2.2 Overall expenditure
2.2.1 Could the Department provide an updated
version of Table 2.2.1, and of the Department's commentary which
accompanied it? Could it also show this data in graphical form?
Could the Department provide a brief commentary, explaining what
expenditure is included under each section of the table? Can the
footnote to table 2.2.1 explain the measures and their applications
for lines D to G? [2.2.1]
1. Expenditure in Table 2.2.1(a) and
Figure 2.2.1(a) is shown on a Stage One Resource Budgeting
basis. Table 2.2.1(a) is consistent with the presentation of the
data in Figure 3.4(a) of the 2004 Departmental Report (CM6204)
and with the expenditure reported in Table 2.1.1(a) of last year's
evidence.
Table 2.2.1(a)
TRENDS IN ACTUAL AND PLANNED EXPENDITURE
ON THE HEALTH AND PERSONAL SOCIAL SERVICES 1999-2000 TO 2002-03
BY AREA OF EXPENDITURE(1)(2)(3)(4) (STAGE ONE RESOURCE BUDGETING)
|
| | |
| | £ million
|
| | 1999-2000
| 2000-01 | 2001-02
| 2002-03 |
| | outturn
| outturn | outturn
| outturn |
|
| Central Government ExpenditureNational Health Service Hospitals, community health, family health (discretionary) and related services
| | | |
|
| Current |
| | | |
A. | Net spending | 36,736
| 40,009 | 44,430
| 48,979 |
B. | Charges and receipts(5) |
1,989 | 2,252
| 2,124 | 2,205
|
C. | Total spending | 38,725
| 42,261 | 46,554
| 51,184 |
D. | Change over previous year in cash (%)
| | 9.1
| 10.2 | 9.9
|
E. | Change over previous year in input unit costs (%)(6)
| | 3.9
| 5.1 | 3.6
|
F. | D adjusted for E (%)
| | 5.1
| 4.8 | 6.1
|
G. | Change over previous years in real terms (%) (total)
| | 7.9
| 7.4 | 6.4
|
H. | Change over previous years in real terms (%) (net)
| | 7.7
| 8.3 | 6.6
|
| Capital |
| | | |
A. | Net spending | 871
| 1,220 | 1,693
| 2,075 |
B. | Charges and receipts(5) |
593 | 621
| 374 | 365
|
C. | Total spending | 1,465
| 1,841 | 2,067
| 2,439 |
D. | Change over previous year in cash (%)
| | 25.7
| 12.3 | 18.0
|
E. | Change over previous year in input unit costs (%)(6)
| | 5.7
| 6.5 | 4.5
|
F. | D adjusted for E (%)
| | 18.8
| 5.4 | 12.9
|
G. | Change over previous years in real terms (%) (total)
| | 24.2
| 9.5 | 14.2
|
|
| National Health Service family health services(non-discretionary)(7)
| | | |
|
| Current |
| | | |
A. | Net spending | 1,796
| 1,875 | 1,951
| 2,023 |
B. | Charges and receipts |
804 | 845
| 885 | 918
|
C. | Total spending | 2,599
| 2,720 | 2,836
| 2,941 |
D. | Change over previous year in cash (%)
| | 4.6
| 4.3 | 3.7
|
E. | Change over previous year in input unit costs (%)(6)
| | 2.7
| 2.1 | 3.1
|
F. | D adjusted for E (%)
| | 1.9
| 2.1 | 0.6
|
G. | Change over previous years in real terms (%) (total)
| | 3.4
| 1.7 | 0.3
|
|
| Departmental administration(8)
| | | |
|
| Current |
| | | |
A. | Net spending | 262
| 288 | 309
| 321 |
B. | Charges and receipts |
26 | 12
| 18 | 21
|
C. | Total spending | 289
| 300 | 327
| 343 |
D. | Change over previous year in cash (%)
| | 4.1
| 8.8 | 4.8
|
G. | Change over previous years in real terms (%) (total)
| | 2.9
| 6.1 | 1.4
|
F. | Cost of Collecting NHS element of NI contributions
| 10 | 15
| 17 | 20
|
|
| Central health and miscellaneous services
| | | |
|
| Current |
| | | |
A. | Net spending | 498
| 514 | 599
| 611 |
B. | Charges and receipts |
117 | 116
| 132 | 163
|
C. | Total spending | 615
| 630 | 732
| 775 |
D. | Change over previous year in cash (%)
| | 2.4
| 16.1 | 5.9
|
G. | Change over previous years in real terms (%) (total)
| | 1.3
| 13.2 | 2.5
|
|
| Other NHS Capital |
| | |
|
A. | Net spending | 37
| 25 | 39
| 33 |
B. | Charges and receipts |
3 | 4
| 0 | 6
|
C. | Total spending | 39
| 29 | 39
| 38 |
D. | Change over previous year in cash (%)
| | -25.8
| 31.8 | -0.5
|
G | Change over previous years in real terms (%)(total)
| | -26.6
| 28.6 | -3.8
|
|
| NHS Total |
| | | |
A. | Net spending | 40,201
| 43,932 | 49,021
| 54,042 |
B. | Charges and receipts (5)
| 3,531 | 3,849
| 3,533 | 3,678
|
C. | Total spending | 43,732
| 47,781 | 52,554
| 57,720 |
D. | Change over previous year in cash (%)
| | 9.3
| 10.0 | 9.8
|
E. | Change over previous year in input unit costs (%)(6)
| | 4.1
| 4.8 | 3.5
|
F. | D adjusted for E (%)
| | 5.0
| 5.0 | 6.1
|
G. | Change over previous years in real terms (%) (total)
| | 8.0
| 7.3 | 6.3
|
H. | Change over previous years in real terms (%) (net)
| | 8.0
| 8.8 | 6.7
|
|
| Central Government Personal
| | | |
|
| Social Services |
| | |
|
A. | Net spending | 14
| 12 | 89
| 145 |
B. | Charges | 0
| 0 | 0
| 38 |
C. | Total spending | 14
| 12 | 90
| 183 |
D. | Change over previous year in cash (%)
| | -14.0
| 638.5 | 104.8
|
G. | Change over previous year in real terms (%)
| | -15.0
| 620.1 | 98.1
|
|
| Central Government (specific and special) grants to local authorities
| | | |
|
A. | Net spending | 526
| 471 | 687
| 1,456 |
B. | Charges | 0
| 0 | 0
| 0 |
C. | Total spending | 526
| 471 | 687
| 1,456 |
D. | Change over previous year in cash (%)
| | -10.4
| 45.9 | 111.8
|
G. | Change over previous year in real terms (%)
| | -11.5
| 42.3 | 104.9
|
|
| Credit Approvals (LA capital)
| | | |
|
A. | Net spending | 49
| 47 | 47
| 47 |
B. | Charges | 0
| 0 | 0
| 0 |
C. | Total spending | 49
| 47 | 47
| 47 |
D. | Change over previous year in cash (%)
| | -3.6
| -0.5 | 0.0
|
G. | Change over previous year in real terms (%)
| | -4.7
| -2.9 | -3.3
|
|
| Health and Personal Social Services Total
| | | |
|
A. | Net spending | 40,789
| 44,461 | 49,844
| 55,689 |
B. | Charges and receipts(5) |
3,532 | 3,850
| 3,533 | 3,716
|
C. | Total spending | 44,321
| 48,311 | 53,377
| 59,406 |
D. | Change over previous year in cash (%)
| | 9.0
| 10.5 | 11.3
|
G. | Change over previous years in real terms (%) (total)
| | 7.8
| 7.7 | 7.7
|
H. | Change over previous years in real terms (%) (net)
| | 7.8
| 9.3 | 8.1
|
|
| Local Authority Personal Social Services
| | | |
|
| Current(9) |
| | | |
A. | Net spending | 10,050
| 10,696 | 11,369
| 12,894 |
B. | Charges and receipts |
1,998 | 2,152
| 2,229 | 2,305
|
C. | Total spending | 12,048
| 12,848 | 13,598
| 15,199 |
D. | Change over previous year in cash (%)
| | 6.6
| 5.8 | 11.8
|
G. | Change over previous years in real terms (%)(total)
| | 5.4
| 3.2 | 8.1
|
|
| Local Authority Personal Social Services
| | | |
|
| Capital |
| | | |
A. | Net spending | 83
| 94 | 88
| 124 |
B. | Charges and receipts |
51 | 62
| 70 | 75
|
C. | Total spending | 134
| 156 | 158
| 199 |
D. | Change over previous year in cash (%)
| | 16.4
| 1.3 | 25.9
|
G. | Change over previous years in real terms (%)(total)
| | 15.1
| -1.2 | 21.8
|
|
| Local Authority Personal Social Services
| | | |
|
| Total |
| | | |
A. | Net spending | 10,133
| 10,790 | 11,457
| 13,018 |
B. | Charges and receipts |
2,049 | 2,214
| 2,299 | 2,380
|
C. | Total spending | 12,182
| 13,004 | 13,756
| 15,398 |
D. | Change over previous year in cash (%)
| | 6.7
| 5.8 | 11.9
|
G. | Change over previous years in real terms (%)(total)
| | 5.5
| 3.2 | 8.3
|
|
| Local Authority, Health and Personal Social Services Total(10)
| | | |
|
A. | Net spending | 50,347
| 54,733 | 60,567
| 67,205 |
B. | Charges and receipts(5) |
5,581 | 6,064
| 5,832 | 6,096
|
C. | Total spending | 55,928
| 60,797 | 66,400
| 73,301 |
D. | Change over previous year in cash (%)
| | 8.7
| 9.2 | 10.4
|
G. | Change over previous years in real terms (%)(total)
| | 7.5
| 6.5 | 6.8
|
| GDP deflator @ 30 June 2004
| 90.7 | 91.8
| 94.1 | 97.3
|
|
Footnotes:
1. Figures may not sum due to rounding.
2. Percentages are rounded to one decimal place.
3. Real terms growth figures differ from those given
last year because of subsequent changes in GDP deflators. Where
not otherwise specified, the figures are calculated on total expenditure
figures and therefore differ from the Departmental Report, where
increases are calculated on net expenditure.
4. The measures in changes in expenditure shown in lines
D to H are as follows;
Line D shows the percentage change in total expenditure.
Line E shows the level of inflation specific to each area of expenditure
(where applicable).
Line F shows the percentage change in total expenditure
after accounting for service specific inflation.
Line G shows the percentage change in total expenditure
after accounting for inflation in the overall economy as measured
by the GDP deflator.
Line H shows the percentage change in net expenditure after
accounting for inflation in the overall economy as measured by
the GDP deflator.
5. Includes NHS trust charges and receipts.
6. Input Cost Data is not available for years where outturn
data is not available.
7. With the introduction of PMEds allocation in 2004-05,
there is no longer any GMS non discretionary funding. All GMS
funding is now discretionary. Therefore, figures for HCFHS and
FHS non discretionary for 1999-00 to 2002-03 have been restated
from those reported in last year's Health Committee evidence (fig
2.2.1a), so as to present a consistent run in expenditure.
8. Include Trading Funds- Medicines Control Agency (MCA)
and NHS Estates Agency.
9. Net budget figures are taken from Local Authority
Revenue Accounts returns.
10. Local Authority, Health and Personal Social Services total
excludes Central Government (Specific and Special) grants to Local
Authorities and Credit Approvals (LA Capital) to avoid double
counting. The total still does include an element of double counting
(unquantifiable) with regard to joint working between hospitals
and local authorities.

2. Expenditure in Table 2.2.1(b) and Figure
2.2.1(b) is shown on a Stage Two Resource Budgeting basis.
Table 2.2.1(b) is consistent with the presentation of the data
in Figure 3.4(b) of the 2004 Departmental Report (CM6204).
Table 2.2.1(b)
TRENDS IN ACTUAL AND PLANNED EXPENDITURE ON THE HEALTH
AND PERSONAL SOCIAL SERVICES 2002-03 TO 2005-06 BY AREA OF EXPENDITURE(1)(2)(3)(4)
(STAGE TWO RESOURCE BUDGETING)
|
| | |
| | £ million
|
| | 2002-03
| 2003-04 | 2004-05
| 2005-06 |
| | | estimated
| | |
| | outturn
| outturn | plan
| plan |
|
| Central Government ExpenditureNational Health Service Hospitals, community health,family health (discretionary) and related services
| | | |
|
| Current |
| | | |
A. | Net spending (13) | 50,834
| 57,594 | 62,641
| 68,735 |
B. | Charges and receipts(5) |
2,205 | 2,204
| 1,867 | 1,867
|
C. | Total spending | 53,039
| 59,799 | 64,509
| 70,602 |
D. | Change over previous year in cash (%)
| | 12.7
| 7.9 | 9.4
|
E. | Change over previous years in real terms (%) (total)
| | 9.7
| 5.4 | 6.8
|
F. | Change over previous years in real terms (%) (net)
| | 10.2
| 6.3 | 7.0
|
| Capital |
| | | |
A. | Net spending | 1,873
| 2,579 | 3,262
| 4,206 |
B. | Charges and receipts(5) |
333 | 277
| 185 | 140
|
C. | Total spending | 2,206
| 2,856 | 3,447
| 4,346 |
D. | Change over previous year in cash (%)
| | 29.5
| 20.7 | 26.1
|
E. | Change over previous years in real terms (%) (total)
| | 26.0
| 18.0 | 23.0
|
|
| National Health Service family health services(non-discretionary)(7)
| | | |
|
| Current |
| | | |
A. | Net spending | 2,023
| 2,097 | 1,906
| 1,969 |
B. | Charges and receipts |
918 | 932
| 680 | 898
|
C. | Total spending | 2,941
| 3,029 | 2,586
| 2,867 |
D. | Change over previous year in cash (%)
| | 3.0
| -14.6 | 10.9
|
E. | Change over previous years in real terms (%) (total)
| | 0.2
| -16.5 | 8.1
|
|
| Departmental administration(8)(14) Current
| | | |
|
A. | Net spending | 321
| 326 | 278
| 293 |
B. | Charges and receipts |
21 | 26
| 16 | 16
|
C. | Total spending | 342
| 353 | 294
| 309 |
D. | Change over previous year in cash (%)
| | 3.2
| -16.5 | 5.1
|
E. | Change over previous years in real terms (%) (total)
| | 0.4
| -18.4 | 2.5
|
|
| Cost of Collecting NHS element of NI contributions
| 17 | 17
| 17 | 15
|
| Central health and miscellaneous services(15) Current
| | | |
|
A. | Net spending | 643
| 1,010 | 1,112
| 910 |
B. | Charges and receipts |
164 | 115
| 112 | 113
|
C. | Total spending | 807
| 1,125 | 1,225
| 1,024 |
D. | Change over previous year in cash (%)
| | 39.4
| 8.8 | -16.4
|
E. | Change over previous years in real terms (%) (total)
| | 35.6
| 6.4 | -18.5
|
|
| Other NHS Capital |
| | |
|
A. | Net spending | 29
| 60 | 31
| 31 |
B. | Charges and receipts |
6 | 0
| 0 | 0
|
C. | Total spending | 35
| 60 | 32
| 31 |
D. | Change over previous year in cash (%)
| | 72.2
| -47.8 | -2.1
|
E. | Change over previous years in real terms (%)(total)
| | 67.6
| -49.0 | -4.5
|
|
| NHS Total |
| | | |
A. | Net spending | 55,724
| 63,667 | 69,231
| 76,144 |
B. | Charges and receipts(5) |
3,646 | 3,555
| 2,860 | 3,035
|
C. | Total spending | 59,370
| 67,221 | 72,092
| 79,179 |
D. | Change over previous year in cash (%)
| | 13.2
| 7.2 | 9.8
|
E. | Change over previous years in real terms (%) (total)
| | 10.2
| 4.8 | 7.1
|
F. | Change over previous years in real terms (%) (net)
| | 11.2
| 6.3 | 7.3
|
|
| Central Government Personal
| | | |
|
| Social Services(16)
| | | |
|
A. | Net spending | 146
| 169 | 220
| 344 |
B. | Charges | 38
| 33 | 38
| 46 |
C. | Total spending | 184
| 202 | 259
| 390 |
D. | Change over previous year in cash (%)
| | 9.6
| 28.1 | 50.8
|
E. | Change over previous year in real terms (%)
| | 6.6
| 25.2 | 47.1
|
|
| Central Government (specific and special)grants to local authorities
| | | |
|
A. | Net spending | 1,456
| 1,463 | 1,831
| 1,818 |
B. | Charges | 0
| 0 | 0
| 0 |
C. | Total spending | 1,456
| 1,463 | 1,831
| 1,818 |
D. | Change over previous year in cash (%)
| | 0.5
| 25.2 | -0.7
|
E. | Change over previous year in real terms (%)
| | -2.2
| 22.4 | -3.2
|
|
| Credit Approvals (LA capital)
| | | |
|
A. | Net spending | 47
| 50 | 53
| 53 |
B. | Charges | 0
| 0 | 0
| 0 |
C. | Total spending | 47
| 50 | 53
| 53 |
D. | Change over previous year in cash (%)
| | 7.5
| 5.4 | 0.9
|
E. | Change over previous year in real terms (%)
| | 4.6
| 3.0 | -1.5
|
|
| Health and Personal Social Services Total
| | | |
|
A. | Net spending | 57,372
| 65,349 | 71,336
| 78,359 |
B. | Charges and receipts(5) |
3,685 | 3,588
| 2,898 | 3,081
|
C. | Total spending | 61,056
| 68,936 | 74,235
| 81,440 |
D. | Change over previous year in cash (%)
| | 12.9
| 7.7 | 9.7
|
G. | Change over previous years in real terms (%) (total)
| | 9.8
| 5.3 | 7.0
|
H. | Change over previous years in real terms (%) (net)
| | 10.8
| 6.7 | 7.1
|
|
| Local Authority Personal Social Services Current(9)(10)
| | | |
|
A. | Net spending | 12,894
| 14,101 | n/a
| n/a |
B. | Charges and receipts(11)
| 2,305 | 2,521
| n/a | n/a
|
C. | Total spending | 15,199
| 16,622 | n/a
| n/a |
D. | Change over previous year in cash (%)
| | | |
|
| | | 9.4
| | |
G. | Change over previous years in real (%)
| | | |
|
| | | 6.4
| | |
|
| Local Authority Personal Social Services Capital
| | | |
|
A. | Net spending | 124
| 174 | n/a
| n/a |
B. | Charges and receipts |
75 | 89
| n/a | n/a
|
C. | Total spending | 199
| 263 | n/a
| n/a |
D. | Change over previous year in cash (%)
| | 32.2
| | |
G. | Change over previous years in real (%) (total)
| | 28.6
| | |
|
| Local Authority Personal Social Services Total
| | | |
|
A. | Net spending | 13,018
| 14,275 | n/a
| n/a |
B. | Charges and receipts |
2,380 | 2,610
| n/a | n/a
|
C. | Total spending | 15,398
| 16,885 | n/a
| n/a |
D. | Change over previous year in cash (%)
| | 9.7
| | |
G. | Change over previous years in real (%) (total)
| | 6.7
| | |
|
| Local Authority, Health and Personal Social Services Total(12)
| | | |
|
A. | Net spending | 70,390
| 79,624 | n/a
| n/a |
B. | Charges and receipts(5) |
6,065 | 6,198
| n/a | n/a
|
C. | Total spending | 76,454
| 85,822 | n/a
| n/a |
D. | Change over previous year in cash (%)
| | 12.3
| | |
G. | Change over previous years in real (%) (total)
| | 9.2
| | |
| GDP deflator @ 30 June 2004
| 97.3 | 100.0
| 102.3 | 104.9
|
|
Footnotes:
1. Figures may not sum due to rounding.
2. Percentages are rounded to one decimal place.
3. Real terms growth figures differ from those given
last year because of subsequent changes in GDP deflators. Where
not otherwise specified, the figures are calculated on total expenditure
figures and therefore differ from the Departmental Report, where
increases are calculated on net expenditure.
4. The measures in changes in expenditure shown
in lines D to F are as follows:
Line D shows the percentage change in total expenditure;
Line E shows the percentage change in total expenditure after
accounting for inflation in the overall economy as measured by
the GDP deflator;
Line F shows the percentage change in net expenditure after accounting
for inflation in the overall economy as measured by the GDP deflator.
5. Includes NHS trust charges and receipts .
6. Input Cost Data is not available for years where
outturn data is not available.
7. With the introduction of PMEds allocation in
2004-05, there is no longer any GMS non discretionary funding.
All GMS funding is now discretionary. Therefore, figures for HCFHS
and FHS non discretionary for 2002-03 to 2005-06 have been restated
from those reported in last year's Health Committee evidence (fig
2.2.1b), so as to present a consistent run in expenditure.
8. Include Trading FundsMedicines Control
Agency (MCA) and NHS Estates Agency.
9. There are no centrally generated "plan"
figures for local authority expenditure, including Personal Social
Services.
10. Net budget figures are taken from Local Authority
Revenue Accounts returns.
11. Local Authorities do not forecast receipts for future
years. It is assumed that receipts for 2003-04 form the same proportion
of the net expenditure as for 2002-03.
12. Local Authority, Health and Personal Social Services
total excludes Central Government (Specific and Special) grants
to Local Authorities and Credit Approvals (LA Capital) to avoid
double counting. The total still does include an element of double
counting (unquantifiable) with regard to joint working between
hospitals and local authorities.
13. | Less HCFHS depreciation of
| 398 | 354
| 511 | 611
|
14. | Less Dept Admin depreciation of:
| 14 | 16
| 17 | 17
|
15. | Less CHMS depreciation of:
| 8 | 14
| 17 | 19
|
16. | Less PSS depreciation of:
| 9 | 12
| 10 | 10
|
17. Growth in NHS expenditure in 2003-04 is distorted
by the definitional changes in para 3. Once these are adjusted
for, growth in NHS expenditure in 2003-04 is 7.3%.

3. The NHS expenditure figures for 2002-03 to 2005-06
(in Table 2.2.1(b)) are different to that referred to by
the Chancellor in the 2002 Budget announcement. Since the 2002
budget announcement, NHS expenditure plans have been changed and
appropriate adjustments made for the following reasons;
Change to the Discount Rate from 6% to 3.5%. From
1 April 2003.
Pensions Indexation: From 2003-04 onwards the Departmental
Expenditure Limit for the Department of Health has been increased
by a switch from the Exchequer's AME spending to cover the increased
cost of pensions. An addition of over £1.6 billion has been
made to the NHS DEL to cover these costs from 2003-04 onwards.
Free Nursing Care: From 2003-04 the NHS is responsible
for paying for the cost of providing Free Nursing Care to those
in Nursing Homes.
Health Care in Prisons: From 2003-04 the Department
of Health is responsible for paying for the cost of providing
health care in Prisons. An addition of over £100 million
to the DH DEL has been made to cover these costs from 2003-04
onwards.
4. As a result of the above adjustments, growth in NHS
expenditure over 2002-03 in 2003-04 is distorted. Once these are
adjusted for, real-terms growth in Net NHS expenditure in 2003-04
is 7.3%, compared to 11.2% shown in table 2.2.1(b).
5. Table 2.2.1(c) gives a brief explanation of
the main areas of expenditure in table 2.2.1(a) and 2.2.1(b).
Table 2.2.1(c)
EXPLANATION OF MAIN AREAS OF EXPENDITURE IN TABLES 2.2.1(a)
AND 2.2.1(b)
Area of Expenditure | Description
|
NHS Hospital and Community health Services and discretionary family health services (HCHS)
| This covers hospital and community health services, prescribing costs for drugs and appliances and General Medical Services (which include reimbursements of GMS GPs' practice staff, premises, out of hours and IM&T expenses). It also includes other centrally funded initiatives, services and special allocations managed centrally by the Department of Health (such as service specific levies which fund activities in the areas of education and training and research and development);
HCFHS includes all GMS funding. This is because of the introduction of the new GP contract in April 2004, which means that there is no longer any GMS non discretionary funding. All GMS funding is now discretionary and PCTs were informed of their 2004-05 PMeds Allocation in February 2004. In order to present a consistent run of expenditure in Table 2.2.1(a) and (b) GMS non-discretionary expenditure has been restated as HCFHS.
|
Capital | Capital expenditure is that used on the acquisition of land and premises, individual works for the provision, adaptation, renewal, replacement or demolition of buildings, items or groups of equipment and vehicles etc.
|
NHS Family Health Services (FHS) (non-cash limited)
| This covers demand-led family health services, such as the cost of general dental and ophthalmic services, dispensing remuneration and income from dental and prescription charges.
|
Departmental Administration | The administrative costs of running the Department of Health.
|
Central health and miscellaneous services (CHMS)
| These are a wide range of activities funded from the Department of Health's spending programmes whose only common feature is that they receive funding direct from the Department and not via health authorities. Some of the services are managed directly by Departmental staff; some by non-departmental public bodies, or other separate executive organisations.
|
Other NHS Capital | Includes the capital elements of Departmental administration and CHMS.
|
NHS Total | The sum of HCHS current and capital expenditure, FHS, Departmental administration, CHMS current expenditure and other NHS capital.
|
Personal Social Services | Personal care services for vulnerable people, including those with special needs because of old age or physical or mental disability. Examples are residential care homes for the elderly, home help and home care services, and social workers that provide help and support for a wide range of people.
|
Central Government (specific and special) grants to local authorities
| Cash grants targeted at services which require a higher priority, where pump priming is appropriate or where the service is needed in only some authorities.
|
Credit Approvals (LA capital) | Central government permission for individual local authorities to borrow or raise other forms of credit for capital purposes.
|
Local Authority Personal Social Services |
Personal care services for vulnerable people, including those with special needs because of old age or physical or mental disability. Examples are residential care homes for the elderly, home help and home care services, and social workers that provide help and support for a wide range of people.
|
Health and Personal Social Services Total |
The sum of NHS total, central Government personal social services, central Government (specific and special) grants to local authorities, credit approvals (LA capital), and civil defence.
|
Local Authority, Health and Personal Social Services Total
| The sum of Health and Personal Social Services Total and Local Authority Personal Social Services Total.
|
2.2.2 What is the Department's assessment of each programme's
performance in 2002-03 against plans for that year, and anticipated
performance in 2003-04 against plans for that year and outturn
in 2002-03? [2.2.2]
1. Table 2.2.2 outlines the significant changes
(ie over £10 million) between estimated outturn reported
in last years evidence (HC1108) and outturn expenditure in table
2.2.1(b) of this years evidence for 2002-03.
2. Table 2.2.2 also shows the significant changes (ie
over £10 million) between Planned expenditure in last years
evidence (HC1108) and estimated outturn expenditure in table 2.2.1(b)
of this years evidence for 2003-04.
Table 2.2.2
COMPARISON OF NET EXPENDITURE PLANS FOR 2002-03 AND 2003-04
WITH THOSE ON PAGES 50-52 OF LAST YEAR'S HEALTH COMMITTEE WRITTEN
EVIDENCE (HC 1108)
The main areas of change (£10 million or over) to
the spending plans for various parts of the programme other than
LAPSS are as follows. The grant to local authorities for central
government is unhypothecated. Local authorities determine their
own expenditure.
|
£ million | Difference
| | 2002-03
|
|
HCFHS current | 2,179
| 2,046 | Presentational change to reflect transfers of GMS services from FHS non discretionary to HCFHS
|
| | 1,112
| Presentational change to reflect transfer of PMS and PDS services from FHS non discretionary to HCFHS current
|
| | -319
| Underspend due to year end slippage on programme spending
|
| | -156
| Outturn for capital changes, provisions depreciation and impairments less than originally estimated
|
| | -405
| Differing presentation of figures for provisions following a change in the discount rate from 6% to 3.5%
|
| | 20
| Transfer from DH Admin current |
| | -99
| Amendment to the depreciation adjustment to reflect actual costs reported by SHAs and PCTs.
|
HCFHS capital | -55
| -60 | Additional Capital Underspend
|
FHS Current | -3,044
| -2,046 | Presentational change to reflect transfers of GMS services from FHS non discretionary to HCFHS
|
| | -1,112
| Presentational change to reflect transfer of PMS and PDS services from FHS non discretionary to HCFHS
|
Departmental Administration | -29
| -20 | Transfer to HCFHS CurrentNHS Pensions to Special Health Authority
|
| | -13
| Transfer to CHMS CurrentCommission for Social Care Inspection
|
CHMS current | -60
| -23 | Underspends on the demand led Welfare Foods budget.
|
| | 13
| Transfer from DH Admin current for the Commision for Social Care Inspection
|
Central Government PSS | -50
| -17 | Machinery of Government Transfers to DfES for Children's Services
|
| | -32
| Underspend due to year end slippage on programme spending
|
PSS Grants to Local Authorities | -509
| -505 | Machinery of Government Transfers to DfES for Children's Services
|
PSS Credit Approvals | -9
| | No changes over £10 million to report
|
| | | |
|
£ million | Difference
| | 2003-04 |
|
HCFHS current | 3,915
| 3,312 | Transfers from FHS non discretionary
|
| | 67
| Transfer from FHS non discretionary for PDS
|
| | 388
| Transfers from HCFHS capital |
| | 359
| Take up of 2002-03 End Year Flexibility (EYF)
|
| | -152
| Transfers to PSS |
| | -95
| Transfers to CHMS current |
| | 11
| Transfers from CHMS current |
| | 17
| Transfers from Departmental admin current |
HCFHS capital | -276
| 250 | Take up of 2002-03 EYF
|
| | -12
| Transfers to Other Government Departments |
| | -388
| Transfer to HCFHS current |
| | -100
| Forecast underspend |
| | -27
| Transfers to CHMS Capital |
FHS current | -3,379
| -3,312 | Transfers to HCFHS Current
|
| | -67
| Transfers to HCFHS for PDS |
Departmental Administration Current | -45
| -17 | Transfer to HCFHS CurrentNHS Pensions to Special Health Authority
|
| | -13
| Transfer to CHMS CurrentCommission for Social Care Inspection
|
CHMS current | 134
| 95 | Transfers from HCFHS current
|
| | 13
| Transfers from Departmental admin current |
| | -28
| Transfer to HCFHS current |
Central Govenrment PSS | 47
| 152 | Transfers from HCFHS capital
|
PSS Grants to Local Authorities | -555
| -613 | Machinery of Government Transfers to DfES for Children's Services
|
PSS Credit Approvals | -9
| | No changes over £10 million to report
|
|
Note: Changes less than £10 million are not listed
and may slightly affect totals.
2.2.3 Could the Department provide a breakdown of what
the additional NHS expenditure in 2003-04 was compared with 2002-03
has been spent on? The impacts on expenditure of additional staff,
increased pay levels, medicines, capital and other expenditures
should be distinguished where possible. [2.2.3]
1. Total NHS expenditure in 2003-04 rose by £5.9
billion, of which £5.2 billion was increased revenue expenditure
and £0.7 billion increased capital expenditure.
2. In Summary, of the additional £5.9 billion in
2003-04 was accounted for in the following proportions:
Extra staff, Drugs and goods and services |
45% |
Pay accounted for | 31%
|
Capital and Training | 18%
|
Cost Pressures | 6%
|
3. This extra cash has been used to:
(a) improve access and quality of services. More
than £2.9 billion of the increase has been used to employ
additional staff, increase prescribing and purchase more goods
and services. Approximately £1.6 billion was spent on additional
staff and £0.9 billion on increased prescribing, the balance
was used to purchase more goods and services. As a result elective
hospital admissions increased by 3.2% or 167,000 procedures and
new outpatient attendances by 3.7% representing an extra 469,000.
The number of prescriptions issued in the community rose by nearly
32.7 million (5.3%). This will be accompanied by significant reductions
in waiting times across the NHS and improved quality and outcomes
in priority areas;
(b) invest for the future. To achieve world class
service standards the NHS needs to invest in people and infrastructure.
Investment in training, capital and research is expected to increase
during the year by almost £1.0 billion. This has helped amongst
other things to enable the opening of 12 hospital schemes (four
of which were major), increase nurse training places by 8%, and
increase medical school intake by over 14%;
(c) ensure that pay levels are sufficient to attract
and retain staff needed to continue to provide sustained improvements
in NHS performance. Around £1.8 billion has been invested
in pay and this is having a direct impact on staff numbers. The
number of staff employed has increased significantly with an extra
5,640 (5.5%) doctors in 2003-04 and an extra 18,840 nurses (5.1%)
(d) to meet unavoidable cost increases such as
inflation on goods and services.
IMPROVING ACCESS
AND QUALITY
OF SERVICE
4. Extra staff, drugs and goods and services account
for 45% of the increase in NHS expenditure. These are key to improving
access and quality of NHS services.
MORE STAFF
5. Delivery of the NHS Plan depends critically upon increasing
staff numbers. In 2003 staff numbers rose significantly over 2002
with increases of:
18,840 more qualified nurses, midwives and health
visitors;
5,640 more doctors; and
5,500 more therapists and scientists.
6. These staff have been deployed to help deliver, amongst
other things:
an extra 364,000 planned procedures which represents
a 4.7% increase of which 181,000 of the extra procedures were
in outpatients (a 10.0 % increase), 167,000 extra elective hospital
admissions (3.2% increase) and 16,000 extra procedures in primary
care (2.2% increase);
deal with an additional 469,000 new out-patient
attendances with a consultant; and
deal with an additional 245,000 or 6.1% increase
in emergency admissions.
PRESCRIBING
The increased spend on drugs reflects a 9.5% growth in
GP and nurse prescribing and around 12% growth in hospital drugs.
7. The growth in GP and nurse prescribing spend on drugs
this year includes:
£179 million on drugs for Coronary Heart
Disease (ie lipid regulating and anti-hypertensives) equivalent
to over nine million more prescriptions;
£55 million on drugs for diabetes or over
two million prescriptions;
£12 million on drugs for depression equivalent
to writing 1.4 million more prescriptions.
INVESTING IN
THE FUTURE
8. Delivery of further improvement in the NHS beyond
2003-04 will depend upon investment for the future in staff, buildings,
equipment and information technology. In 2003-04 the additional
investment allowed, amongst other things:
INVESTMENT IN
TRAINING
an increase in Nurse and midwife training places
1,850 (8%);
an increase in therapist and scientist training
places of 1,600 or 17%;
an increase of intake of medical students of 753
(14.3%).
INVESTMENT IN
BUILDINGS, EQUIPMENT
AND INFRASTRUCTURE
a 11% increase in the level of general capital
allocations (to around £1.6 billion) to maintain and improve
the NHS estate;
12 hospital schemes opened in 2003-04 (four of
which were major) with a capital value of nearly £400 million;
Expanding and modernisation of services for Coronary
Heart Disease £103 million, including work to progress 13
major tertiary schemes and enabling works for over 40 cardiac
catheterisation laboratories;
Central purchase of major Cancer equipment, including
17 new MRI scanners, 19 Linear Accelerators, 33 CT Scanners and
over 130 items of breast screening equipment; and
There are 42 NHS Local Improvement Finance Trust
(LIFT) schemesthe initiative designed to invest over £1
billion into primary and social care facilitiesof which
six reached financial close in 2003-04.
PAY INCREASES
TO RECRUIT
AND RETAIN
STAFF
9. The NHS is a labour intensive organisation and pay
accounts for roughly 59% of total spend. Consequently pay increases
absorb a significant part of the additional spend. The main elements
of the total increase in pay bill are:
pay awards (including pay modernisation) for NHS
staff totalling £1.4 billion;
other costs including change in occupational and
grade mix and national insurance contributions of around £400
million.
10. Investment in pay is, of course, vital to both recruit
and retain staff.
PRICE INCREASES
11. As well as investment in staff and additional activity
the NHS, faces day-to-day price rises in goods, services and drugs.
We estimate that these cost the NHS around an extra £350
million in 2003-04.
2.2.4 Could the Department provide information on NHS income
from charges over the last 10 years by type of charge? [2.2.5]
1. Table 2.2.4 shows the breakdown of NHS income
from charges over the last 10 years (1993-94 to 2002-03) by type
of charge.

2.2.5 Could the Department provide comparative information
about total NHS spending in England in relation to total NHS spending
in Wales and total NHS spending in Scotland? [2.2.6]
1. Table 2.2.5 shows Net NHS Expenditure in
England, Wales and Scotland for 2003-04. It also shows Net NHS
expenditure per head of population for each of these countries.
Table 2.2.5
TOTAL NET NHS EXPENDITURE FOR ENGLAND, WALES AND SCOTLAND
2003-04
|
| Net NHS Expenditure(1)(2)
| Net NHS Expenditure per head of population (3)(4)
|
| £ million
| £ |
|
England | 63,314
| 1,270 |
Scotland(5) | 7,281
| 1,440 |
Wales(5) | 3,767
| 1,290 |
|
1. Estimated outturn on a stage 2 Resource Budgeting
basis
2. Figures exclude expenditure on departmental administration
3. Calculated using population figures: 2002 Based
resident population projections (2001 Census)
4. Figures are rounded to the nearest £10
5. Expenditure figures for Wales and Scotland have
been provided by NHS Finance, The Welsh Assembly Government and
The Scottish Executive Health Department, respectively.
2.3 Programme Budgets
2.3.1 Could the Department update the information on
expenditure on Programme Budgets provided in Tables 2.3.1-2.3.7
[2.3.1]
1. Historically the response to this question is in two
parts, and two types of program budgeting have been reported.
However, we no longer collect the data required to produce one
of these types of program, this question therefore deals with
one methodology produced before and one new methodology. This
new methodology will be based on information drawn mainly from
programme budgeting returns produced by primary care trusts (PCTs)
as part of their annual accounts process.
2. 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 2002-03.
OLD PROGRAMME BUDGET METHODOLOGY
3. 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 2002-03.
4. 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.
5. Expenditure on HCHS is shown in Table 2.3.1(a).
The corresponding annual growth rates are also given. These rates
are for the period 1991-92 to 1995-96 and 1997-98 to 2003-04.
Figures 2.3.1(a) to 2.3.1(d) illustrate the breakdown of
expenditure between the main programmes and how this has changed
for 1992-93, 1996-97, 1998-99 and 2002-03.
Abbreviations used in Table 2.3.1
CHS | = community health services;
|
DC | = day care;
|
DP | = day patient;
|
HCHS | = Hospital and Community Health Services;
|
IP | = inpatient;
|
JF | = joint finance;
|
LD | = learning disabilities;
|
MH | = mental health;
|
OP | = outpatient;
|
YD | = younger people with physical and/or sensory disabilities;
|