3. NHS Resources and Activity
(continued)
3.9.6 Could the Department update the information
given in Tables 3.9.6? [3.9.6]
1. An update of Table 3.9.6(a) and
3.9.6(b) is attached.
Table 3.9.6(a)
NUMBERS OF ADMISSIONS AND REMOVALS
England by admission type
|
| Ordinary
| Day Case
|
| 6 months to: | Admitted
| Removed | Admitted
| Removed |
|
| Sep 88 | 941,363
| 72,131 | 359,213
| 18,419 |
| Mar 89 | 938,864
| 86,256 | 392,645
| 23,871 |
| Sep 89 | 959,516
| 92,715 | 420,536
| 26,784 |
| Mar 90 | 934,164
| 109,963 | 454,266
| 31,041 |
| Sep 90 | 910,557
| 101,572 | 465,603
| 36,409 |
| Mar 91 | 888,291
| 125,408 | 496,554
| 43,510 |
| Sep 91 | 918,376
| 115,338 | 534,998
| 47,616 |
| Mar 92 | 938,842
| 157,759 | 601,316
| 67,267 |
| Sep 92 | 901,687
| 124,675 | 638,905
| 67,044 |
| Mar 93 | 879,834
| 139,707 | 691,201
| 80,873 |
| Sep 93 | 829,580
| 131,708 | 712,016
| 85,040 |
| Mar 94 | 800,632
| 137,604 | 768,249
| 97,207 |
| Sep 94 | 796,780
| 136,907 | 849,379
| 111,295 |
| Mar 95 | 804,411
| 143,757 | 925,446
| 129,361 |
| Sep 95 | 763,117
| 128,408 | 943,405
| 131,830 |
| Mar 96 | 767,412
| 139,901 | 1,026,419
| 147,724 |
| Sep 96 | 761,967
| 132,833 | 1,056,084
| 154,879 |
| Mar 97 | 683,421
| 117,203 | 1,047,602
| 147,084 |
| Sep 97 | *
| * | *
| * |
| Mar 98 | *
| * | *
| * |
| Sep 98 | 687,330
| 134,836 | 1,189,074
| 194,417 |
| Mar 99 | 682,511
| 136,383 | 1,267,592
| 206,796 |
| Sep 99 | 662,461
| 120,560 | 1,175,154
| 175,132 |
| Mar 00 | 628,114
| 130,814 | 1,216,451
| 196,281 |
| Sep 00 | 632,607
| 119,418 | 1,112,734
| 172,900 |
| Mar 01 | 608,008
| 133,715 | 1,113,989
| 187,898 |
| Sep 01 | 598,444
| 122,255 | 1,008,152
| 164,812 |
| Mar 02 | 612,537
| 128,485 | 1,025,052
| 165,982 |
| Sep 02 | 615,575
| 119,585 | 1,017,050
| 162,831 |
| Mar 03 | 624,559
| 134,841 | 1,073,797
| 184,096 |
| Sep 03 | 626,734
| 125,352 | 1,029,740
| 171,141 |
| Mar 04 | 638,826
| 136,551 | 1,096,344
| 188,301 |
|
Source: KH06 NHS Trust-based figures
* In the year 1997-98, information was collected annually
only.
Table 3.9.6(b)
NUMBER OF SELF DEFERRALS
England by admission type
|
| Number at: | Ordinary
| Day Case |
|
| Sep 88 | 40,753
| 8,433 |
| Mar 89 | 37,098
| 8,769 |
| Sep 89 | 38,224
| 9,905 |
| Mar 90 | 36,441
| 9,735 |
| Sep 90 | 39,274
| 11,865 |
| Mar 91 | 36,115
| 11,998 |
| Sep 91 | 33,868
| 12,469 |
| Mar 92 | 30,965
| 13,151 |
| Sep 92 | 35,992
| 18,134 |
| Mar 93 | 35,800
| 19,095 |
| Sep 93 | 41,550
| 24,142 |
| Mar 94 | 39,189
| 25,185 |
| Sep 94 | 43,538
| 34,946 |
| Mar 95 | 42,188
| 37,152 |
| Sep 95 | 45,004
| 42,650 |
| Mar 96 | 45,112
| 44,908 |
| Sep 96 | 46,876
| 49,632 |
| Mar 97 | 46,022
| 49,390 |
| Sep 97 | *
| * |
| Mar 98 | *
| * |
| Sep 98 | 42,330
| 52,928 |
| Mar 99 | 40,098
| 50,667 |
| Sep 99 | 38,955
| 50,398 |
| Mar 00 | 36,270
| 44,771 |
| Sep 00 | 37,014
| 46,595 |
| Mar 01 | 35,610
| 39,864 |
| Sep 01 | 38,823
| 42,971 |
| Mar 02 | 34,614
| 37,049 |
| Sep 02 | 35,461
| 39,192 |
| Mar 03 | 32,382
| 36,534 |
| Sep 03 | 34,018
| 39,950 |
| Mar 04 | 29,895
| 35,980 |
|
Source: KH07A NHS Trust-based figures.
* In the year 1997-98, information was collected annually
only.
3.9.7 Could the Department update the information provided
in Tables 3.9.7? [3.9.7]
1. An update of Table 3.9.7 is below.
Table 3.9.7
TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY AND WAITING
LISTS
|
England
Year ended: | Non Emergency Activity1, 3
(,000)
| Emergency Activity1, 2, 3
(,000)
| Waiting Lists5
(,000)
|
|
| 31 March 1997 | 4,347
| 3,598 | 1,158
|
| 31 March 1998 | 4,432
| 3,729 | 1,298
|
| 31 March 1999 | 4,849
| 3,848 | 1,073
|
| 31 March 2000 | 4,914
| 3,887 | 1,037
|
| 31 March 2001 | 5,024
| 3,943 | 1,007
|
| 31 March 20024 | 5,060
| 3,961 | 1,035
|
| 31 March 20034 | 5,287
| 4,007 | 992
|
| 31 March 20046 | 5,454
| 4,252 | 906
|
|
Source: KH07 NHS Trust based figures, Heatlh Authority
Quarterly and Monthly monitoring returns
1. From 30 June 1998, activity growth is calculated on the
basis of first finished consultant episodes.
2. Elective activity includes waiting list, booked and planned
admissions.
3. Non-emergency and emergency activity are figures for admissions
purchased by the NHS (commissioner based). Waiting list figures
relate to numbers of patients waiting in NHS trusts (provider
based).
4. Earlier figures are from Health Authorities. With the abolition
of Health Authorities, figures for 2001-02 and 2002-03 are based
on returns from Trusts and PCTs.
5. Figures for years prior to 2003-04 have been rebased to
allow direct comparison.
6. Subject to revision.
3.9.8 Could the Department update the information provided
in Table 3.9.8? [3.9.8]
1. The information requested is provided in Table
3.9.8.
Table 3.9.8
AVERAGE WAITING TIMES AND NUMBERS FOR FIRST OUTPATIENT
APPOINTMENTS
|
| | |
England |
| Quarter | Median waiting time (weeks)
| Outpatients Seen after GP written referral
| Total first
attendances
seen
|
|
| Q3 1993-94 | 6.01
| 1,490,439 | 1,683,116
|
| Q4 1993-94 | 5.47
| 1,809,117 | 2,118,240
|
| Q1 1994-95 | 5.42
| 1,603,723 | 1,966,464
|
| Q2 1994-95 | 5.69
| 2,026,726 | 2,411,193
|
| Q3 1993-95 | 5.82
| 2,019,438 | 2,412,634
|
| Q4 1994-95 | 5.72
| 2,003,009 | 2,569,639
|
| Q1 1995-96 | 6.01
| 1,804,040 | 2,415,895
|
| Q2 1995-96 | 6.31
| 1,847,549 | 2,524,893
|
| Q3 1995-96 | 6.07
| 1,904,040 | 2,566,011
|
| Q4 1995-96 | 6.02
| 2,010,249 | 2,715,403
|
| Q1 1996-97 | 6.13
| 1,869,773 | 2,577,037
|
| Q2 1996-97 | 6.18
| 1,893,706 | 2,635,007
|
| Q3 1996-97 | 6.05
| 1,921,446 | 2,650,803
|
| Q4 1996-97 | 6.05
| 1,880,217 | 2,642,116
|
| Q1 1997-98 | 6.17
| 1,904,564 | 2,689,803
|
| Q2 1997-98 | 6.37
| 1,896,977 | 2,675,056
|
| Q3 1997-98 | 6.25
| 1,888,560 | 2,663,871
|
| Q4 1997-98 | 6.27
| 1,919,032 | 2,732,305
|
| Q1 1998-99 | 6.49
| 1,827,140 | 2,660,499
|
| Q2 1998-99 | 6.80
| 1,881,607 | 2,739,913
|
| Q3 1998-99 | 6.89
| 1,894,358 | 2,732,047
|
| Q4 1998-99 | 6.99
| 1,929,607 | 2,803,960
|
| Q1 1999-00 | 7.09
| 1,837,726 | 2,714,179
|
| Q2 1999-00 | 7.31
| 1,907,904 | 2,798,366
|
| Q3 1999-00 | 7.32
| 1,935,766 | 2,791,712
|
| Q4 1999-00 | 7.58
| 2,028,664 | 2,953,779
|
| Q1 2000-01 | 7.11
| 1,884,939 | 2,795,853
|
| Q2 2000-01 | 7.45
| 1,949,273 | 2,863,533
|
| Q3 2000-01 | 7.38
| 2,005,711 | 2,919,968
|
| Q4 2000-01 | 7.38
| 2,098,170 | 3,050,816
|
| Q1 2001-02 | 6.89
| 1,895,469 | 3,020,570
|
| Q2 2001-02 | 7.21
| 1,961,853 | 3,099,821
|
| Q3 2001-02 | 7.27
| 2,047,053 | 3,209,768
|
| Q4 2001-02 | 7.57
| 2,111,633 | 3,282,456
|
| Q1 2002-03 | 7.03
| 1,925,171 | 3,131,580
|
| Q2 2002-03 | 7.15
| 2,017,304 | 3,183,497
|
| Q3 2002-03 | 7.22
| 2,037,703 | 3,232,958
|
| Q4 2002-03 | 7.34
| 2,092,696 | 3,330,764
|
| Q1 2003-04 | 6.86
| 1,934,432 | 3,287,221
|
| Q2 2003-04 | 7.05
| 2,015,385 | 3,345,338
|
| Q3 2003-04 | 7.01
| 2,043,324 | 3,336,063
|
| Q4 2003-04 | 7.08
| 2,093,093 | 3,461,908
|
|
Source: QM08 NHS Trust-based figures, KH09Q and QMOP
(attendances 2001-02 onwards)
|
3.9.9. Could the Department update the information
provided in Tables 3.9.9? [3.9.9]
1. Updates to Tables 3.9.9(a) to (d) are
below.
Table 3.9.9(a)
ESTIMATED TOTAL NUMBER OF NHS GP CONSULTATIONS IN ENGLAND
PER YEAR
|
| Year | Total consultations
(to the nearest 1,000,000)
|
|
| 1991 | 214,000,000
|
| 1992 | 232,000,000
|
| 1993 | 252,000,000
|
| 1994 | 224,000,000
|
| 1995 | 235,000,000
|
| 1996 | 254,000,000
|
| 1997 | n/a
|
| 1998 | 217,000,000
|
| 1999 | n/a
|
| 2000 | 220,000,000
|
| 2001 | 217,000,000
|
| 2002 | 241,000,000
|
|
| Source: The consultation estimates are prepared using General Household Survey (GHS) data and ONS mid year population estimates.
|
Table 3.9.9(b)
NUMBERS OF REFERRALS FOR FIRST OUTPATIENT APPOINTMENTS
|
| England |
| Referrals for first OP appointment
|
| Quarter | GP
| Other | Total
|
|
| Q3 1993-94 | 1,440,814
| 383,043 | 1,823,857
|
| Q4 1993-94 | 1,777,656
| 344,218 | 2,121,874
|
| Q1 1994-95 | 1,819,356
| 340,342 | 2,159,698
|
| Q2 1994-95 | 2,058,342
| 432,163 | 2,490,505
|
| Q3 1994-95 | 1,993,288
| 424,785 | 2,418,073
|
| Q4 1994-95 | 2,125,033
| 483,637 | 2,608,670
|
| Q1 1995-96 | 2,099,602
| 533,986 | 2,633,588
|
| Q2 1995-96 | 2,106,125
| 612,669 | 2,718,794
|
| Q3 1995-96 | 2,104,221
| 564,377 | 2,668,598
|
| Q4 1995-96 | 2,237,690
| 611,431 | 2,849,121
|
| Q1 1996-97 | 2,210,968
| 671,360 | 2,882,328
|
| Q2 1996-97 | 2,186,116
| 716,100 | 2,902,216
|
| Q3 1996-97 | 2,138,071
| 745,224 | 2,883,295
|
| Q4 1996-97 | 2,157,003
| 744,835 | 2,901,838
|
| Q1 1997-98 | 2,328,045
| 824,639 | 3,152,684
|
| Q2 1997-98 | 2,224,842
| 818,295 | 3,043,137
|
| Q3 1997-98 | 2,153,204
| 837,943 | 2,991,147
|
| Q4 1997-98 | 2,285,631
| 847,327 | 3,132,958
|
| Q1 1998-99 | 2,301,253
| 847,767 | 3,149,020
|
| Q2 1998-99 | 2,282,527
| 861,021 | 3,143,548
|
| Q3 1998-99 | 2,239,178
| 818,292 | 3,057,470
|
| Q4 1998-99 | 2,316,827
| 834,171 | 3,150,998
|
| Q1 1999-2000 | 2,317,334
| 863,030 | 3,180,364
|
| Q2 1999-2000 | 2,270,191
| 872,706 | 3,142,897
|
| Q3 1999-2000 | 2,214,415
| 840,426 | 3,054,841
|
| Q4 1999-2000 | 2,339,485
| 884,742 | 3,224,227
|
| Q1 2000-01 | 2,356,768
| 907,634 | 3,264,402
|
| Q2 2000-01 | 2,318,477
| 931,285 | 3,249,762
|
| Q3 2000-01 | 2,287,884
| 915,406 | 3,203,290
|
| Q4 2000-01 | 2,399,641
| 963,146 | 3,362,787
|
| Q1 2001-02 | 2,403,361
| 998,386 | 3,401,747
|
| Q2 2001-02 | 2,358,005
| 1,004,419 | 3,362,424
|
| Q3 2001-02 | 2,322,399
| 1,001,622 | 3,324,021
|
| Q4 2001-02 | 2,386,577
| 1,012,131 | 3,398,708
|
| Q1 2002-03 | 2,415,744
| 1,060,349 | 3,476,093
|
| Q2 2002-03 | 2,453,148
| 1,080,701 | 3,533,849
|
| Q3 2002-03 | 2,362,178
| 1,052,160 | 3,414,338
|
| Q4 2002-03 | 2,424,804
| 1,106,192 | 3,530,996
|
| Q1 2003-04 | 2,425,663
| 1,139,591 | 3,565,254
|
| Q2 2003-04 | 2,448,980
| 1,162,821 | 3,611,801
|
| Q3 2003-04 | 2,401,147
| 1,137,102 | 3,538,249
|
| Q4 2003-04 | 2,526,447
| 1,204,148 | 3,730,595
|
|
| Source: QM08 NHS Trust-based figures
|
Table 3.9.9(c)
NUMBER OF PLACEMENTS ON WAITING LIST (DECISION TO ADMIT)
|
| England |
| Quarter | Number of
decisions
to admit
|
|
| Q1 1991-92 | 772,512
|
| Q2 1991-92 | 793,501
|
| Q3 1991-92 | 820,827
|
| Q4 1991-92 | 870,775
|
| Q1 1992-93 | 836,550
|
| Q2 1992-93 | 858,452
|
| Q3 1992-93 | 890,264
|
| Q4 1992-93 | 895,002
|
| Q1 1993-94 | 853,524
|
| Q2 1993-94 | 869,617
|
| Q3 1993-94 | 862,073
|
| Q4 1993-94 | 916,501
|
| Q1 1994-95 | 919,679
|
| Q2 1994-95 | 924,721
|
| Q3 1994-95 | 937,033
|
| Q4 1994-95 | 983,974
|
| Q1 1995-96 | 944,241
|
| Q2 1995-96 | 967,048
|
| Q3 1995-96 | 1,005,019
|
| Q4 1995-96 | 1,052,517
|
| Q1 1996-97 | 1,031,618
|
| Q2 1996-97 | 1,034,147
|
| Q3 1996-97 | 1,033,372
|
| Q4 1996-97 | 1,012,374
|
| Q1 1997-98 | *
|
| Q2 1997-98 | *
|
| Q3 1997-98 | *
|
| Q4 1997-98 | *
|
| Q1 1998-99 | 1,018,946
|
| Q2 1998-99 | 1,063,473
|
| Q3 1998-99 | 1,054,530
|
| Q4 1998-99 | 1,052,374
|
| Q1 1999-2000 | 1,033,256
|
| Q2 1999-2000 | 1,042,575
|
| Q3 1999-2000 | 1,035,313
|
| Q4 1999-2000 | 1,047,934
|
| Q1 2000-01 | 988,441
|
| Q2 2000-01 | 982,086
|
| Q3 2000-01 | 972,485
|
| Q4 2000-01 | 992,918
|
| Q1 2001-02 | 928,736
|
| Q2 2001-02 | 934,025
|
| Q3 2001-02 | 958,877
|
| Q4 2001-02 | 959,799
|
| Q1 2002-03 | 917,299
|
| Q2 2002-03 | 941,534
|
| Q3 2002-03 | 948,312
|
| Q4 2002-03 | 971,245
|
| Q1 2003-04 | 917,649
|
| Q2 2003-04 | 943,457
|
| Q3 2003-04 | 954,998
|
| Q4 2003-04 | 986,640
|
|
Source: KH06 NHS Trust-based figures.
*In the year 1997-98, information was collected annually only.
|
Table 3.9.9(d)
NUMBER OF ATTENDANCES AT FIRST OUTPATIENT APPOINTMENTS
|
England
| |
|
| Quarter | Outpatients
seen after GP
written referral
| Total first
attendances
seen
|
|
| Q3 1993-94 | 1,490,439
| 1,683,116 |
| Q4 1993-94 | 1,809,117
| 2,118,240 |
| Q1 1994-95 | 1,603,723
| 1,966,464 |
| Q2 1994-95 | 2,026,726
| 2,411,193 |
| Q3 1993-95 | 2,019,438
| 2,412,634 |
| Q4 1994-95 | 2,003,009
| 2,569,639 |
| Q1 1995-96 | 1,804,040
| 2,415,895 |
| Q2 1995-96 | 1,847,549
| 2,524,893 |
| Q3 1995-96 | 1,904,040
| 2,566,011 |
| Q4 1995-96 | 2,010,249
| 2,715,403 |
| Q1 1996-97 | 1,869,773
| 2,577,037 |
| Q2 1996-97 | 1,893,706
| 2,635,007 |
| Q3 1996-97 | 1,921,446
| 2,650,803 |
| Q4 1996-97 | 1,880,217
| 2,642,116 |
| Q1 1997-98 | 1,904,564
| 2,689,803 |
| Q2 1997-98 | 1,896,977
| 2,675,056 |
| Q3 1997-98 | 1,888,560
| 2,663,871 |
| Q4 1997-98 | 1,919,032
| 2,732,305 |
| Q1 1998-99 | 1,827,140
| 2,660,499 |
| Q2 1998-99 | 1,881,607
| 2,739,913 |
| Q3 1998-99 | 1,894,358
| 2,732,047 |
| Q4 1998-99 | 1,929,607
| 2,803,960 |
| Q1 1999-2000 | 1,837,726
| 2,714,179 |
| Q2 1999-2000 | 1,907,904
| 2,798,366 |
| Q3 1999-2000 | 1,935,766
| 2,791,712 |
| Q4 1999-2000 | 2,028,664
| 2,953,779 |
| Q1 2000-01 | 1,884,939
| 2,795,853 |
| Q2 2000-01 | 1,949,273
| 2,863,533 |
| Q3 2000-01 | 2,005,711
| 2,919,968 |
| Q4 2000-01 | 2,098,170
| 3,050,816 |
| Q1 2001-02 | 1,895,469
| 3,020,570 |
| Q2 2001-02 | 1,961,853
| 3,099,821 |
| Q3 2001-02 | 2,047,053
| 3,209,768 |
| Q4 2001-02 | 2,111,633
| 3,282,456 |
| Q1 2002-03 | 1,925,171
| 3,131,580 |
| Q2 2002-03 | 2,017,304
| 3,183,497 |
| Q3 2002-03 | 2,037,703
| 3,232,958 |
| Q4 2002-03 | 2,092,696
| 3,330,764 |
| Q1 2003-04 | 1,934,432
| 3,287,221 |
| Q2 2003-04 | 2,015,385
| 3,345,338 |
| Q3 2003-04 | 2,043,324
| 3,336,063 |
| Q4 2003-04 | 2,093,093
| 3,461,908 |
|
Source: QM08 NHS Trust-based figures
QMOP (attendances 2001-02 onwards)
|
3.9.10 What additional mechanisms have been put in place
since last year's response to deal with waiting lists/time, and
what has been the cost of these additional mechanisms? [3.9.10]
1. The key national measures taken over the past year
(2003-04) to support the NHS in reducing waiting lists and waiting
times included:
— creating an Integrated National Orthopaedic Strategy,
including tailored support to those Trusts facing the highest
degree of challenge in reducing waiting times for orthopaedic
patients;
— establishing a cataracts programme aimed at delivering
a maximum waiting time of three months by December 2004;
— supporting the NHS in establishing a further 13
NHS Treatment Centres and procuring additional FFCEs through the
independent sector;
— introducing the new "Choice at Six Months"
framework (for implementation from April 2004) to offer faster
treatment to those patients currently waiting the longest; and
— through the Modernisation Agency, supporting trusts
in implementing the Clinically Prioritise and Treat approach,
which helps trusts ensure clinical priority while delivering reduced
waiting times.
2. These policies and programmes have involved a mix
of national and local investment. Many of the programmes have
had a range of objectives and benefits, and it is not possible
to pinpoint the precise expenditure attributable to the objective
of reducing waiting times and lists. However, the most significant
items of national investment have been:
— An additional £73 million to purchase more
than 80,000 cataract operations to reduce cataract waiting times
to 6 months by March 2004 and 3 months by December 2004—four
years ahead of the NHS Plan target.
— An additional £96.5 million to help establish
NHS TCs and further £40 million allocated through the Access
Transformation Fund to support the NHS TC programme and surgical
modernisation more generally.
— ISTCs—please cross refer to the answers
provided under 1.3.2 and 1.3.3
3. The success of these measures and those undertaken
locally can be judged by the significant reductions in NHS waiting
times. Between March 2003 and March 2004, the number of inpatients
waiting over nine months fell by over 53,000 and the number waiting
over six month by over 109,000. Over the same period, the number
of outpatients waiting over 17 weeks fell by over 35,000 and the
number waiting over 13 week by over 76,000.
3.9.11 What progress has the Department made in identifying
a better way of measuring NHS productivity? What elements of
a productivity measure have so far been selected?
1. The following response is an inclusive answer to both
question 3.9.11 above, and 3.9.12.
2. In the past, DH has measured NHS efficiency by comparing
output growth with input growth. Input growth was calculated from
programme budget expenditure. Output growth was calculated using
the Cost Weighted Activity Index, an index of 12 activity categories
weighted in line with expenditure on each activity category. We
have moved away from CWAI as:
— The index only included 12 activity types and
places 60% of the expenditure weight on inpatients and a further
20% of the weight on outpatients which means.
— The index gave no credit for more complex case-mix.
— Shifting activity to more cost effective settings,
such as from inpatients to outpatients, reduced recorded output.
3. In addition:
— The CWAI had a secondary care focus and failed
to include new types of NHS activity.
— Quality of care was not considered.
4. DH has therefore developed a new NHS Outputs Index.
This index is derived mainly using data published in the National
Schedule of Reference Costs. In 2002-03 the NHS Output Index 2002-03
covered over 1,700 activity categories. The advantages of the
new NHS Outputs Index include:
— Being better able to capture changes in case-mix
as a result of using more detailed activity data.
— The reduction in output resulting from shifting
activity from inpatients to outpatients is reduced.
— Broadens coverage to include primary care.
— New data included for activity of increasing importance—eg
NHS Direct.
— The amount of activity included in the measure
will grow as reference cost coverage expands.
ATKINSON REVIEW
OF MEASUREMENT
OF GOVERNMENT
OUTPUT AND
PRODUCTIVITY FOR
THE NATIONAL
ACCOUNTS
5. The Atkinson Review was established by Len Cook, the
National Statistician to improve the measurement of government
output and productivity in the National Accounts. It is led by
Sir Tony Atkinson, Warden of Nuffield College, Oxford, supported
by a team based in the Office for National Statistics. The Review
team published an interim report in July 2004 with final conclusions
due in January 2005.
6. We have been working closely with the team and the
ONS to develop better measures for health and social care output
and have agreed action plan between us. The DH have collaborated
with the Atkinson Review on:
— Improving the measurement of NHS outputs.
— Improving the measurement of NHS inputs expenditure.
— Improving the measurement of the NHS input price
deflator.
— Longer term research into Measuring NHS Outputs
and Productivity.
7. As a result of our co-operation with the Atkinson
Review, a calendar year version of the NHS Outputs Index was adopted
by ONS as the basis of measuring health outputs in National Accounts,
with revised figures being published in June 2004. We will continue
to work with the Atkinson Review team at ONS as part of our work
on Outputs, Productivity and Value for Money.
OUTPUTS, PRODUCTIVITY
AND VALUE
FOR MONEY
8. Productivity and Value for Money Measures compare
the rate of growth for expenditure with the rate of growth of
output. For the NHS value for money measure, we propose to calculate
expenditure based on the activity items included in the NHS Outputs
Index. In 2002-03 this measure would have covered around three
quarters of NHS expenditure, and should increase in line with
the increase in coverage of reference costs.
9. To generate a value for money measure, we have to
adjust expenditure for:
— Expenditure on quality.
10. DH is currently working with the Atkinson Review
team at ONS to determine the appropriate price deflator for NHS
value-for-money and productivity measures. We have to apply price
deflators to enable us to consider the volume of inputs required
to deliver NHS activity.
3.9.12 For a number of years, Cost Weighted Efficiency
Index (CWEI) has been used to assess NHS efficiency growth. This
measure has become inadequate as a measure of efficiency due to
changes in recent years in the way health care is delivered. New
development to replace the CWEI was mentioned in the 2003 Departmental
Report as well as this year's. Could the Department provide an
update on this?
1. See response to question 3.9.11.
3.10 Payment by results
3.10.1 How much NHS expenditure was paid to Trusts
via HRG tariff based payments in 2003-04? How much activity did
it purchase? What are expected expenditure and activity under
"payment by results" in 2004-05 and 2005-06?
1. The table below shows expenditure and activity covered
by the national tariff being introduced as part of Payment by
Results. Expenditure relates to the year in which the activity
took place (2003-04 expenditure is in 2003-04 prices).
|
| Year | £ million
| Activity—spells
|
|
| 2003-04 | 61
| 32,000 |
| 2004-05 | 3,300
| 2,200,000 |
| 2005-06 | 21,100
| 13,500,000 |
|
|
