6. DEPARTMENTAL REPORT
6.1 Public Service
Agreement (PSA) Targets
6.1.1 SR 2004, target 1. The department
has not reported on the latest life expectancy figures. What are
the current life expectancy figures for newborns? (Q102)
ANSWER
1. The latest published data relate to the
three-year period 2002-04. In England in 2002-04, the period of
life expectancy at birth was as follows:
2. These have risen from a baseline of 75.0
years for males and 79.9 years for females in 1997-99.
3. The SR 2004 target 1 is to reach a period
life expectancy of 78.6 years for males and 82.5 years for females,
by 2009-11 (the 3-year average centred around 2010).
4. The next data update, to incorporate
figures for 2005, is due for publication in late November 2006.
5. Period life expectancy for a given area
and time period is calculated using age specific mortality rates
for that area and time period and makes no allowance for changes
in mortality rates in future years.
6. Period life expectancy at birth figures
for England are available calculated by the Government Actuary's
Department from data for single calendar years and also calculated
using data averaged over a period of three consecutive years.
The latter has the effect of smoothing year-by-year variations.
6.1.2 SR 2004, target 2. Why has the
gap in infant mortality between "routine and manual"
and other groups widened? Why has the relative gap in life expectancy
at birth increased, and why has the gap for females widened so
much more than for males (by 8% and 1% respectively)? (Q103)
ANSWER
1. We know that health inequalities are
persistent, stubborn and difficult to change. We have been very
open about the high degree of challenge the target represents.
The drivers of infant mortality and low life expectancy are complex
and there is no simple answer to the question of why gap continues
to widen.
2. The Status Report on the Programme for
Action (2005) showed that the infant mortality gap between "routine
and manual groups" and the whole population widened from
13% in 1997-99, to 16% in 2000-02, and 19% in 2001-03, in line
with the previously reported trend. However, the latest data for
2002-04 show no further widening in the gap—it remains at
19%. The infant mortality rate has fallen for all social groups
since 1997-99, the baseline period for the target. It stands at
a historic low—4.9 deaths per 1,000 live births for the
population as a whole and 5.9 per 1,000 live births for "routine
and manual" groups. It has fallen faster in higher social
groups than in "routine and manual" groups resulting
in a widening of the relative health inequalities gap.
3. An internal review of the infant mortality
aspect of the target is in hand to actively address the widening
gap identified in the Status Report. Its aim is to improve local
delivery of the target by focusing action in areas with the highest
incidence of infant mortality in "routine and manual"
groups, and on interventions most likely to be effective in reducing
the rate among these groups.
4. It should be noted that there is a time
lag between the implementation of new policy initiatives and achievement
as reflected in the data. Infant mortality rates are published
annually—currently the latest data available are for 2004.
5. Life expectancy is improving across England
for both men and women, but it is currently improving more slowly
in the Spearhead Group of areas with the worst health and deprivation
and the relative gap in life expectancy continues to widen.
6. The Status Report identified a range
of indicators, many of which continue to show no narrowing of
the gap. However, there are some signs of progress, for example
on child poverty and housing. We have already seen reductions
in Cancer and Cardiovascular (CVD) inequalities, with a 9.4% reduction
in the absolute cancer inequality gap and a 24.7% reduction in
the absolute CVD inequality gap.
7. It is expected that changes in the long
established gap in life expectancy across geographical areas will
take time to halt and reverse, and there are different "lead
times" (the gap between change in exposure to risk and change
in disease rate) for different diseases, some of which are very
lengthy.
8. Reversing the widening trend in the inequalities
gap will need sustained commitment at national and local level.
The Status Report shows how far we have to go and signals where
action is needed.
9. Initial work to partition the change
in the inequality gap by age group and disease category shows
that although changes in mortality for females in the ages of
five to 74 have worked to reduce the gap, deaths in the under
one years and deaths in the 75 and over age group have actually
widened the overall gap.
10. In terms of the major diseases which
are causing the widening for women, although action on CVD is
narrowing the gap in inequalities, cancer and a range of "all
other causes" are widening the gap.
6.1.3 SR 2004, target 2. What action
has the Health Inequalities Unit identified as necessary to improve
the Department's ability to hit the life expectancy target? (Q104)
ANSWER
1. At the end of 2005, a review of the Health
Inequalities Life Expectancy Target, commissioned by DH and Treasury,
identified the following key actions to deliver the target:
— Improving our understanding
of the key interventions which will impact on life expectancy
in Spearhead areas by 2010. The main diseases, which are leading
to shorter lives in Spearhead areas, are cardiovascular diseases
and respiratory diseases. Fast gains in life expectancy can be
made by reducing the prevalence of smoking, effective control
of blood pressure and cholesterol and good care of people with
long-term conditions.
— Improving performance management.
We have made health inequalities a "Top 6" priority
for the NHS and a mandatory target within Local Area Agreements,
with the aim of seeing faster improvements in Spearhead areas
compared to the England average. We need to ensure that inequalities
is addressed through Local Delivery Plans and the new commissioning
agenda.
— Communication and engagement.
An essential part of this will be spreading best practice across
the Spearhead areas and providing support for areas that are struggling.
We know, for example, that some Spearhead areas have the best
smoking cessation services and highest rates of quitters, others
are well below average. People in Spearhead areas have high needs
and need the best quality services. That will be the challenge
for the new SHAs and PCTs.
2. We also need better mechanisms to engage
with people living in deprived communities as, in general, the
aspirations and expectations they have about health and life expectancy
are lower than elsewhere.
6.1.4 CSR 1998, targets 3 and 4. Both
these targets show slippage. Why has this happened and what action
is being taken to address it? (Q105)
ANSWER
1. The most recent position, based on the
latest available data and analysis by the Department of Health,
is provided in the Table 105a to Table 105d.
2. Latest data for 2002-04 (three-year average)
for CSR 1998 target 3 (reduction in the death rate from accidents)
show an increase of 1% from the baseline (1995-97).
3. On the basis of one year's extra data
we would not expect to see much change on the position reported
last year, especially as the monitoring data for target 3 are
three-year average rates and there are two overlapping years of
data between the latest three-year average and the figures reported
last year (the average of 2002, 2003, 2004 compared with the average
of 2001, 2002, and 2003). Based on data to 2002-04, the 65 and
over group continues to account for the main part of the increase
in the death rate from accidents. Falls account for the main part
of the increase in the death rate from accidents in those over
65.
4. Latest data for financial year 2003-04
for CSR 1998 target 4 (reduction in the rate of hospital admission
for serious accidental injury) show an increase of 4.5% from the
baseline (1995-96), again based on one year's extra data from
that reported last year. As before, the 65 and over group accounts
for the main part of the increase in the admission rate. Falls
account for nearly three-quarters of admissions for serious accidental
injury in the 65 and over group, and are a key factor in the increase
in the admission rate.
5. The latest data available for CSR 1998
targets 3 and 4 pre-dates a key milestone of the National Service
Framework for Older People for "all local health and social
care systems to establish an integrated falls service by April
2005". Falls services may help address the current slippage
against CSR 1998 targets 3 and 4 once these become fully established
and integrated.
6. Despite the slippage in the 65 and over
age range, the latest data show a continuing reduction in accident
death rates in age bands under 15 and 15-24 years. Serious accidental
injury rates among children are also continuing to decrease. This
is associated with work being taken across Government to prevent,
for example, land transport accidents, fire deaths and falls from
height in the construction industry.
Table 105a
DEATH RATES FROM ACCIDENTS—PROGRESS
BY SELECTED AGE GROUPS
Death rate from accidents per 100,000 population)(1)(3)
|
| Age group | 1995-97
| 2001-03 | 2002-04
| % change 1995-97
to 2002-04(2)
|
|
| Under 15 | 4.1
| 3 | 2.9
| -29% |
| 15 to 24 | 17.8
| 15.3 | 15.2
| -15% |
| 25 to 64 | 13
| 13.1 | 12.9
| -1% |
| 65 and over | 50.1
| 56.6 | 57.6
| 15% |
|
| Source: Office for National Statistics
|
| Footnotes: |
| 1. Death rates are directly age-standardised rates for all persons, England.
|
| 2. A % change less than 0 is a reduction, greater than 0 is an increase.
|
| 3. 1995-97 data coded used ICD9 (codes E800-E928 exc. E870-E879 used for accidents); 2001-03 and 2002-04 data coded using ICD10 (codes V01-X59 used for accidents). Due to the change from ICD9 to ICD10 there are small discontinuities in the comparison between the periods.
|
|
Table 105b
DEATH RATES FROM ACCIDENTS AMONG 65 AND OVER— CONTRIBUTION
OF SELECTED ACCIDENT CATEGORIES
(Death rate from accidents per 100,000 population)(1)(4)
|
| Accident category | 1995-97
| 2001-03 | 2002-04
| % change for ages 65 and over
1995-97 to
2002-04(2)(3)(5)
|
|
| Land transport | 7.8
| 7.0 | 6.6
| -2% |
| Falls | 14.1
| 19.0 | 20.0
| 12% |
| Drowning and submersion | 0.4
| 0.4 | 0.4
| 0% |
| Smoke, fire and flames | 2.3
| 1.6 | 1.6
| -1% |
| Poisoning | 1.1
| 0.9 | 0.8
| -1% |
| Other and unspecified incidents | 24.3
| 27.7 | 28.1
| 8% |
|
| Source: Office for National Statistics.
|
| Footnotes: |
| 1. Death rates are directly age-standardised rates for all persons, England.
|
| 2. The contributions from each accident category are the impact of each category on the % change for all accidents (not the % change in the death rate for each category).
|
| 3. A contribution to % change less than 0 is a reduction, greater than 0 is an increase.
|
| 4. 1995-97 data coded used ICD9 (codes E800-E928 exc E870-E879 used for accidents); 2001-03 and 2002-04 data coded using ICD10 (codes V01-X59 used for accidents). Due to the change from ICD9 to ICD10 there are small discontinuities in the comparison between the periods.
|
| 5. The contributions from each category sum to the % change for all accidents for ages 65 and over.
|
Table 105c
ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY— PROGRESS
BY SELECTED AGE GROUPS
(Admission rate for serious accidental injury per 100,000
population)(1)
|
| Age group | 1995-96(3)
| 2002-03 | 2003-04
| % change 1995-96
to 2003-04(2)
|
|
| Under 15 | 131.7
| 97.2 | 90.2
| -31% |
| 5 to 14 | 120.8
| 84.1 | 77.8
| -36% |
| 15 to 64 | 221.2
| 223.3 | 226.1
| 2% |
| 65 and over | 1,280.2
| 1,442.5 | 1,459.4
| 14% |
|
Source: Data based from Hospital Episode Statistics
(ICD10 codes Vo1-X59, Y40-Y84 used for all accidents).
Footnotes:
1. Admission rates are directly age-standardised rates for
all persons, England.
2. A % change less than 0 is a reduction, greater than 0 is
an increase.
3. Figures for 1995-96 are estimates based on trend for subsequent
years (due to data quality problems for some areas in 1995-96).
Table 105d
ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY AMONG AGES
65 AND OVER—CONTRIBUTION OF SELECTED ACCIDENT CATEGORIES
(Death rate from accidents per 100,000 population)(1)
|
| Accident category | 1996-97
| 2003-04 | % change for ages 65 and over(2)(3)
|
|
| Land transport | 52.7
| 48.4 | -0.3%
|
| Falls | 941.9
| 1,057.7 | 8.8%
|
| Drowning and submersion | 0.1
| 0.2 | 0.0%
|
| Smoke, fire and flames | 4.3
| 2.3 | -0.2%
|
| Poisoning | 9.7
| 9.6 | 0.0%
|
| Other and unspecified incidents | 300.4
| 341.2 | 3.1%
|
|
Source: Data based from Hospital Episode Statistics
(ICD10 codes Vo1-X59, Y40-Y84 used for all accidents).
Footnotes:
1. Admission rates are directly age-standardised rates for
all persons, England.
2. The contributins from each accident category are the impact
of each category on the % change for all accidents (not the %
change in the admission rate for each category).
3. A contribution to % change less than 0 is a reduction,
greater than 0 is an increase.
4. Comparison is with 1996-97 rather than 1995-96 due to data
quality problems for some areas in 1995-96.
6.2 Capital Investment
6.2.1 A number of changes have been made to the commissioning
of PFI projects. In particular, SHAs have been asked to work with
Trusts and PCTs to reaffirm their capital investment plans in
light of movement of services into community settings, and the
introduction of Payment by Results. Furthermore, trusts with significant
deficits have been prevented from proceeding to market with large
capital projects without plans to deal with the deficits before
financial close. How many capital projects, and to what value,
have been delayed or cancelled by PCTs and Trusts as a result
of these reviews since April 2005? (Q106)
ANSWER
1. Since the announcement of the PFI revalidation process
on 26 January the PFI schemes at the following trusts have all
had reviews completed by the Department (the capital value of
each scheme is given in brackets after the name of the trust):
— Walsall Hospitals NHS Trust (£142 million).
— Salford Royal Hospitals NHS Trust (£112
million).
— South Devon Healthcare NHS Trust (£163
million.)
— Tameside and Glossop (£68 million).
— University Hospitals Leicester (£711
million).
— University Hospital of North Staffordshire
(£272 million).
2. On 18 August 2006, it was announced that these schemes
had been reviewed and would be allowed to proceed to the next
stage of the approvals process.
3. In addition, two other Trusts had schemes that were
very close to financial close when the revalidation process was
announced:
— Barts and The London NHS Trust (£1 billion).
— St. Helen's and Knowsley NHS Trust (£338
million).
— University Hospital Birmingham NHS Trust
(£627 million).
4. These schemes had their key assumptions tested by
the main principles of the review process in March and April 2006,
but were not subject to a formal review.
5. A consideration of the financial health of the trust
and the local health economy has been a key element of the review
process. One of the conditions under which approval was given
to the six schemes announced on 18 August was that before contracts
could be signed trusts will need to be in good financial health,
delivering at least run-rate balance (which means month on month
balance where a trust has an underlying deficit) prior to the
date of signature.
6. The review process concerns only those schemes with
a capital value greater than £75 million (Tameside and Glossop
NHS Trust had its scheme reviewed because it was batched with
the scheme at Salford Royal Hospitals NHS Trust). The purpose
of the process is to ensure that all schemes properly take account
of the current reforms to the NHS such as choice, a movement of
services into primary and community settings and the new financial
regime. The reviews ensure that only schemes that have clearly
demonstrated their long-term affordability and sustainability
are allowed to proceed.
7. The reviews have not resulted in delay to any schemes
since they focus on aspects that would usually have been considered
as part of the approval of final business cases.
8. One scheme, at Essex Rivers NHS Trust (£185 million),
has been cancelled as a result of the review process. This was
announced by the Trust itself on 14 June.
9. A further 27 schemes are still to be reviewed. We
intend to announce the outcomes of these reviews in due course.
6.2.2 A May 2006 BMA survey concluded that three quarters
of GP practices felt their premises were not suitable for their
future needs and six in every 10n practices worked from premises
unsuitable for their current needs. The Association called for
a "sustained and consistent government commitment to recurrent
revenue to back up capital investments". What is the Department's
assessment of the suitability of those GP surgeries which have
not benefited from LIFT funding for meeting current and future
needs? What plans, if any, does the Department have to increase
funding to support capital investment in primary care outside
LIFT schemes? (Q107)
ANSWER
1. The Department holds no recent comprehensive survey
data on the circa 9,000 GP premises in England. It is expected
that PCTs should be aware of the condition of the GP premises
in their areas and the priorities for capital investment.
2. It should be pointed out that the BMA's survey was
far from comprehensive, covering just 3% of GP premises, and its
conclusions are surprising, given that between publication of
the NHS plan in July 2000 and the end of 2004 approaching 3,000
premises were replaced or substantially refurbished.
3. Most of these premises improvements were achieved
without NHS LIFT, but now that NHS LIFT is very much on stream
it is delivering on average one new building per week during 2006
with 80 facilities open to date. The PCTs where LIFT companies
are established cover more than half of the country's population.
4. We are nevertheless aware that much remains to be
done and this year we have allocated over £2 billion in operational
and strategic capital to the NHS to address local investment priorities,
including the condition of primary care estate that isn't covered
by LIFT schemes. These capital allocations represent on average
19% growth compared to 2005-06s allocations.
6.2.3 The Department has not allocated £1 billion
(19%) of its capital budget as there may be additional costs arising
from accelerated Foundation Trust capital expenditure and implementation
of the White Paper. Given that Monitor would be expected to hold
data on Foundation Trust's planned capital expenditure, why is
the Department unable to forecast this more accurately? Has the
Department finalised its use of the unallocated budget yet, and
if so, how will it be applied? (Q108)
ANSWER
1. A potential acceleration of Foundation Trusts' capital
expenditure was just one of the factors, which, at the time of
producing the Departmental Report and the slightly earlier main
estimate for Parliament, might have given rise to a significant
increase in recorded capital expenditure. Two other major issues
were:
— Connecting for Health, where a review of
capitalisation policies was under consideration, which might have
increased the proportion of the planned expenditure to be capitalised;
and,
— The White Paper Community Hospitals programme,
which had not at the time been fully defined and costed.
2. It was because of all three factors, that we considered
it reasonable to regard the £1,009 million that at the time
had not been earmarked for other uses as a necessary contingency,
of which £500 million had already been agreed with the Treasury
as Departmental Unallocated Provision (DUP) ie only to be drawn
when need could be demonstrated.
3. Forecasting NHS capital expenditure has always been
problematic whatever basis is used. We chose to use the same basis
for our initial forecasting of Foundation Trusts' capital expenditure
as we used for NHS Trusts, which was to aggregate a pro-rata
(based on Turnover) share of each investment programme aimed at
the Trust sector. At the time, DH Finance was not in possession
of a recent forecast from Monitor of 2006-07 Foundation Trust
capital expenditure to use as an alternative scenario, to inform
our assumptions about capital spend.
4. Now that the year is underway and we are in the process
of agreeing Public Dividend Capital Allocations for Foundation
Trusts, we will have a bottom-up, project-based estimate for Foundation
Trust capital expenditure to inform our Spring Supply estimates
for Parliament and we will undertake a further check using Monitor's
forecast of capital spend.
5. We will continue to consider further uses for DH's
unspent capital until "Spring Supply" though we do not
expect further large allocations to be made. The capital commitments
as at 14 August 2006 are shown in Table 108. This shows an under-commitment
including the DUP agreed with Treasury of £733 million.
Table 108
APPLICATION OF CAPITAL RESOURCES AS AT 27 JULY COMPARED
TO APPLICATIONS IN APRIL'S 2006 DEPARTMENTAL REPORT
|
£ millions
| Disposition of resources agreed at time of February 2006 main estimates & DR2006
| Disposition of resources agreed at 27 July 2006 "Finance & InvestmentSub-Committee"of DH Board
|
|
| Total capital resource for Investment in Health
| | 6,543
| | 6,543
|
| Less: PFI Investment | |
-1,111 | |
-1,111 |
| Gross Public Capital available for investment in DH and NHS
| | 5,432
| | 5,432
|
| Less: | |
| | |
| Capital funding for Department of Health operations
| 18 | |
16 | |
| Capital grants to independent sector parties
| 66 | |
66 | |
| Costs from the management and disposal of the "retained estate":
| 10 | |
0 | |
| NHS Trust Receipts from asset sales (normally re-invested locally)
| 120 | |
120 | |
| CFH central capital spend | 1,000
| | 920 |
|
| Other central capital spend, including Capital Funding for ALBs and funds for innovations in capital procurement
| 144 | |
201 | |
| | -1,358
| | -1,323
|
| HCHS capital available for allocation to NHS Organisations:
| | 4,074
| | 4,109
|
| To be allocated as follows: |
| | | |
| Direct allocations to Strategic Health Authorities, NHS Trusts and Primary Care Trusts
| | | |
|
| SHA Stategic Capital | 941
| | 941 |
|
| Trust and PCT Operational Capital | 1,100
| | 1,101 |
|
| Total Direct Allocations for local prioritisation
| | 2,041
| | 2,041
|
| Programme Capital Budgets and un-committed funds
| | | |
|
| Unspent Programme Capital b/f from 2005-06 |
| | 23
| |
| PACS & other local implementation of CfH
| 124 | |
207 | |
| Community Hospitals | 20
| | 20 |
|
| Choose & Book Incentives | 55
| | 55 |
|
| Resource cover and enabling for IS procurements
| 114 | |
114 | |
| Coronary Heart Disease | 40
| | 40 |
|
| CAMHS Specialist Services and other Childrens investements
| 37 | |
50 | |
| Drugs Misuse | 38
| | 38 |
|
| DSPD | 20 |
| 20 |
|
| Mental health place of safety and PICU development
| 65 | |
65 | |
| High Secure Facilities | 23
| | 23 |
|
| Older people, including funds for Audiology and improving environments in care-homes and hospices
| 26 | |
30 | |
| Dental School expansion | 20
| | 20 |
|
| Medical school places & radiology Academies
| 18 | |
7 | |
| Improving provision of decontamination services in the NHS
| 43 | |
43 | |
| Public capital elements of major PFI schemes and other investments in physical capacity
| 15 | |
109 | |
| Estimated capital expenditure by first 32 FTs
| 365 | |
326 | |
| Dentistry - funding for premises improvements
| | | 40
| |
| Emergency Care (ambulance performance incentives)
| | | 25
| |
| Learning Dissability transferring service users from NHS to tenented accommodation in line with policy
| | | 25
| |
| Funding to improve environments in care homes and hospices
| | | 50
| |
| Emergency preparedness | |
| 2 |
|
| Various small pilot schemes |
| | 1 |
|
| Cancer—Radiotherapy training |
| | 2 |
|
| Contingency (including £500 million DUP)
| 1,009 | |
733 | |
| | 2,033
| | 2,068
|
|
6.2.4 In its submission to the Committee's inquiry
into NHS Deficits, the Department identified that there was slippage
in capital expenditure of £1,162 million in 2005-06, compared
with £547 million in 2004-05. What steps has the Department
taken to speed up the delivery of capital projects? Based on the
most recent data from NHS bodies, what is the expected underspend
at the end of 2006-07? (Q109)
ANSWER
1. As stated in the report on 2005-06's financial performance
that was published on 7 June alongside the Chief Executive's Report,
rather than being due exclusively due to the NHS lacking the capacity
to deliver capital projects, the NHS £1,162 million underspend
was due to range of factors, including deliberate slippage to
free up cash to finance revenue overspends.
2. Furthermore, capital investment is not a free good
and gives rise to revenue capital charges. As a consequence, it
may be one of the first things to be postponed in organisations
that have deficits to tackle. It is therefore improved revenue
performance and the measures that are being put in place to achieve
this (eg introducing turnaround teams at Trusts with large deficits)
which will have the greatest impact in increasing the rate of
capital investment in the NHS.
3. At Month 3, the NHS was forecasting a capital underspend
of £416 million against the capital earmarked for it in 2006-07.
Although the outturn may end up being higher than this, it does
look as though there will be a lower capital underspend than in
2005-06.
6.3 Reforms to the Management of the NHS
6.3.1 A review by the King's Fund, Assessing the New
NHS Consultant Contract, has identified significant variation
in the implementation of the consultant contract. For example,
(i) 7am to 7pm working days have been classified as two PAs by
some trusts and three PAs by others; (ii) there are disparities
in the classification of emergency work between Bands; and, (iii)
there are differing ceilings on the number of PAs a consultant
can be contracted for in a week. Why has there been such variation
in the implementation of the consultant contract? (Q110)
ANSWER
1. With the exception of work done in premium time (7
pm to 7 am in the week and work done at weekends), a programmed
activity has a timetable value of four hours. Therefore, a normal
12-hour working day cannot be covered by two programmed activities.
We understand the report is referring to one trust in London.
We have no reason to believe variations such as this are widespread.
2. "A Practical Guide to Calculating On-Call Work"
was issued in March 2004 and a "Guide to Determining On-Call
Availability Supplements" was issued in August 2004.
3. This depends on what is agreed at job plan reviews
with individuals. Consultants may choose to contract with their
employer for additional programmed activities; indeed, it is a
requirement of the contract that they offer their employer first
call on an additional programmed activity before they undertake
any private work.
4. The 2003 contract was neither implemented at a uniform
rate or in exactly the same way in each and every NHS organisation.
Those organisations with a large number of consultants or more
complex multi site structures or less well developed HR or medical
management structures or less relaxed working relationships understandably
took longer than others. In some organisations job planning was
already well established whilst others were undertaking this activity,
in any meaningful or robust sense, for the first time.
6.3.2 The same review also identified that "the
first round of job planning has been largely a retrospective mapping
exercise of how consultants spend their time", rather than
a prospective exercise intended to enable Trusts to meet their
aims better. What specific steps is the Department taking to ensure
that Trusts take a prospective approach to job planning, and what
evidence is there that progress is being made? What process would
a Trust have to go through to alter the terms of those contracts
made under the new arrangements which it already holds with its
consultants? (Q111)
ANSWER
1. The Consultant Contract Implementation Team produced
a number of guidance documents including "Consultant Job
Planning: Standards of Best Practice", January 2004, and
the "Consultant Job Planning Toolkit", January 2005.
The Toolkit included a section on effective job planning; a training
package; a reference manual; and an evaluation framework. It was
jointly launched with the BMA at a national conference and this
was followed by roadshows and training days around the country—all
SHAs and Trusts were given the chance to attend these. The Toolkit
is available on line and includes a training package which trusts
can use locally.
2. The Consultant Contract Benefits Realisation Team
(CCBRT) worked for SHAs from March 2005 to 31 May 2006 to collect
and share examples of good practice in producing jobs plans across
the NHS. Their report has been delivered to the office of the
SHAs. We understand that it suggests that Trusts are becoming
more proactive in their attitude towards job planning.
3. Job plans agreed under the contract should be kept
under regular review and renewed annually through negotiation
between individual consultants and their employers. A survey carried
out in October 2005 by the Health and Social Care Information
Centre for the Department of Health showed that the number of
programmed activities per week per consultant had fallen slightly
from a similar survey carried out by the Department of Health
in October 2004. The PAs had fallen from an average of 11.17 in
October 2004 to 10.83 in October 2005.
4. The process for trusts to alter the terms of a consultant's
contract lies in the Job Plan review. The Job Plan sets out all
of a consultant's NHS duties and responsibilities and the service
to be provided for which the consultant is accountable. As well
as listing the NHS duties of the consultant, the Job Plan also
lists the number of programmed activities for which s/he is contracted
and paid, his/her objectives and agreed supporting resources.
5. It is a requirement of the contract that the Job Plan
is reviewed annually, and this may result in a revised prospective
Job Plan. However, the consultant and manager may conduct interim
reviews and agree changes (if necessary) where duties, responsibilities,
accountability arrangements or objectives have changed or need
to change significantly within the year.
6.3.3 There is evidence that a number of consultants
in London are working beyond the number of PAs they are contracted
for eg the Royal College of Physicians reported that the average
consultant physician is working for 14.9 PAs per week compared
to the average consultant contract of 11.1 PAs. How has the Department
assessed the real working hours of consultants beyond their contracted
hours and what implications do you see for service quality and
morale? (Q112)
ANSWER
1. Consultants enjoy a high level of independence and
professional autonomy and may through personal choice and preference
work additional hours in any given period whilst reducing their
hours at other times. Furthermore, the additional contribution
may be of their own choosing and not at the direction of the employer.
2. Also, it was never expected that excess working hours
for any or all would be eradicated overnight—the contract
is a way of bringing hours under control by agreement.
3. The most effective way of narrowing any gap is in
effective management and skilful job planning, especially objective
setting. A survey in October 2005 carried out by the Health and
Social Care Information Centre for the Department of Health showed
that the average number of PAs per consultant had fallen from
11.17 in 2004 to 10.83 in 2005.
4. The Healthcare Commission's staff survey, conducted
in October 2005, found that the staff were "generally satisfied
with their jobs" with evidence of sustained improvement in
key areas such as training, learning and development, access to
flexible working, support staff with dependents and staff safety
work. This is despite the challenging times faced by the NHS.
All 570 NHS trusts and 25 Strategic Health Authorities in England
took part in the survey. A total of 209,124 NHS employees responded,
which 58% of those staff who were invited to take part in th survey.
The occupational group distribution of respondents to the survey
was broadly similar to that of the NHS workforce in England as
a whole.
5. Consultants are paid for the work they agree in their
job plan. Consultants may through personal choice and preference
work additional hours in any given period whilst reducing their
hours at other times. Furthermore, the additional contribution
may be of their own choosing and not at the direction of the NHS
employer. If the job plan is for more than 11 PAs then the NHS
Trust should challenge and address this through its approach to
job planning.
6.3.4 Based on the unaudited accounts, please explain
how much PCTs' expenditure on GMS in 2005-06 is expected to have
been compared to the allocation made? (Q113)
ANSWER
The information requested is given in Table 113.
Table 113
2005-06 NGMS ALLOCATION AND GIG ENVELOPE AGAINST Q4 INTERIM
YEAR-END SPEND
|
| £ millions | Total Allocation
| 2005-06 provisional figure based on un-audited accounts)
| Variance (under)/over
|
|
| GMS (Global Sum and MPIG) | 1,941
| 1,993 | 51
|
| PMS Contracts | 2,254
| 2,023 | -231
|
| Quality Outcome Framework (QOF) | 927
| 1,098 | 171
|
| Enhanced Services | 676
| 649 | -26
|
| PCO Admin (discretionary payments) | 94
| 182 | 88
|
| Premises (including actual/notional rents and improvement grants)
| 452 | 413
| -38 |
| Information Technology | 65
| 68 | 4
|
| Out of hours | 105
| 346 | 242
|
| Other | 65
| 45 | -20
|
| Dispensing | 917
| 873 | -44
|
| Total | 7,495
| 7,691 | 196
|
|
Source: Quarter 4 FIMS (FHS)4 2005-06 aunaudited returns
from 303 PCTs, England.
6.3.5 Where PCTs have made available additional resources
to support the GP contract, how have these additional resources
been financed? Please provide specific details. (Q114)
ANSWER
1. The new contracts were backed by a guaranteed 36%
increase in resources in England, rising from £5 billion
in 2002-03 to £6.8 billion in 2005-06. Such increases for
primary care are unprecedented and a measure of the Government's
commitment to improved care for all.
2. Evidence from PCT expenditure forecasts show that
PCTs have made available additional resources to secure the range
of services and improvements in care to meet national and local
priorities. The overall increase in resources is now forecast
to be nearly 50% for the three-year period (equating to spend
on primary medical care services of around £7.5 billion in
2005-06[2]).
3. The increased investment is directly benefitting the
vast majority of patients who are experiencing improvements not
only in the range of services available locally but also improvements
in the quality of clinical services they receive.
4. We identified for 2004-05 that PCTs had to manage
a financial pressure of £150 million. Current 2005-06 forecasts
identify there is likely to be a similar financial pressure that
PCTs will be managing overspends of £150 million to £200
million, however, final figures will not be available until late
autumn to confirm in the context of up to a £7 billion allocation
as a consequence of resourcing the contracts.
5. This is a consequence of continued overspend on allocation
primarily from:
— high achievement in the Quality and Outcomes
Framework;
— increased spend on out-of-hours; but
— offset by further efficiency savings in PMS
contracts.
6. High levels of achievement in the Quality and Outcomes
Framework are to be congratulated. It shows we have a system in
place that motivates general practice to provide high quality
evidence based clinical care. This benefits the vast majority
of patients and improves health prevention in ten of the most
common long-term illnesses as well as impacting on the wider NHS,
for example, fewer avoidable hospital admissions due to better
chronic disease management.
7. Increased spending on out-of-hours shows that PCTs
are maximising use of their unified budgets in order to establish
integrated networks of unscheduled care provision so that when
patients contact out-of-hours services they can be assured that
their clinical needs will be consistently met through fast and
convenient access to care, delivered by the most appropriate professional
in the most appropriate place.
8. Revisions to the GMS contract negotiated by NHS Employers
ensure the contract will continue to:
— deliver better services for patients—through
investment in new services including incentives for improved access
and choice;
— be fair to the profession—in view of
the substantial investments made over the last three years, practices
can maintain their profit levels where they deliver our priorities;
and
— represent good value for money to taxpayers—and
for 2006-07 introduce zero increase for inflation and new service
investments funded in the main from recycled efficiency savings.
9. The agreement also includes an ongoing commitment
that the GP contract will continue to deliver efficiencies and
productivities in the future.
10. Information specifically on how PCTs have made available
resources over and above allocated sums is not available centrally.
6.3.6 In its recent report on out-of-hours care, the
NAO found that, if all PCTs matched the best in their rural/urban
classification, up to £134 million could be saved in the
commissioning of primary care. What steps has the Department taken
to address the variation in costs, and what value of savings does
it expect PCTs to make and when? (Q115)
ANSWER
1. There is considerable scope to provide a more cost
effective out-of-hours service. The NAO report makes clear that
it is unrealistic to expect savings of £134 million but that
savings of some £50 million should be achievable if the least
efficient services upped their game. PCTs and service providers
can look to improve cost effectiveness in a number of ways:
— Driving value for money from future tendering
processes based on real competition.
— Continuing to test the cost effective use
of other health professionals alongside GPs in out-of-hours teams.
— Developing activity and cost data to better
understand what is happening and where there is room to improve
performance.
— Analysing case mix to see if particular patient
groups can be targeted to reduce reliance on the out-of-hours
services and respond better to their needs.
— Commissioning integrated urgent care services
to reduce duplication and multiple hand-offs between services
which patients experience as a disjointed journey to the care
they need.
— Providers making further operational improvements
to deliver more effective use of staff and infrastructures
2. We have supported the NHS in this in two ways:
— We wrote to PCTs on the day of publication of
the NAO report with data showing their position compared to the
most cost effective service in their grouping. We expect PCTs
will consider the data and take action to improve their respective
position. SHAs will have a key performance management role in
ensuring this.
— The National Audit Office and Department hosted
a joint conference for SHAs, PCTs and out-of-hours providers on
the 20 July 2006. The main focus of the conference was for PCTs
and out-of-hours providers to learn from the many examples of
best practice that were shared on the day. The conference also
involved master classes to ensure PCTs could identify and take
action on the changes required in their benchmark groupings as
well as any general lessons.
3. We have not set a specific timetable for savings to
be achieved, Primary care trusts (PCTs) are responsible for the
commissioning of local services and are expected to plan for and
achieve financial balance. We expect each PCT to consider the
NAO's report and to look for appropriate measure to improve their
effectiveness in the cost of out-of-hours services.
6.3.7 In the Departmental Report, the Department states
that 32 Trusts have now achieved Foundation status, and a further
24 have applied to Monitor for FT status. It is envisaged in the
Report that "most acute and mental health trusts will apply
for Foundation status within the next three years". Subsequent
reports in the press suggest that "well under 50% of Trusts
are set to achieve Foundation status by April 2008. Others may
be held back for years by their inability to break even and by
the cost of hospital building schemes under private finance initiatives".
What is the Department's current assessment of the number of trusts
that will achieve foundation status in each of the next three
years, and how does this compare to your original projections?
(Q116)
ANSWER
1. There are now 48 NHS foundation trusts, 45 of these
are acute trusts and three are mental health trusts. Further waves
of NHS foundation trusts are set to follow.
2. The DH is establishing a timeframe for when the remaining
acute and mental health NHS trusts are likely to become NHS foundation
trusts. All acute NHS trusts have completed the Whole Health Community
Diagnostic Programme. This process identifies the key areas each
trust should address in order to be able to apply successfully
for foundation trust status. It is a rigorous 10-week assessment
covering strategy and business planning, governance, service performance
and external relations. Mental health NHS trusts are also completing
a diagnostic exercise. In the light of the diagnostic process,
a trajectory is being developed for when the remaining NHS acute
health trusts are likely to be able to become foundation trusts.
Until this is confirmed, we cannot legitimately answer the question
in full.
3. Today, NHS foundation trusts account for some of the
best-performing elements of the NHS, supported by local communities,
and providing new, innovative services to patients. It remains
the Government's policy that all NHS acute and mental health trusts
should be in a position to apply for foundation status at the
earliest available opportunity. The Whole Health Community Diagnostic
Programme will provide a sense of readiness for each acute Trust
that has not yet applied for foundation status and a clear view
of actions needed to secure a successful application.
6.3.8 The Department expects that the cost of Wave
1 and Wave 2 ISTCs may amount to an investment of £3 billion
over five years. Overall, what is the total minimum payment which
will be made to suppliers during this period, irrespective of
levels of demand? (Q117)
ANSWER
1. The figure stated is incorrect. As set out in the
2006 Departmental Report, it is expected that the second phase
of our procurement from the independent sector for elective procedures
will represent an investment of approximately £3 billion
over five years.
2. This is in addition to Wave 1 of the programme which
represents an investment of approximately £1.6 billion over
five years. For Wave 1 this amount is the minimum take payment
to providers over the life of the contracts. Figures for the Phase
2 electives procurement are not yet available as the procurement
is ongoing and contracts, which are not expected to be on the
same level of take-or-pay basis as wave 1, are subject to negotiation.
6.3.9 How many practices are currently making use
of the opportunities to commission using an indicative budget
offered by PBC and what proportion of the total budget available
for PBC is managed in this way? How do these figures compare with
the Department's targets? (Q118)
ANSWER
1. As of 31 August 2006, 6,260 GP practices (74%) had
taken up an incentive payment to become involved in practice based
commissioning (PBC).
2. Practice indicative budgets must include as a minimum:
— all services covered by the national tariff
under payment by results in 2006-07; and
3. Further to this, the Department does not collect data
on the proportion of the total PCT budget devolved as indicative
budgets to practices.
4. There are no Department targets for practice uptake
of PBC, or the proportion of the total PCT budget devolved as
indicative budgets.
5. This is the only data available for this year. This
year is a foundation year to ensure that the building blocks are
in place. Practice uptake is an indication of the success of this
policy, but it only provides information of practice interest,
not change in behaviour. We are considering the indicators for
next year (following achieving universal coverage) which will
look to understand in more detail the changes made under PBC.
The intention is to publish these indicators towards the end of
the year.
6.3.10 What incentive do practices have to make use
of PBC? (Q119)
ANSWER
1. PBC gives practices greater freedoms to redesign services
to better meet the needs of their patients, therefore improving
patient care. It gives primary care clinicians access to commissioning
decisions which were previously not available to them. It incentivises
better use of resources, and facilitates demand management.
2. In addition to this, the new GMS contract contains
a directed enhanced service (DES) for PBC. The PBC DES enables
practices to access resources to support PBC.
3. The DES has two components; the first is payable to
practices on the production of a plan which sets out how services
will be redesigned. The plan will be agreed with the PCT. The
first component amounts to 95 pence per patient.
4. The second component is available for reinvestment
in redesigned services for patients. It is made available once
practices have delivered the objectives set out in the plan. As
a minimum, component two amounts to 95 pence per patient. Where
practices free up resources above this amount, they can instead
choose to access these freed up resources to reinvest in patient
care.
6.3.11 How is commissioning being integrated at the
primary care and social care interface, and in particular how
is PBC coordinating with Local Area Agreements and Local Strategic
partnerships? (Q120)
ANSWER
1. Integrating commissioning at a primary care and social
care level is a significant driver behind many of the recent NHS
reforms.
2. Following on from "Health reform in England—update
and commissioning framework" (July 2006), a second phase
of the commissioning framework will be published in December 2006.
This will address commissioning for primary care services, health
and wellbeing, long-term conditions, and joint commissioning with
local government. It will build upon the existing commissioning
flexibilities established in Section 31 of the 1999 Health Act.
3. Practice based commissioning (PBC) gives practices
greater flexibilities to redesign local services to ensure they
better meet the needs of their patients. To achieve this they
need to engage with other partners when reshaping health services.
4. The process of practices identifying what service
improvements will be made, how this will free up resources and
the subsequent use of such resources must take into account the
priorities in Local Area Agreements agreed with local partners.
6.3.12 The technical guidance for the implementation
of Payment by Results in 2006-07 suggests that there were some
data quality issues associated with the 2004-05 reference costs
data. What were these issues and how have they been addressed?
What implications do these data quality issues have for the fairness
of the PBR tariff? (Q121)
ANSWER
1. The technical guidance was referring to the normal
data cleaning stage within the tariff calculation process. It
did not mean that there were abnormal data quality issues with
2004-05 reference costs compared to previous years.
2. For the purposes of calculating the tariff, outliers
are removed to ensure that the average cost data used are representative
and not skewed. This process ensures that the PbR tariff is fair
to organisations and they will not suffer any consequence of unrepresentative
costing information submitted as part of the reference costs.
6.3.13 Some changes have been made to strengthen the
labour element of the market forces factor (MFF) eg it has been
expanded from 119 to 303 zones. However, it is based on labour
market data from 2001-03. How accurate will this labour market
data be for 2006-07 and 2007-08, especially given the significant
economic and wage growth in England since then? (Q122)
ANSWER
1. The calculations for the MFF are based on geographical
wage differentials between areas. Economic and wage growth will
not affect the calculated MFF values, if that growth is fairly
general across the country. It is only if parts of the country
grow very differently from others that geographical wage differentials
will be affected. The differentials are expected to be reasonably
stable over short to medium timescales, for example, over five
years.
2. 2003 was the latest year for which labour market earnings
data were available at the time of the last resource allocation
round. 2005 is now the latest year available. The Office for National
Statistics (ONS) does not produce projections of geographical
labour market earnings.
3. Research currently underway for the Department of
Health and the Advisory Committee on Resource Allocation (ACRA)
includes updating labour market information that the MFF calculations
are based on. The research is specifically looking at updating
the labour market information from 2001-03 to 2003-05.
4. Provisional results indicate that the wage differentials
have not changed substantially between 2001-03 and 2003-05.
6.3.14 The adjustment to the tariff for capital costs
is based on average capital costs. For some trusts with large
capital programmes, this might underfund their expenditure. How
many Trusts receive an allocation for capital costs which is lower
than their capital costs, and how much is the shortfall in each
case? What steps is the Department taking to adjust for this?
(Q123)
ANSWER
1. Under Payment by Results (PbR), providers do not receive
a specific allocation for the revenue cost of their capital investments.
2. The national tariff is currently based on average
costs reported by NHS organisations. These average costs will
show the full cost of providing the service, including the cost
of buying and maintaining buildings. The annual tariff uplift
takes account of anticipated increases in capital charges, and
the revenue impact of new Private Finance Initiative projects
becoming operational.
3. We recognise that a tariff based on national average
costs may not always fully reflect the local costs of a brand
new facility. For this reason, the NHS Bank has provided additional
funding, above and beyond the national tariff, to help pay the
procurement costs of large PFI hospitals, and to help with the
running costs of any major capital investment, whether PFI or
publicly funded, for the first five years of its operation. In
future SHAs will be responsible for managing these arrangements.
4. Sound capital investment can contribute to increased
productivity, for example, through economies of scale by consolidation
of multiple sites, better clinical adjacencies, more efficient
use of utilities, and so on. The overall affordability of large
capital programmes ultimately depends on effective financial management
by Trusts. To obtain the necessary approvals, Trusts will need
to demonstrate that they are planning operational efficiencies
for their new facilities—eg through more aggressive benchmarking
of Length Of Stay, day case rates and unit costs.
5. We are implementing a more flexible financial regime
under the Foundation Trust model in parallel with the roll-out
of PbR. The more flexible financial regime allows Trusts greater
access to different capital funding options.
6.3.15 Data from Monitor has identified bad debts
in Foundation Trusts of £28m because Primary Care Trusts
may not pay for treatment of local patients. What is the value
of disputed payments between Primary Care Trusts and NHS Trusts
and how many Trusts and PCTs are involved? What mechanisms exist
to resolve disputes, and how have these mechanisms been employed
since the introduction of PBR? (Q124)
ANSWER
1. The pre-audited Foundation Trust (FT) accounts state
that the charge to I&E for provisions for bad and doubtful
debts (including disputed balances) is £28 million in 2005-06.
2. The Department does not collect information on the
value or number of disputed payments between PCTs and NHS trusts.
3. The NHS Bank issued best practice guidance to all
NHS bodies on the mechanisms to resolve disputes between NHS organisations
in April 2004. Briefly, where an agreement cannot be reached between
individual organisations the billing organisation should seek
conciliation from the local SHA. In the event of the conciliation
failing to secure resolution the SHA should make a ruling which
is binding on both parties. This does not apply to disputes between
FTs and PCTs as they have contracts that are legally binding.
4. The Departments model contract for FTs includes a
dispute resolution procedure. Briefly, this is in three stages:
(1) First the Parties will attempt to settle any dispute
that arises out the Agreement by negotiation represented by senior
clinicians or commissioning officers on each side for an initial
period and then by Chief Executives on each side for second period,
(both periods need to be agreed locally: 10 and five Operational
Days is suggested);
(2) Secondly if negotiation fails, the Parties will attempt
to resolve the dispute by submitting it to mediation, within a
short period to be agreed locally (five Operational Days is suggested)
by a mediation service provider agreed by the Parties, or, in
default, The Centre for Effective Dispute Resolution (CEDR); and
(3) If the dispute remains unsolved by mediation after
a further period to be agreed locally (20 Operational Days is
suggested) the Parties will submit the dispute to a decision by
a panel of experts, who are appointed during a short period to
be agreed locally (5 Operational Days is suggested), of either
one or two experts from each side with a third or fifth appointed
jointly by agreement or in default by CEDR and the decision of
the panel will be final and binding and (33.4) enforceable in
the courts.
5. The FT may be using its own contract rather than the
Departments model, and therefore other dispute arrangements may
apply.
6. The Department does not collect information relating
to the application of dispute resolution mechanisms by individual
bodies. There has been no change to the recommended best practice
guidance issued since the introduction of PBR.
6.3.16 To what extent does PBR create incentives for
Trusts to improve and potentially manipulate the coding of their
activity to increase their income? We understand that coding will
be audited by the Audit Commission. How will errors in the coding
be corrected and what sanctions applied if trusts are found to
have over-reported their activity? (Q125)
ANSWER
1. Clinical and administrative data will drive reimbursement
under PbR and there is therefore a very strong incentive to ensure
that the data is correct. Where data quality is currently poor,
changes designed to improve data quality could legitimately result
in increased income without increased productivity. In these cases,
the Code of Conduct provides guidance on how such changes should
be agreed between provider and commissioner and cannot result
in changes in payment in-year.
2. There is also a theoretical possibility of data manipulation
not in order to improve data quality but to increase income. The
Department is therefore working with the Audit Commission on an
Assurance Framework for PbR which aims to support the improvement
of data quality and to ensure that those improvements are legitimate.
3. The Framework will strengthen existing arrangements
for the local monitoring of data quality but also proposes the
introduction of national benchmarking of data between providers
(so that unusual practice can be identified) and independent external
audit of clinical coding against case notes. The audits can be
targeted using the results of the national benchmarking as well
as random to monitor general standards of data quality.
4. Where such an audit reveals error which has resulted
in payments already made being identified as inaccurate it will
usually be too late to amend the payment and the emphasis will
be on improving future reconciliation. The Commission is therefore
recommending that specific actions should flow from audits. These
could include financial penalties for poor data quality; further
investigations at the expense of the ttust where data quality
is poor or specific concerns are raised and referral of cases
of suspected fraud to the NHS Counter Fraud and Security Management
Service.
5. The Department is currently considering these recommendations.
6.4 Expenditure
6.4.1 What common traits has the Department identified
in those PCTs which are under or over target share? For example,
are they predominantly urban or rural, or disadvantaged or prosperous
at either extreme. (Q126)
ANSWER
1. Figure 126a to Figure 126d show that
under target PCTs are proportionately more likely to be in the
East and West Midlands and East of England. They are more likely
to be disadvantaged and predominantly rural. Over target PCTs
are proportionately more likely to be in London and the South
East. They are also more likely to be prosperous and urban.
2. There are 88 Spearhead PCTs, based upon the Local
Authority areas that are in the bottom fifth nationally for three
or more of the following five indicators:
— Male life expectancy at birth.
— Female life expectancy at birth.
— Cancer mortality rate in under 75s.
— Cardio Vascular Disease mortality rate in under
75s.
— Index of Multiple Deprivation 2004 (Local Authority
Summary), average score.
3. There are 44 Growth Area PCTs in one of four DCLG
growth areas:
— London, Stansted, Cambridge, Peterborough.
— Milton Keynes and South Midlands.
4. The DEFRA rural and urban classification of PCTs is
according to the level and type of rurality found within each
PCT at the time of the 2001 Census.
6.4.2 For those PCTs who face higher costs under PBR,
what will the financial impact of the decision to change the purchasing
parity adjustment from 100% to 50% be, and how many PCTs will
be affected? (Q127)
ANSWER
The impact at PCT level of the decision to change the purchasing
parity adjustment from 100% to 50% in 2006-07 is presented in
Table 127.
Table 127
IMPACT OF 2006-07 PPA (AT 50% AS ALLOCATED) COMPARED TO
WHAT PPA WOULD HAVE BEEN AT 100%
|
| | £000s
|
PCT
Code | PCT Name
| Variance (50%-100%) £000s (-ve means lower adjustment under 50% PPA, +ve higher)
|
|
| 5L8 | Adur, Arun and Worthing PCT
| -2,609 |
| 5AW | Airedale PCT | -1,038
|
| 5ED | Amber Valley PCT |
-2,710 |
| 5FA | Ashfield PCT | 1,079
|
| 5LL | Ashford PCT | 1,199
|
| 5HG | Ashton, Leigh and Wigan PCT
| 5,581 |
| 5C2 | Barking and Dagenham PCT
| 844 |
| 5A9 | Barnet PCT | 3,944
|
| 5JE | Barnsley PCT | 2,592
|
| 5GR | Basildon PCT | -852
|
| 5ET | Bassetlaw PCT | 288
|
| 5FL | Bath and North East Somerset PCT
| 2,373 |
| 5F8 | Bebington and West Wirral PCT
| 138 |
| 5GD | Bedford PCT | -122
|
| 5GE | Bedfordshire Heartlands PCT
| -4,452 |
| 5FH | Bexhill and Rother PCT
| 1,140 |
| TAK | Bexley PCT | 1,272
|
| 5GP | Billericay, Brentwood and Wickford PCT
| -2,688 |
| 5H2 | Birkenhead and Wallasey PCT
| 3,074 |
| 5CC | Blackburn with Darwen PCT
| 3,011 |
| 5HP | Blackpool PCT | -565
|
| 5G6 | Blackwater Valley and Hart PCT
| -3,868 |
| 5HQ | Bolton PCT | 6,693
|
| 5CE | Bournemouth Teaching PCT
| 261 |
| 5G2 | Bracknell Forest PCT |
-1,113 |
| 5CF | Bradford City Teaching PCT
| -902 |
| 5CG | Bradford South and West PCT
| -958 |
| 5K5 | Brent Teaching PCT |
-2,220 |
| 5LQ | Brighton and Hove City PCT
| 3,372 |
| 5JF | Bristol North PCT |
250 |
| 5JG | Bristol South and West PCT
| 1,944 |
| 5JL | Broadland PCT | 1,518
|
| 5A7 | Bromley PCT | -3,921
|
| 5EV | Broxtowe and Hucknall PCT
| 1,344 |
| 5G8 | Burnley, Pendle and Rossendale PCT
| 4,410 |
| 5DQ | Burntwood, Lichfield and Tamworth PCT
| -1,041 |
| 5JX | Bury PCT | 1,316
|
| 5J6 | Calderdale PCT | 3,832
|
| 5JH | Cambridge City PCT |
-121 |
| 5K7 | Camden PCT | 6,384
|
| 5MM | Cannock Chase PCT |
41 |
| 5LM | Canterbury and Coastal PCT
| 1,343 |
| 5D4 | Carlisle and District PCT
| 4,569 |
| 5JP | Castle Point and Rochford PCT
| -3,022 |
| 5H4 | Central Cheshire PCT |
-15 |
| 5KT | Central Cornwall PCT |
-310 |
| 5AL | Central Derby PCT |
-3,572 |
| 5HA | Central Liverpool PCT
| 7,331 |
| 5CL | Central Manchester PCT
| -2,553 |
| 5JT | Central Suffolk PCT |
-1,229 |
| 5JC | Charnwood and North West Leicestershire PCT
| -325 |
| 5JN | Chelmsford PCT | -705
|
| 5KW | Cheltenham and Tewkesbury PCT
| -2,787 |
| 5DV | Cherwell Vale PCT |
-3,821 |
| 5H3 | Cheshire West PCT |
1,725 |
| 5EA | Chesterfield PCT |
-655 |
| 5G4 | Chiltern and South Bucks PCT
| -931 |
| 5F2 | Chorley and South Ribble PCT
| -4,131 |
| 5C3 | City and Hackney Teaching PCT
| -1,290 |
| 5GM | Colchester PCT | -2,459
|
| 5KY | Cotswold and Vale PCT
| -1,134 |
| 5MD | Coventry Teaching PCT
| -5,877 |
| 5KJ | Craven, Harrogate and Rural District PCT
| -1,373 |
| 5MA | Crawley PCT | -2,054
|
| 5K9 | Croydon PCT | -1,716
|
| 5GW | Dacorum PCT | -2,141
|
| 5J9 | Darlington PCT | 2,603
|
| 5CM | Dartford, Gravesham and Swanley PCT
| 1,621 |
| 5AC | Daventry and South Northamptonshire PCT
| -706 |
| 5H7 | Derbyshire Dales and South Derbyshire PCT
| -645 |
| 5KA | Derwentside PCT | 2,783
|
| 5CK | Doncaster Central PCT
| 13 |
| 5EK | Doncaster East PCT |
673 |
| 5EL | Doncaster West PCT |
842 |
| 5HV | Dudley Beacon and Castle PCT
| 1,499 |
| 5HT | Dudley South PCT |
198 |
| 5KC | Durham and Chester-le-Street PCT
| 4,181 |
| 5J8 | Durham Dales PCT |
-846 |
| 5HX | Ealing PCT | 276
|
| 5KD | Easington PCT | 866
|
| 5JK | East Cambridgeshire and Fenland PCT
| -4,297 |
| 5FT | East Devon PCT | -1,974
|
| 5KP | East Elmbridge and Mid Surrey PCT
| -4,176 |
| 5FD | East Hampshire PCT |
-598 |
| 5LN | East Kent Coastal PCT
| 3,395 |
| 5HK | East Leeds PCT | 3,059
|
| 5H9 | East Lincolnshire PCT
| 2,840 |
| 5ML | East Staffordshire PCT
| -522 |
| 5KQ | East Surrey PCT | -389
|
| 5E3 | East Yorkshire PCT |
1,152 |
| 5LR | Eastbourne Downs PCT |
1,011 |
| 5MY | Eastern Birmingham PCT
| -4,523 |
| 5H5 | Eastern Cheshire PCT |
531 |
| 5E5 | Eastern Hull PCT |
2,257 |
| 5EY | Eastern Leicester PCT
| -2,054 |
| 5E7 | Eastern Wakefield PCT
| -8,918 |
| 5LY | Eastleigh and Test Valley South PCT
| -1,202 |
| 5D5 | Eden Valley PCT | 420
|
| 5H6 | Ellesmere Port and Neston PCT
| -999 |
| 5C1 | Enfield PCT | -1,838
|
| 5AJ | Epping Forest PCT |
-626 |
| 5ER | Erewash PCT | -499
|
| 5FR | Exeter PCT | -1,636
|
| 5LX | Fareham and Gosport PCT
| -951 |
| 5HE | Fylde PCT | 303
|
| 5KF | Gateshead PCT | 999
|
| 5EC | Gedling PCT | 1,071
|
| 5GT | Great Yarmouth PCT |
-403 |
| 5EX | Greater Derby PCT |
-4,336 |
| 5A8 | Greenwich Teaching PCT
| 4,078 |
| 5L5 | Guildford and Waverley PCT
| -4,323 |
| 5J1 | Halton PCT | 2,417
|
| 5KH | Hambleton and Richmondshire PCT
| -463 |
| 5H1 | Hammersmith and Fulham PCT
| -675 |
| 5C9 | Haringey Teaching PCT
| 148 |
| 5DC | Harlow PCT | 173
|
| 5K6 | Harrow PCT | -3,476
|
| 5D9 | Hartlepool PCT | -1,420
|
| 5FJ | Hastings and St Leonards PCT
| 843 |
| 5A4 | Havering PCT | 2,606
|
| 5MX | Heart of Birmingham Teaching PCT
| 612 |
| 5CN | Herefordshire PCT |
1,220 |
| 5CP | Hertsmere PCT | 1,231
|
| 5F4 | Heywood and Middleton PCT
| 1,424 |
| 5HN | High Peak and Dales PCT
| -1,582 |
| 5AT | Hillingdon PCT | 1,577
|
| 5JA | Hinckley and Bosworth PCT
| -1,231 |
| 5MC | Horsham and Chanctonbury PCT
| -2,362 |
| 5HY | Hounslow PCT | -1,620
|
| 5LJ | Huddersfield Central PCT
| 2,183 |
| 5GF | Huntingdonshire PCT |
-6,668 |
| 5G7 | Hyndburn and Ribble Valley PCT
| 1,666 |
| 5JQ | Ipswich PCT | -1,874
|
| 5DG | Isle of Wight PCT |
-720 |
| 5K8 | Islington PCT | -110
|
| 5K4 | Kennet and North Wiltshire PCT
| -687 |
| 5LA | Kensington and Chelsea PCT
| 645 |
| 5A5 | Kingston PCT | 766
|
| 5J4 | Knowsley PCT | -1,341
|
| 5LD | Lambeth PCT | -4,399
|
| 5KN | Langbaurgh PCT | 1,019
|
| 5HJ | Leeds North East PCT |
1,489 |
| 5HM | Leeds North West PCT |
1,019 |
| 5HH | Leeds West PCT | -596
|
| 5EJ | Leicester City West PCT
| -1,552 |
| 5LF | Lewisham PCT | 1,940
|
| 5D3 | Lincolnshire South West Teaching PCT
| -916 |
| 5GC | Luton PCT | 1,682
|
| 5L2 | Maidstone Weald PCT |
1,834 |
| 5GL | Maldon and South Chelmsford PCT
| -2,493 |
| 5AM | Mansfield District PCT
| 749 |
| 5L3 | Medway PCT | 2,130
|
| 5EH | Melton, Rutland and Harborough PCT
| -1,392 |
| 5FX | Mendip PCT | 1,264
|
| 5FV | Mid Devon PCT | -2,064
|
| 5KM | Middlesbrough PCT |
-1,552 |
| 5E9 | Mid-Hampshire PCT |
1,704 |
| 5FK | Mid-Sussex PCT | -936
|
| 5CQ | Milton Keynes PCT |
1,099 |
| 5DD | Morecambe Bay PCT |
3,259 |
| 5A1 | New Forest PCT | -2,804
|
| 5AP | Newark and Sherwood PCT
| -812 |
| 5DK | Newbury and Community PCT
| -940 |
| 5D7 | Newcastle PCT | -613
|
| 5HW | Newcastle-under-Lyme PCT
| 1,778 |
| 5C5 | Newham PCT | -1,135
|
| 5KR | North and East Cornwall PCT
| 981 |
| 5MW | North Birmingham PCT |
-511 |
| 5CH | North Bradford PCT |
-731 |
| 5FQ | North Devon PCT | 1,235
|
| 5CD | North Dorset PCT |
-368 |
| 5AN | North East Lincolnshire PCT
| 3,246 |
| 5DT | North East Oxfordshire PCT
| 138 |
| 5EG | North Eastern Derbyshire PCT
| 11 |
| 5DF | North Hampshire PCT |
-861 |
| 5GH | North Hertfordshire and Stevenage PCT
| -1,556 |
| 5J7 | North Kirklees PCT |
6,181 |
| 5EF | North Lincolnshire PCT
| 1,448 |
| 5G9 | North Liverpool PCT |
-1,809 |
| 5CR | North Manchester PCT |
5,999 |
| 5JM | North Norfolk PCT |
278 |
| 5AF | North Peterborough PCT
| -3,281 |
| 5EE | North Sheffield PCT |
3,025 |
| 5M8 | North Somerset PCT |
-4,435 |
| 5ME | North Stoke PCT | 3,366
|
| 5L6 | North Surrey PCT |
-5,305 |
| 5E1 | North Tees PCT | 4,455
|
| 5D8 | North Tyneside PCT |
-984 |
| 5MP | North Warwickshire PCT
| -4,723 |
| 5LW | Northampton PCT | -3,268
|
| 5LV | Northamptonshire Heartlands PCT
| -3,093 |
| TAC | Northumberland PCT |
-3,739 |
| 5A2 | Norwich PCT | 4,011
|
| 5EM | Nottingham City PCT |
3,153 |
| 5MG | Oldbury and Smethwick PCT
| 1,586 |
| 5J5 | Oldham PCT | 2,088
|
| 5DW | Oxford City PCT | -8,609
|
| 5F1 | Plymouth Teaching PCT
| -2,786 |
| 5KV | Poole PCT | -376
|
| 5FE | Portsmouth City Teaching PCT
| 81 |
| 5HD | Preston PCT | -1,270
|
| 5DL | Reading PCT | -1,707
|
| 5NA | Redbridge PCT | -387
|
| 5MR | Redditch and Bromsgrove PCT
| 1,535 |
| 5M6 | Richmond and Twickenham PCT
| 74 |
| 5JY | Rochdale PCT | 3,397
|
| 5H8 | Rotherham PCT | -273
|
| 5MH | Rowley Regis and Tipton PCT
| 898 |
| 5GK | Royston, Buntingford and Bishop's Stortford PCT
| -678 |
| 5M9 | Rugby PCT | -782
|
| 5FC | Rushcliffe PCT | 818
|
| 5F5 | Salford PCT | 1,659
|
| 5KK | Scarborough, Whitby and Ryedale PCT
| -448 |
| 5KE | Sedgefield PCT | 2,393
|
| 5E2 | Selby and York PCT |
1,949 |
| 5EP | Sheffield South West PCT
| 553 |
| 5EN | Sheffield West PCT |
4,078 |
| 5LP | Shepway PCT | 1,196
|
| 5M2 | Shropshire County PCT
| -2,568 |
| 5DM | Slough PCT | -1,547
|
| 5D1 | Solihull PCT | -2,941
|
| 5FW | Somerset Coast PCT |
171 |
| 5FN | South and East Dorset PCT
| 342 |
| 5M1 | South Birmingham PCT |
-2,818 |
| 5JJ | South Cambridgeshire PCT
| -3,605 |
| 5GJ | South East Hertfordshire PCT
| -3,005 |
| 5DX | South East Oxfordshire PCT
| 55 |
| 5EQ | South East Sheffield PCT
| 3,179 |
| 5A3 | South Gloucestershire PCT
| -2,539 |
| 5CV | South Hams and West Devon PCT
| 328 |
| 5LK | South Huddersfield PCT
| 1,192 |
| 5HL | South Leeds PCT | 1,459
|
| 5JD | South Leicestershire PCT
| -916 |
| 5HC | South Liverpool PCT |
1,648 |
| 5AA | South Manchester PCT |
-3,812 |
| 5AG | South Peterborough PCT
| -326 |
| 5M5 | South Sefton PCT |
1,769 |
| 5K1 | South Somerset PCT |
1,089 |
| 5MF | South Stoke PCT | 1,217
|
| 5KG | South Tyneside PCT |
4,684 |
| 5MQ | South Warwickshire PCT
| -5,945 |
| 5FP | South West Dorset PCT
| 8 |
| 5FF | South West Kent PCT |
3,762 |
| 5DY | South West Oxfordshire PCT
| 1,359 |
| 5MN | South Western Staffordshire PCT
| -334 |
| 5DJ | South Wiltshire PCT |
-864 |
| 5MT | South Worcestershire PCT
| -2,059 |
| 5L1 | Southampton City PCT |
-3,058 |
| 5AK | Southend on Sea PCT |
-489 |
| 5G1 | Southern Norfolk PCT |
1,003 |
| 5F9 | Southport and Formby PCT
| 1,234 |
| 5LE | Southwark PCT | -5,146
|
| 5GX | St Albans and Harpenden PCT
| 448 |
| 5J3 | St Helens PCT | 5,284
|
| 5HR | Staffordshire Moorlands PCT
| 1,534 |
| 5F7 | Stockport PCT | -4,212
|
| 5JR | Suffolk Coastal PCT |
-1,680 |
| 5JW | Suffolk West PCT |
-3,455 |
| 5KL | Sunderland Teaching PCT
| 9,125 |
| 5L7 | Surrey Heath and Woking PCT
| -5,419 |
| 5LT | Sussex Downs and Weald PCT
| -143 |
| 5M7 | Sutton and Merton PCT
| 991 |
| 5L4 | Swale PCT | 1,425
|
| 5K3 | Swindon PCT | 2,254
|
| 5LH | Tameside and Glossop PCT
| 2,953 |
| 5K2 | Taunton Deane PCT |
-743 |
| 5FY | Teignbridge PCT | 127
|
| 5MK | Telford and Wrekin PCT
| 632 |
| 5AH | Tendring PCT | 158
|
| 5GQ | Thurrock PCT | -1,398
|
| TAL | Torbay PCT | 3,255
|
| 5C4 | Tower Hamlets PCT |
10,976 |
| 5F6 | Trafford North PCT |
-2,054 |
| 5CX | Trafford South PCT |
1,551 |
| 5GN | Uttlesford PCT | -64
|
| 5DP | Vale of Aylesbury PCT
| -4,790 |
| 5E8 | Wakefield West PCT |
3,866 |
| 5M3 | Walsall Teaching PCT |
382 |
| 5NC | Waltham Forest PCT |
2,651 |
| 5LG | Wandsworth PCT | 2,325
|
| 5J2 | Warrington PCT | -835
|
| 5GV | Watford and Three Rivers PCT
| 60 |
| 5JV | Waveney PCT | 1,691
|
| 5MJ | Wednesbury and West Bromwich PCT
| -967 |
| 5GG | Welwyn Hatfield PCT |
1,947 |
| 5D6 | West Cumbria PCT |
869 |
| 5KX | West Gloucestershire PCT
| -860 |
| 5E6 | West Hull PCT | 2,986
|
| 5F3 | West Lancashire PCT |
3,723 |
| 5D2 | West Lincolnshire PCT
| 886 |
| 5CY | West Norfolk PCT |
-6,117 |
| 5FM | West of Cornwall PCT |
1,335 |
| 5DH | West Wiltshire PCT |
-1,749 |
| 5L9 | Western Sussex PCT |
-2,640 |
| 5LC | Westminster PCT | 376
|
| 5G3 | Windsor, Ascot and Maidenhead PCT
| -1,178 |
| TAG | Witham, Braintree and Halstead PCT
| 651 |
| 5DN | Wokingham PCT | -2,818
|
| 5MV | Wolverhampton City PCT
| 1,233 |
| 5G5 | Wycombe PCT | 922
|
| 5DR | Wyre Forest PCT | -290
|
| 5HF | Wyre PCT | 1,131
|
| 5E4 | Yorkshire Wolds and Coast PCT
| -562 |
| Total |
0 |
|
Source: 2006-07 PbR Baseline Exercise.
6.4.3 The Human Resources Development Strategy will
fall from £62.8 million in 2005-06 to £49.8 million
in each of the subsequent years. What are the reasons for this?
(Q128)
ANSWER
1. The sum of overall funding for the Human Resource
Development Strategy (HRDS) Grant and the National Training Strategy
(NTS) Grant is the same as in 2005-06, £157.609 million.
2. We have however, re-aligned funding by moving a £13
million sub-programme, to support post-qualifying training of
registered social workers and other key professional groups in
the social care workforce, from the HRDS Grant into the NTS Grant.
Therefore, although the HRDS grant has been reduced to £49.750
million the NTS grant has increased to £107.859 million.
3. This transfer of funding was approved by the Local
Government Association.
6.4.4 From 2006-07, the method of allocating the funding
"Formula" grant to local authorities is changing based
on a Relative Needs Formula (RNF) for each service block. It is
intended that the resource allocation will more accurately reflect
need for services. What difference does the change make for individual
councils? Will there be cuts in funding and, if so, how much will
be cut and which councils will be affected? (Q129)
ANSWER
1. Responsibility for the administration of the general
formula grant resides with the Department for Communities and
Local Government.
2. The new adult social services RNF formula incorporates
the latest available 2001 census data, is based on up to date
surveys of social service clients and has been developed following
a rigorous process of academic research. As a result, it better
reflects the actual need for services for older people, younger
adults and children and will therefore achieve a more equitable
allocation of resources.
3. The Department of Health recognised that introducing
the new formula will cause a step-change in allocations for a
number of councils, especially in relation to funding for younger
adults services and have therefore applied appropriate floor damping
mechanisms to help local authorities manage any redistributive
effect.
4. A floor of 2.7% above 2005-06 allocations has therefore
been applied to the Younger Adults RNF formulae to help local
authorities to manage this change.
5. The calculation of Formula Grant is subject to a funding
floor and therefore no councils will receive a cut in funding.
The current Local Government Finance Settlement announced that
the overall grant allocated to local authoriteies would increase
by £2.7 billion (4.5%) in 2006-07, and by £3.1 billion
(5%) in 2007-08.
6. In 2006-07, every local authority providing social
services received at least a 2.0% increase in formula grant compared
to 2005-06, on a like-for-like basis.
6.5 Activity, Performance & Efficiency
6.5.1 The Department expects to save £500 million
annually through the reduction of the number of arm's length bodies
(ALBs), SHAs and PCTs in its delivery chain. The Technical Note
states that the transitional costs of restructuring the ALBs (eg
early retirement or redundancy costs) will not be taken into account
in assessing the efficiency savings. Are the savings on the restructuring
of the SHAs and PCTs also gross of transitional costs? How much
are the transitional costs for restructuring ALBs, SHAs and PCTs
expected to be? (Q130)
ANSWER
1. The Efficiency Technical Note sets out how Gershon
efficiency benefits will be calculated. These are defined as annual
savings sustainable beyond March 2008 that can be reinvested into
front-line services. Transitional costs are one-off costs occurring
during implementation of business changes.
2. During the Gershon reporting periods up to 2008, we
therefore state the sustainable benefit that has been realised
after excluding known non-recurrent transition costs.
3. However, for both the ALB and SHA/PCT programmes,
transitional costs will have ceased before March 2008. The full
expected £500 miilion saving in 2008 is therefore cash releasing
as defined by Gershon, available for reinvesting in front-line
care from 2008-09.
4. As noted in the response to Question 98, at this time
it is not possible to confirm or accurately forecast transitional
(redundancy) costs for SHA/PCT restructuring.
5. Transition costs for relocation and redundancies as
a result of the ALB review were £10 million in 2005-06 and
are expected to be around £13 million in 2006-07.
6.5.2 What steps has the Department taken to ensure
that there is no adverse impact on service quality arising from
the PCT and SHA restructuring programme? (Q131)
ANSWER
1. At an organisational level, transition arrangements
are in place to make sure that all NHS bodies can continue to
carry out their core functions and commission quality care for
patients. The new PCTs have been set up in "shadow"
form as old PCTs are winding down, so the handover of management
functions will be seamless.
2. Stronger commissioning with more involvement from
front-line staff like GPs will mean that NHS services reflect
patients' needs more closely and should help to accelerate improvements
in local services—not set services back.
3. The reconfiguration of PCTs is the first stage in
delivering a robust infrastructure from which to strengthen the
commissioning function of PCTs. The next stage focuses on ensuring
that each PCT has the necessary leadership skills and capability.
A "fitness for purpose" programme is being implemented
in some PCTs and will be rolled out across all PCTs between now
and March 2007.
4. This programme, alongside a broader development programme
for PCTs, will ensure that all PCTs—including those where
no changes are being made to the boundaries—are strong,
confident organisations with a high degree of professionalism
and a constructive culture. They will be led by people who will
be able to demonstrate to their staff and the communities they
serve that PCTs are fit for driving forward the NHS reforms that
we are currently implementing.
6.5.3 A component of the Department's Efficiency targets
was a reduction or elimination of central budgets. This is expected
to save £500 million. The Technical Note makes clear the
review of current budgets was intended to take place in autumn
2005 with benefits occurring from April 2006. However, the central
revenue and capital budgets planned for 2006-07 of £14.8
billion (Fig 3.8) are higher than those planned for 2005-06 of
£13.7 billion (Fig 3.8 of the 2005 Departmental Report).
What savings and reductions has the Department planned to make
in 2006-07, and why has the overall figure for central budgets
gone up between 2006-07 and 2005-06? (Q132)
ANSWER
1. The figures quoted include capital expenditure forecasts
for each year. However, the estimated efficiency saving related
to revenue expenditure and specifically to the reduction or elimination
of existing individual revenue budgets so that the underlying
rate of growth would be reduced. This was the principle on which
the original forecast as part of our Gershon target was agreed
with Treasury and the Office of government Commerce.
2. The equivalent figures for revenue from Fig 3.8 of
DR 2005 and DR2006 are £11.7 billion and £11.9 billion
ie a 2% growth.
3. This 2% growth in central budgets compares to an overall
revenue growth of 7.8% in 2006-07 over 2005-06. Had central budgets
been allowed to grow at the level of the revenue settlement then
the value for 2006-07 central budgets would have been £12.6
billion, an increase of £0.9 billion on 2005-06.
4. Therefore, the figures illustrate that the Department
has achieved significant real savings on central budgets. However
we have recognised the inherent difficulties of presenting these
as solely down to "efficiency" and advised OGC at our
last review in May that we would not include these in our declared
Gershon efficiency gains.
5. It is not possible to supply a like for like comparison
of individual budgets in 2005-06 and 2006-07 because, as a consequence
of the review of 2006-07 budgets, responsibility and resource
for a significant proportion have been transferred to the NHS
via SHAs.
6. This reflects the desire to ensure better, more timely
targeting of central funding to meet local priorities.
6.5.4 The basis of measurement for the Department's
efficiency under the Public Funding & Regulation workstream
is the Department's administration cost limit. However, this will
be affected in 2006-07 by the reclassification of the Health and
Social Care Information Centre from administration to programme
budgets. Will this reclassification be counted as an efficiency
saving? (Q133)
ANSWER
1. The DH Change programme resulted in some functions
and their related headcount and staffing costs being eliminated
or reduced, and also in some other functions being transferred
to other organisations outside of the core department.
2. The Efficiency Technical Note makes clear that the
latter reductions are not counted as efficiency savings—declared
efficiency savings are lower less than the absolute reduction
in ACL expenditure. To ensure this, the 2003 baseline ACL, is
reduced by the operating cost of any transferred functions.
3. The Health & Social Care Information Centre falls
within this category of transferred organisations and as such
is now funded from programme budgets. The above adjustment ensures
that this reclassification does not count as part of our efficiency
saving.
6.5.5 A further component of the efficiency plans
is to increase the income recoverable where personal injury compensation
is payable. Income has only increased by £8 million (7%)
between 2003-04 and 2004-05, even though the law has enabled income
to be collected in a greater range of circumstances since 2003.
What targets does the Department have for revenue collection going
forward, and how does it plan to strengthen revenue collection?
(Q134)
ANSWER
1. The increase in income of £8 million relates
only to recoveries from the existing road traffic accident (RTA)
scheme introduced by the Road Traffic (NHS Charges) Act 1999,
which allows costs to be recovered in road traffic accident cases
only and represents a significant increase on the previous year.
2. Part 3 of the Health and Social Care (Community Health
and Standards) Act 2003 made provision for the establishment of
a scheme to recover the costs of providing treatment to an injured
person where that person has made a successful personal injury
compensation claim against a third party. This builds on the existing
scheme.
3. For a variety of reasons, Part 3 of the 2003 Act has
not yet been commenced, and the expanded Injury Costs Recovery
(ICR) scheme is therefore not yet in effect. The intention is
that it will be implemented from 29 January 2007. Once bedded
in, we envisage that the expanded scheme could result in recovered
income of approximately £190 million pa over and above the
£120 million + pa that the RTA scheme already recovers (using
the recovery rates currently in place for the RTA scheme), money
that will be returned direct to the NHS trusts that provided treatment.
4. However, as with the RTA scheme, the ICR scheme will
only come into play if the injured person makes a personal injury
compensation claim which is successful. Moreover, injured persons
have up to three years after the incident in which to make a claim,
which may then take several months, perhaps years, to reach a
settlement. All of this is entirely outside the Department of
Health's control, and rightly so. Thus, it will be several years
before the ICR scheme is fully bedded in, and it is inappropriate
to set targets for the level of income recovered when we have
no influence on the fundamental trigger point for the scheme.
5. Nevertheless, there is already a centralised and efficient
method of recovery for the RTA scheme, which is administered on
behalf of the Department of Health by the Compensation Recovery
Unit (CRU—part of the Department for Work and Pensions).
These arrangements will continue to apply in respect of the ICR
scheme. Compensators will have a legal obligation to inform the
CRU of all compensation claims made and the CRU carries out regular
compliance checks to ensure this action is being taken.
6.5.6 The Main Estimates suggest that the Department
will only recover £25 million of the costs of treating visitors
from the European Economic Area. This is down from £27 million
in 2005-06. Why is revenue declining given the increasing numbers
of overseas visitors, and the increasing costs of healthcare?
What steps is the Department taking to boost recovery? More generally,
what is the Department's estimate of the costs of treating all
overseas visitors, and how much is actually recovered, either
by Trusts or the Department? (Q135)
ANSWER
1. Successive Governments have not required the NHS to
provide statistics on the number of overseas visitors seen or
treated under the provisions of the NHS (Charges to Overseas Visitors)
Regulations 1989, as amended, or on the costs of treatment. It
is therefore not possible to provide the information requested
on the estimated costs of treating all overseas visitors, nor
the amounts recovered.
2. However, the UK has bilateral arrangements with several
EEA Member States and claims are made against other member states.
These claims are mainly based on statistical data and depend on
a number of factors. This means that the amount recovered may
fluctuate from year to year. The estimated outturn is shown in
Table 135, which shows the amount recovered in each year
since 2002-03 and is more than the main estimated budgets.
3. The Department is currently reviewing the collection
of information on EEA visitors to ensure that it is as accurate
and comprehensive as possible to ensure that the correct amount
of money is recovered from other EEA states.
Table 135
UK CLAIMS AGAINST MEMBER STATES
|
| Year | Claim type
| UK claims against Member States
|
| | £ thousands
|
|
| 2002-03 | Actual cost
| 14,200 |
| Lump sums
| 17,300 |
| Total |
31,500 |
| 2003-04 | Actual cost
| 15,248 |
| Lump sums
| 9,926 |
| Total |
25,174 |
| 2004-05 | Actual cost
| 18,700 |
| Lump sums
| 12,500 |
| Total |
31,200 |
| 2005-06 | Actual cost
| 20,600 |
| Lump sums
| 14,400 |
| Total |
35,000 |
|
Source: The 2005-06 Resource Accounting and Budgeting
(RAB) Outurn exercise.
Footnotes:
1. The information is compiled in line with the requirements
of "Government Accounting 2000" and National Audit Office
(NAO).
2. Claims against the UK are made in national currency and
converted in to 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/EHIC (temporary visitors and E112 cases (referrred patients).
4. Lump sums under Articles 94 & 95 of Regulation 574/72
include 121s (pensioners).
5. Figures may not add up due to rounding.
6.5.7 Expenditure on NHS Pensions is expected to be
£11.1 billion in 2007-08, an increase of 193% on 2000-01.
During this time, its share of the total resource budget of the
Department of Health will have climbed from 7.7% to 11.1%. How
does the Department propose to address the significant increase
in NHS pension costs? (Q136)
ANSWER
1. The figures quoted of 7.7% to 11.1% are not directly
comparable figures, due to a transfer of funds from the Departmental
annually managed expenditure (AME) to cover pension indexation
in 2003-04 of £1.6 million.
2. To calculate actual percentage of resource budget
(DEL) in 2000-01 the pensions transfer has been included at £1.1
million (deflated by the overall DEL growth from 2000-01 to 2003-04).
3. The actual comparable figures are 10% in 2000-01 and
11% in 2007-08, the actual increase forecast being in the region
of 1%.
4. Growth in pay and pensions forms a key part of the
analysis of baseline pressures forecasts that are used to inform
discussions with HMT at spending review. Also, new policy commitments
ae subject to robust affordability analysis which cover workforce
and pension implications.
5. The Department also suggests in evidence to the pay
review bodies that pensions implications are considered in their
overall pay settlement recommendations.
6. Under the reformed NHS pension Scheme, normal pension
age will increase from 60 to 65 for new entrants, reducing the
long-term pressure on the scheme.
6.5.8 The BMA has stated that the increased pay under
the new GMS contract will result in an increase in the number
of GPs taking early retirement in the next two years. The same
issue may apply in other areas of the Health Service. What impact
did the Department expect the pay arrangements to have on the
retirement plans for GPs, consultants and other NHS staff when
the reforms were introduced, and how do these compare to the actuary's
current expectations? Based on the latest data available, how
do current rates of early retirement compare to these expectations
and to previous years? What evidence is there of increased interest
in early retirement eg more purchases of added years or AVCs or
greater numbers of enquiries to NHS Pensions on the subject? Can
we have what figures you have available? (Q137)
ANSWER
1. The available data on GP retirements provided by the
Business Services Authority Pensions Division is given in Table
137. The data suggests that there has been an increase in
voluntary early retirements in the years ending in March 2006
and that this has continued so far in the year ending March 2007.
But, because of the restrictions in terms of the data, as explained
in the table notes, it is not possible to confirm the scale of
any change.
2. The overall numbers of GPs retiring, significantly
reduced in the period 2004—2006 but then appear (based on
initial 2007 data) to be returning to historic levels. Whilst
choosing to take early retirement may be a factor in the increase,
the levels of retirement down to ill-health has significantly
reduced due possibly to the way the new contract allows GPs to
better manage individual workload. But, overall it is not possible
to say what the overall long-term effects of new contractual arrangements
might be in terms of an increase in early retirement.
3. Following the introduction of the "pensions on-line"
system, which has enabled many enquiries about early retirement
to be handled locally, it is not possible to give useful information
about levels of enquiries.
4. Information on experience compared to actuarial assumptions
is normally produced in the regular cycle of pension scheme valuations,
the next of which is expected to be published next year.
5. We expected no significant effects on retirements
from Agenda for Change or the Consultant contract.
Table 137
GENERAL PRACTITIONERS RETIREMENTS AND REASONS FOR RETIREMENT
|
| Reasons for retirement
|
| Year end 31 March | Age
| Ill Health | Deferred pension
benefit
| Unknown and voluntary early retirement
| Total
pension
awards
|
|
| 1997 | 465 |
185 | 82
| 49 | 781
|
| 1998 | 451 |
171 | 72
| 46 | 740
|
| 1999 | 394 |
140 | 61
| 35 | 630
|
| 2000 | 330 |
142 | 62
| 34 | 568
|
| 2001 | 536 |
151 | 63
| 39 | 789
|
| 2002 | 564 |
196 | 93
| 35 | 888
|
| 2003 | 524 |
147 | 77
| 34 | 782
|
| 2004 | 452 |
117 | 37
| 33 | 639
|
| 2005 | 355 |
90 | 47
| 43 | 535
|
| 2006 | 392 |
70 | 31
| 74 | 567
|
| 2007 | 572 |
28 | 2
| 125 | 727
|
| Total | 5,035
| 1,437 | 627
| 547 | 7,646
|
|
Source: Business Services Authority Pensions Division.
Footnotes:
1. The NHS Pension Division administers the scheme for members
in England and Wales. The data reflects all retirements. It has
not been possible to disaggregate Welsh doctor data.
2. Retirement data held by the NHS Pensions Division is designed
primarily to record scheme membership to allow the calculation
and payment of retirement pensions and to support periodic actuarial
investigations by the government Actuary to ensure that contribution
rates will allow the scheme to meet it's future liabilities. This
means that data can only, be routinely extracted by individual
member, to calculate benefits, or for actuarial groups for valuation.
3. The NHS Pension Divisions's data recording system manages
over 1.2 million active records Most of which are subject to regular
updates year on year. Retirement data will therefore represent
a "snapshot" at a given period, which will be subject
to change over time.
4. The table above does not reflect accurately the position
of all retirement pensions awarded in scheme year-end 2006. Whilst
the data is always representative of a "snapshot" at
the time of the extract, systems that record certain types of
pension awards have not yet been updated to reflect those completed
in the final three to four months of the scheme year-end 2006.
This time lag of updating will cause a shortfall in all the figures
stated. It is impossible to project how many awards processed
have not yet been updated on the system.
5. The figures include all retirements on grounds of age,
ill health, premature retirements following redundancy or interests
of efficiency and voluntary early retirement before age 60 (introduced
from 6 March 1995). Where possible data is shown separately for
each category.
6.5.9 Based on the Department's reporting of progress
against CSR 1998, target 32, there has been little progress in
reducing sickness absence across the NHS since 2000. How is the
4.6% absence rate broken down between long- and short-term absences
and between different kinds of staff? The Department has reported
a £65 million efficiency gain for reduced sickness and use
of agency staff. Of this, how much relates to reduced use of agency
staff, and how much to reduced sickness? (Q138)
ANSWER
1. The national sickness and absence figure for the NHS
is based on an overall sickness and absence rate provided by each
NHS organisation. In 2005, the overall sickness and absence figure
for the NHS fell slightly to 4.5% from 4.6% in 2004. This figure
is the percentage of working days lost due to sickness within
an organisation and the national average is calculated using a
weighted average based on the staff numbers at each organisation.
Statistics on the length of absences and absence rates for different
types of staff are not collected.
2. The annual national sickness and absence figures since
2000 are given in Table 138.
3. £41 million of the £65 million relates to
reduced sickness. This is the calculated reduced cost of labour
resulting from the 0.1% reduction in paid sickness hours.
Table 138
NATIONAL NHS SICKNESS AND ABSENCE RATES, ENGLAND
|
| Year | Annual rate (%)
|
|
| 2000 | 4.7
|
| 2001 | 4.5
|
| 2002 | 4.6
|
| 2003 | 4.7
|
| 2004 | 4.6
|
| 2005 | 4.5
|
|
Source: The Information Centre for Health and Social
Care.
2
Forecast outturn-still subject to final validation. Back
| 
