospitals NHS Trust	3,211,840
RXD	East Sussex County Healthcare NHS Trust	1,306,311
RXF	Mid Yorkshire Hospitals NHS Trust	1,573,182
RXG	South West Yorkshire Mental Health NHS Trust	661,460
RXH	Brighton and Sussex University Hospitals NHS Trust	8,086,450
RXJ	West Kent NHS and Social Care Trust	2,564,000
RXK	Sandwell & West Birmingham Hospitals NHS Trust	1,663,522
RXL	Blackpool, Fylde and Wyre Hospitals NHS Trust	338,447
RXM	Derbyshire Mental Health Services NHS Trust	1,324,384
RXN	Lancashire Teaching Hospitals NHS Trust	1,268,475
RXP	Co Durham & Darlington Acute Hospital NHS Trust	2,147,758
TAD	Bradford District Care Trust	2,678,448
TAE	Manchester Mental Health & Social Care Trust	1,603,415
TAF	Camden & Islington Mental Health & Social Care Trust	7,148,354
	England	516,031,943

Source: Annual Financial Returns of NHS Trusts

Table 1.1.3(b)

SALARIES AND WAGES NON NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2002-03 ENGLAND

Code	Primary Care Trust	Nursing, midwifery and health visiting (£)
5A1	New Forest PCT	424,086
5A2	Norwich PCT	1,591,730
5A3	South Gloucestershire PCT	54,330
5A4	Havering PCT	1,424,459
5A5	Kingston PCT	883,508
5A7	Bromley PCT	566,995
5A8	Greenwich PCT	124,310
5A9	Barnet PCT	775,675
5AA	South Manchester PCT	346,355
5AC	Daventry and South Northamptonshire PCT	40,000
5AF	North Peterborough PCT	960
5AG	South Peterborough PCT	0
5AH	Tendring PCT	707,277
5AJ	Epping Forest PCT	441,508
5AK	Southend on Sea PCT	31,271
5AL	Central Derby PCT	205,705
5AM	Mansfield District PCT	8,594
5AN	North East Lincolnshire PCT	0
5AP	Newark and Sherwood PCT	0
5AT	Hillingdon PCT	32,275
5AW	Airedale PCT	45,325
5AX	Bexley PCT	81,822
5C1	Enfield PCT	474,789
5C2	Barking and Dagenham PCT	119,807
5C3	City and Hackney Teaching PCT	1,550,038
5C4	Tower Hamlets PCT	1,147,950
5C5	Newham PCT	746,728
5C6	Walthamstow, Leyton and Leytonstone PCT	308,878
5C7	Chingford, Wanstead and Woodford PCT	1,167,129
5C8	Redbridge PCT	53,585
5C9	Haringey Teaching PCT	562,162
5CC	Blackburn with Darwen PCT	47,519
5CD	North Dorset PCT	609,804
5CE	Bournemouth Teaching PCT	910
5CF	Bradford City PCT	141,856
5CG	Bradford South and West PCT	9,688
5CH	North Bradford PCT	121,023
5CK	Doncaster Central PCT	0
5CL	Central Manchester PCT	127,110
5CM	Dartford, Gravesham and Swanley PCT	236,931
5CN	Herefordshire PCT	768,673
5CP	Hertsmere PCT	154,203
5CQ	Milton Keynes PCT	743,164
5CR	North Manchester PCT	49,180
5CV	South Hams and West Devon PCT	8,047
5CW	Torbay PCT	43,601
5CX	Trafford South PCT	85,209
5CY	West Norfolk PCT	133,367
5D1	Solihull PCT	234,774
5D2	West Lincolnshire PCT	9,742
5D3	Lincolnshire South West Teaching PCT	17,131
5D4	Carlisle and District PCT	40,391
5D5	Eden Valley PCT	5,081
5D6	West Cumbria PCT	0
5D7	Newcastle PCT	35,357
5D8	North Tyneside PCT	0
5D9	Hartlepool PCT	92,691
5DC	Harlow PCT	32,790
5DD	Morecambe Bay PCT	44,799
5DF	North Hampshire PCT	382,914
5DG	Isle of Wight PCT	0
5DH	West Wiltshire PCT	50,753
5DJ	South Wiltshire PCT	33,578
5DK	Newbury and Community PCT	0
5DL	Reading PCT	353,345
5DM	Slough PCT	79,136
5DN	Wokingham PCT	11,586
5DP	Vale of Aylesbury PCT	153,708
5DQ	Burntwood, Lichfield and Tamworth PCT	91,120
5DR	Wyre Forest PCT	10,881
5DT	North East Oxfordshire PCT	236,027
5DV	Cherwell Vale PCT	253,632
5DW	Oxford City PCT	359,027
5DX	South East Oxfordshire PCT	253,951
5DY	South West Oxfordshire PCT	757,798
5E1	North Tees PCT	40,080
5E2	Selby and York PCT	166,623
5E3	East Yorkshire PCT	1,088
5E4	Yorkshire Wolds and Coast PCT	309,865
5E5	Eastern Hull PCT	13,085
5E6	West Hull PCT	3,151
5E7	Eastern Wakefield PCT	5,410
5E8	Wakefield West PCT	24,648
5E9	Mid-Hampshire PCT	0
5EA	Chesterfield PCT	257
5EC	Gedling PCT	94,955
5ED	Amber Valley PCT	286,601
5EE	North Sheffield PCT	0
5EF	North Lincolnshire PCT	0
5EG	North Eastern Derbyshire PCT	9,850
5EH	Melton, Rutland and Harborough PCT	40,229
5EJ	Leicester City West PCT	41,789
5EK	Doncaster East PCT	0
5EL	Doncaster West PCT	0
5EM	Nottingham City PCT	888,295
5EN	Sheffield West PCT	0
5EP	Sheffield South West PCT	103,575
5EQ	South East Sheffield PCT	0
5ER	Erewash PCT	98,984
5ET	Bassetlaw PCT	8,425
5EV	Broxtowe and Hucknall PCT	158,813
5EX	Greater Derby PCT	4,191
5EY	Eastern Leicester PCT	0
5F1	Plymouth Teaching PCT	0
5F2	Chorley and South Ribble PCT	28,929
5F3	West Lancashire PCT	32,745
5F4	Heywood and Middleton PCT	5,588
5F5	Salford PCT	121,947
5F6	Trafford North PCT	69,534
5F7	Stockport PCT	5,217
5F8	Bebington and West Wirral PCT	534
5F9	Southport and Formby PCT	212,972
5FA	Ashfield PCT	0
5FC	Rushcliffe PCT	379,589
5FD	East Hampshire PCT	818,280
5FE	Portsmouth City Teaching PCT	436,187
5FF	South West Kent PCT	17,347
5FH	Bexhill and Rother PCT	42,426
5FJ	Hastings and St Leonards PCT	0
5FK	Mid-Sussex PCT	924
5FL	Bath and North East Somerset PCT	2,590,413
5FM	West of Cornwall PCT	17,029
5FN	South and East Dorset PCT	70,986
5FP	South West Dorset PCT	277,023
5FQ	North Devon PCT	51,039
5FR	Exeter PCT	105,918
5FT	East Devon PCT	128,731
5FV	Mid Devon PCT	59,220
5FW	Somerset Coast PCT	193,754
5FX	Mendip PCT	251,236
5FY	Teignbridge PCT	13,593
5G1	Southern Norfolk PCT	40,551
5G2	Bracknell Forest PCT	137,121
5G3	Windsor, Ascot and Maidenhead PCT	68,379
5G4	Chiltern and South Bucks PCT	185,653
5G5	Wycombe PCT	161,004
5G6	Blackwater Valley and Hart PCT	142,160
5G7	Hyndburn and Ribble Valley PCT	35,212
5G8	Burnley, Pendle and Rossendale PCT	215,283
5G9	North Liverpool PCT	21,047
5GC	Luton PCT	93,981
5GD	Bedford PCT	29,760
5GE	Bedfordshire Heartlands PCT	375,529
5GF	Huntingdonshire PCT	0
5GG	Welwyn Hatfield PCT	29,508
5GH	North Hertfordshire and Stevenage PCT	69,958
5GJ	South East Hertfordshire PCT	91,964
5GK	Royston Buntingford & Bishop's Stortford	585,612
5GL	Maldon and South Chelmsford PCT	229,114
5GM	Colchester PCT	462,690
5GN	Uttlesford PCT	212,231
5GP	Billericay, Brentwood and Wickford PCT	0
5GQ	Thurrock PCT	0
5GR	Basildon PCT	0
5GT	Great Yarmouth PCT	20,488
5GV	Watford and Three Rivers PCT	68,535
5GW	Dacorum PCT	12,945
5GX	St Albans and Harpenden PCT	154,000
5H1	Hammersmith and Fulham PCT	720,821
5H2	Birkenhead and Wallasey PCT	1,383
5H3	Cheshire West PCT	15,824
5H4	Central Cheshire PCT	28,156
5H5	Eastern Cheshire PCT	18,740
5H6	Ellesmere Port and Neston PCT	193,497
5H7	Derbyshire Dales & South Derbyshire PCT	128,655
5H8	Rotherham PCT	0
5H9	East Lincolnshire PCT	44,112
5HA	Central Liverpool PCT	392,436
5HC	South Liverpool PCT	2,597
5HD	Preston PCT	448,806
5HE	Fylde PCT	0
5HF	Wyre PCT	0
5HG	Ashton, Leigh and Wigan PCT	0
5HH	Leeds West PCT	35,365
5HJ	Leeds North East PCT	13,467
5HK	East Leeds PCT	96,401
5HL	South Leeds PCT	197,528
5HM	Leeds North West PCT	1,203
5HN	High Peak and Dales PCT	23,113
5HP	Blackpool PCT	0
5HQ	Bolton PCT	272,128
5HR	Staffordshire Moorlands PCT	21,220
5HT	Dudley South PCT	8,419
5HV	Dudley Beacon and Castle PCT	160,135
5HW	Newcastle-under-Lyme PCT	17,486
5HX	Ealing PCT	841,704
5HY	Hounslow PCT	468,490
5J1	Halton PCT	24,837
5J2	Warrington PCT	9,860
5J3	St Helens PCT	8,000
5J4	Knowsley PCT	0
5J5	Oldham PCT	184,127
5J6	Calderdale PCT	31,840
5J7	North Kirklees PCT	1,287
5J8	Durham Dales PCT	774
5J9	Darlington PCT	9,000
5JA	Hinckley and Bosworth PCT	0
5JC	Charnwood and NW Leicestershire PCT	28,280
5JD	South Leicestershire PCT	19,693
5JE	Barnsley PCT	116,286
5JF	Bristol North PCT	177,553
5JG	Bristol South and West PCT	296,379
5JH	Cambridge City PCT	262,149
5JJ	South Cambridgeshire PCT	8,705
5JK	East Cambridgeshire and Fenland PCT	181,797
5JL	Broadland PCT	26,518
5JM	North Norfolk PCT	144,487
5JN	Chelmsford PCT	0
5JP	Castle Point and Rochford PCT	21,952
5JQ	Ipswich PCT	26,880
5JR	Suffolk Coastal PCT	5,240
5JT	Central Suffolk PCT	145,289
5JV	Waveney PCT	201,966
5JW	Suffolk West PCT	56,298
5JX	Bury PCT	41,862
5JY	Rochdale PCT	51,022
5K1	South Somerset PCT	162,240
5K2	Taunton Deane PCT	103,649
5K3	Swindon PCT	139,343
5K4	Kennet and North Wiltshire PCT	269,436
5K5	Brent Teaching PCT	3,718,811
5K6	Harrow PCT	282,321
5K7	Camden PCT	2,724,097
5K8	Islington PCT	1,390,145
5K9	Croydon PCT	1,928,115
5KA	Derwentside PCT	12,484
5KC	Durham and Chester-le-Street PCT	0
5KD	Easington PCT	2,065
5KE	Sedgefield PCT	1,075
5KF	Gateshead PCT	15,225
5KG	South Tyneside PCT	68,219
5KH	Hambleton and Richmondshire PCT	75,169
5KJ	Craven, Harrogate and Rural District PCT	81,774
5KK	Scarborough, Whitby and Ryedale PCT	74,077
5KL	Sunderland Teaching PCT	0
5KM	Middlesbrough PCT	0
5KN	Langbaurgh PCT	132,504
5KP	East Elmbridge and Mid Surrey PCT	712,765
5KQ	East Surrey PCT	230,768
5KR	North and East Cornwall PCT	68,692
5KT	Central Cornwall PCT	23,705
5KV	Poole PCT	1,164
5KW	Cheltenham and Tewkesbury PCT	2,924
5KX	West Gloucestershire PCT	9,787
5KY	Cotswold and Vale PCT	133,995
5L1	Southampton City PCT	185,967
5L2	Maidstone Weald PCT	35,274
5L3	Medway PCT	472,290
5L4	Swale PCT	270,218
5L5	Guildford and Waverley PCT	661,069
5L6	North Surrey PCT	873,691
5L7	Woking Area PCT	257,548
5L8	Adur, Arun and Worthing PCT	588,562
5L9	Western Sussex PCT	242,746
5LA	Kensington and Chelsea PCT	2,292,705
5LC	Westminster PCT	1,717,902
5LD	Lambeth PCT	2,504,874
5LE	Southwark PCT	529,772
5LF	Lewisham PCT	409,492
5LG	Wandsworth PCT	1,260,979
5LH	Tameside and Glossop PCT	76,581
5LJ	Huddersfield Central PCT	0
5LK	South Huddersfield PCT	0
5LL	Ashford PCT	0
5LM	Canterbury and Coastal PCT	199,350
5LN	East Kent Coastal PCT	153,124
5LP	Shepway PCT	2,730
5LQ	Brighton and Hove City PCT	0
5LR	Eastbourne Downs PCT	1,034
5LT	Sussex Downs and Weald PCT	196,614
5LV	Northamptonshire Heartlands PCT	4,485
5LW	Northampton PCT	64,214
5LX	Fareham and Gosport PCT	712,113
5LY	Eastleigh and Test Valley South PCT	0
5M1	South Birmingham PCT	3,632,612
5M2	Shropshire County PCT	290,895
5M3	Walsall Teaching PCT	330,448
5M5	South Sefton PCT	240,109
5M6	Richmond and Twickenham PCT	530,639
5M7	Sutton and Merton PCT	210,136
5M8	North Somerset PCT	724
5M9	Rugby PCT	8,665
5MA	Crawley PCT	27,390
5MC	Horsham and Chanctonbury PCT	2,282
5MD	Coventry Teaching PCT	0
5ME	North Stoke PCT	26,379
5MF	South Stoke PCT	0
5MG	Oldbury and Smethwick PCT	3,816
5MH	Rowley Regis and Tipton PCT	8,898
5MJ	Wednesbury and West Bromwich PCT	0
5MK	Telford and Wrekin PCT	118,005
5ML	East Staffordshire PCT	43,477
5MM	Cannock Chase PCT	32,421
5MN	South Western Staffordshire PCT	7,424
5MP	North Warwickshire PCT	1,628,190
5MQ	South Warwickshire PCT	717,701
5MR	Redditch and Bromsgrove PCT	169,816
5MT	South Worcestershire PCT	99,997
5MV	Wolverhampton City PCT	253,787
5MW	North Birmingham PCT	68,272
5MX	Heart of Birmingham Teaching PCT	80,370
5MY	Eastern Birmingham PCT	328,118
TAC	Northumberland Care Trust	0
TAG	Witham, Braintree and Halstead Care Trust	101,939
	England	73,685,708

Source: Annual Financial Returns of Primary Care Trusts

Table 1.1.3(c)

SALARIES AND WAGES NON NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2002-03 ENGLAND

Code	Strategic Health Authority	Nursing, Midwifery and Health Visiting (£)
Q01	Norfolk, Suffolk and Cambridgeshire SHA	0
Q02	Bedfordshire and Hertfordshire SHA	0
Q03	Essex Strategic HA	0
Q04	North West London Strategic HA	0
Q05	North Central London Strategic HA	20,391
Q06	North East London Strategic HA	0
Q07	South East London Strategic HA	0
Q08	South West London Strategic HA	0
Q09	Northumberland, Tyne & Wear SHA	0
Q10	County Durham and Tees Valley SHA	0
Q11	North & East Yorkshire & North Lincolnshire SHA	0
Q12	West Yorkshire Strategic HA	0
Q13	Cumbria and Lancashire Strategic HA	0
Q14	Greater Manchester Strategic HA	0
Q15	Cheshire & Merseyside Strategic HA	0
Q16	Thames Valley Strategic HA	0
Q17	Hampshire and Isle of Wight Strategic HA	0
Q18	Kent and Medway Strategic HA	0
Q19	Surrey and Sussex Strategic HA	0
Q20	Avon, Gloucestershire and Wiltshire SHA	0
Q21	South West Peninsula Strategic HA	0
Q22	Dorset and Somerset Strategic HA	0
Q23	South Yorkshire Strategic HA	0
Q24	Trent Strategic HA	0
Q25	Leicestershire, Northamptonshire and Rutland SHA	0
Q26	Shropshire and Staffordshire SHA	0
Q27	Birmingham and the Black Country SHA	0
Q28	Coventry, Warwickshire, Herefordshire & Worcestershire SHA	0
	England Total	20,391

Source: Annual Financial Returns of Strategic Health Authorities

  1.1.4  How many GPs and consultants respectively have been employed by the NHS, and how many have left the NHS in each year since 1997? Could these figures be provided for both headcount and Whole Time Equivalent?

  1.  The number of GPs employed by the NHS, and the number who left the NHS in each year since 1997 is shown in Table 1.1.4a. The number of medical and dental consultants employed by the NHS in each year since 1997 is shown in Table 1.1.4b.

  2.  Figures have been provided for both headcount and whole time equivalent.

Table 1.1.4(b)

HOSPITAL, PUBLIC HEALTH MEDICINE AND COMMUNITY HEALTH SERVICES (HCHS) MEDICAL AND DENTAL CONSULTANTS

	Numbers	WTE
1997	21,474	19,661
1998	22,324	20,432
1999	23,321	21,410
2000	24,401	22,186
2001	25,782	23,064
2002	27,070	24,756
2003	28,750	26,341
December 2003	29,217	26,671
March 2004	30,176	27,564
June 2004	30,171	27,640

Source: Department of Health medical and dental workforce census.

All data is as at 30 September each year, except for where stated.

1.2  Reconfiguration of hospital services

1.2.1  What criteria are used by the Department in determining the reconfiguration of hospital services? What role do Royal Colleges play in this process?

  1.  There is no criteria used by the Department in determining the reconfiguration of hospital services. Ultimately, it is for local health services to decide, with their local populations, and in the light of relevant guidance and standards, how acute hospital services should be organised.

  2.  To help the NHS set a clear direction of travel when considering service expansion and redesign, the Department of Health published Keeping the NHS Local: A New Direction of Travel on 14 February 2003. It challenges the mindset that "biggest is best", and puts patients and the public at the centre of the process. The approach to service change described in this document are presented as guidance.

  3.  There are three core principles that are derived from the modernisation strategy laid out in the NHS Plan and all health communities are expected to apply when developing service models: developing options for change with people, not for them; focus on redesign not relocate; taking a whole systems view.

  4.  The Royal Colleges, in the past have undertaken the responsibility for setting standards and supervision of postgraduate medical education including responsibility for accrediting postgraduate posts for junior doctors in hospitals. The receiving or removing of accreditation for posts in some cases has had significant influence over the configuration of services.

  5.  In 2003, the Postgraduate Medical Education and Training Board was formed to act independently of Government as a professional UK competent authority to supervise postgraduate medical education and training. To assure the quality of training, the Board will be responsible for monitoring training and accrediting junior doctor posts in the NHS. The aim is to ensure that medical education and training will be aligned with the needs of the future NHS and other employers.

1.3  Treatment Provided Outside the NHS

  1.3.1  Could the Department please update the information provided in response to last year's questionnaire on NHS expenditure on health care purchased from independent UK providers, with figures broken down between acute and non-acute care and by specialty? [1.3.1]

  1.  The table shows expenditure by NHS bodies on the purchase of healthcare from non-NHS bodies. The figures include expenditure on services provided by all non-NHS bodies, including local authorities and other statutory bodies, as well as independent healthcare providers. The figures cannot be broken down between acute and non-acute care.

Table 1.3.1

EXPENDITURE ON PURCHASE OF HEALTHCARE FROM NON NHS BODIES

Year	Expenditure on Purchase of Healthcare from Non NHS Bodies (£000s)
1999-2000	1,301,196
2000-01	1,549,172
2001-02	1,792,967
2002-03	2,236,656(1)
2003-04	[not yet available]
Source:Annual financial returns of NHS trusts, primary care trusts and health authorities.
(1)we are still awaiting revised estimates from four PCTs.

  1.3.2  How do the most recent prices paid by the NHS for independently provided inpatient and day case treatment compare with NHS reference costs for the same treatments and procedures? [1.3.2]

  1.  Questions 1.3.2 and 1.3.3 are answered together in the table below in respect of:

—  2002-03 data from Appendix SRC5 of the Payment by Results Core Tools 2004 document. This activity principally represents purchasing under traditional short term, and low volume arrangements from the independent sector (IS). Similar data for 2003-04 is not yet available.

—  2003-04 data for completed activity from operational IS-TC programme schemed.

—  Future predicted activity and cost data across the contracted Wave 1 IS-TC programme schemes and those Wave 1 schemes still in procurement. (Predicted data is subject to final negotiation on a number of schemes.)

  This quantitative data makes no reference to the varying commercial terms achieved under different procurement arrangements, or the benefits delivered to the NHS. The figures cannot therefore be used as even a relative measure of value for money achieved.

Data Range	No of Activities	Cost from IS	NHS Equiv. Cost	Difference
2002-03 data set	55,000	£100 million	£70 million	40%
2003-04 IS-TC programme	3,663	£3.3 million	£3.0 million	9%

  1.3.3  Could the Department provide us with a global figure for the cost of elective surgery provided to NHS patients in the private sector to tackle waiting lists, alongside a global figure for the cost of the same number of procedures on the NHS. Could the total private sector cost be broken down by Trust and PCT? [1.3.3]

  1.  Please see combined response to 1.3.2 above.

  1.3.4  Could the Department please update the information provided in response to last year's questionnaire concerning NHS spending on health care provided outside the UK? [1.4.1]

  1.  There are two separate systems in operation. Regulations (EEC) 1408/71 and 574/72 co-ordinate the social security and health care systems of the member states of the European Community and the European Economic Area. These Regulations cover, amongst other things, emergency health care for temporary visitors (the E111 arrangements) and referral of patients specifically for treatments of pre-existing conditions (the E112 scheme).

  2.  A direct referral scheme outside the scope of the European Community arrangements is also available in England. Between January and April 2002 there was a pilot scheme in south east England whereby a number of surgical procedures were commissioned directly by the NHS from healthcare providers in France and Germany. One hundred and ninety patients were treated under this pilot at a cost of £1.1 million.

  3.  This was extended for orthopaedic treatment overseas, with patients drawn from five different areas. A total of 872 patients to date have been referred for treatment abroad as part of the overseas treatment programme at a cost of £5.7 million. The option of receiving treatment abroad has also been offered as part of two patient Choice pilot schemes. This includes all programme costs, for treatment, travel, comprehensive rehabilitation and outpatient clinics run within the UK by European clinicians.

  4.  A total of 21 cardiac patients have to date also been treated abroad at a cost £300,000.

  5.  The data in Table 1.3.4 below shows, in resource terms, costs of treatment provided under the terms of the Regulations to UK insured persons. Actual treatment costs are used for both emergency care (E111) and for patients referred specifically for treatment (E112) as well as other categories of persons covered. But claims do not necessarily distinguish between categories so that no cost distribution between E111 and E112 arrangements is available. Patient numbers are not available since claims may cover several episodes of care for a single individual. However, the UK approved the following number of patient referrals under E112 arrangements as follows:

2001-02	1,167
2002-03	1,070
2003-04	985

  6.  Lump sum costs cover, in particular state pensioners who have relocated to other member states; the costs of their health care lie with the member state paying the pension (unless they also have a pension from the member state of residence).

  7.  No precise information is available on types of treatment covered. For E111, emergency care covers the range from minor ambulatory care to major trauma. E112s cover maternity care, ongoing treatment begun in the UK, specialised care not available in the UK and care for which there is a long UK waiting time.

  8.  It is estimated that the overall resource requirement for treatment under the Regulation in other EEA member states in 2004-05 will be £466 million.

Table 1.3.4

COSTS OF TREATMENT PROVIDED UNDER THE TERMS OF THE REGULATIONS TO UK INSURED PERSONS

Year	Claim type	Member States claims against the United Kingdom £000s	UK claims against Member States £000s
	Actual cost	28,200	15,800
2001-02	Lump sums	203,700	15,500
	Total	231,900	31,300
	Actual cost	26,500	14,200
2002-03	Lump sums	233,200	17,300
	Total	249,700	31,500
	Actual cost	40,091	15,248
2003-04	Lump sums	273,909	9,926
	Total	314,000	25,174

1.  Figures are based on latest available information and used in the 2003-04 Resource Accounting and Budgeting (RAB) outturn exercise. This information is compiled in line with the requirements of "Government Accounting 2000" and National Audit Office (NAO);

2.  Claims against UK are made in national currency and converted in sterling by using the quarterly mean exchange rates published by the EU commission;

3.  Actual costs under Article 93 of Regulation 574/72 include E111s (temporary visitors) and E112 cases (referred patients);

4.  Lump sums under Articles 94 and 95 of Regulation 574/72 include E121s (pensioners).

  1.3.5  Could the Department please supply a breakdown of the costs of setting up each independent sector treatment centre? Which costs are borne by the private companies involved and which by the NHS?

  1.  The IS-TC programme has been procured on the basis of a full service contract, whereby the independent provider invests in the facilities and start-up costs required to deliver a complete package of care for NHS patients, in line with the requirements of the local NHS. This care will be paid for on the basis of completed treatments, the price for which will include any set up costs that the independent provider may incur in order to deliver the service required. Because of the nature of the contracts, set up costs are not broken down. The service contracts have been negotiated on the basis of procuring much needed additional clinical capacity at value for money prices.

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2   Adjusted to take account of Dearing transfer of 1,017 nursing degree places to NHS 1992-93 to 1997-98. Back

3   UPE's include GMS Unrestricted Principals, PMS Contracted GPs and PMS Salaried GPs. Back

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Prepared 21 February 2005