| 1.1.1 | What has net NHS expenditure and annual change in net NHS expenditure been (a) in current prices (b) in real terms and (c) adjusted for NHS-specific inflation in each year and planned year since 1993-94? What has net NHS expenditure been as a proportion of GDP in each year since 1993-94? (Q1)
| 1 |
| 1.1.2 | What has net NHS expenditure, net NHS expenditure per head and net NHS expenditure as a proportion of GDP been in (a) England (b) Wales (c) Scotland (d) Northern Ireland and (e) the United Kingdom in each year since 1997-98? (Q2)
| 2 |
| 1.2.1 | Could table 2.2.1, detailing trends in actual and planned expenditureon health and personal social services by area of expenditure, be updated, together with the commentary on it? (Q3)
| 3 |
| 1.2.2 | What is the Department's assessment of expenditure on each programme in 2004-05 against plans for that year, and anticipated expenditure by programme in 2005-06 against plans for that year and outturn in 2004-05? (Q4)
| 4 |
| 1.2.3 | What has additional NHS expenditure in 2005-06 compared with 2004-05 been spent on? Is it possible to provide a more detailed breakdown than last year? (Q5)
| 5 |
| 1.3.1 | Can the Department detail improvements in the scope and quality of programme budgeting? What changes are planned over the next year? (Q6)
| 6 |
| 1.3.2 | What was expenditure on cancer (a) in £ (b) as a proportion of total expenditure and (c) per head of population by Primary Care Trust in 2003-04 and 2004-05? Could the Department comment on these data and the quality of them? (Q7)
| 8 |
| 1.4.1 | What has NHS income from charges been since 1997-98, by type of charge? (Q8)
| 9 |
| 2.1.1 | Could the department detail NHS capital spending by category of expenditure from 1997-98 to 2007-08? (Q9)
| 10 |
| 2.2.1 | Could the Department list all publicly funded capital projects with a total cost above £10 million which are under construction? Could this include original and current estimated completion dates and costs and percentagetime/cost overruns and savings? (Q10)
| 11 |
| 2.2.2 | Could the Department provide a commentary on publicly funded capital projects where there are significant discrepancies between original estimates of completion dates and/or expenditures and current estimates? (Q11)
| 12 |
| 2.3.1 | Could the Department provide expenditure profiles of capital expenditure on PFI schemes from 1997-98 onwards by (a) region and (b) scheme by broad capital cost of scheme? (Q12)
| 15 |
| 2.3.2 | Could the Department detail increases to the capital cost of PFIschemes and comment on any increases over 10%? (Q13)
| 16 |
| 2.3.3 | Could the Department provide an update of Tables 5.3.5, showing, for projects over £25 million in value, a comparison between the PFI price and the publicly financed option? The publicly financed comparator's costings should be broken down into (a) basic construction contract, distinguishing pre-implementation and post-implementation costs (b) the value of risk adjustment, again distinguishing pre-implementation and post implementation costs, in both £ million and percentage terms, and (c) the final total real full-life costof both options. (Q14)
| 17 |
| 2.3.4 | What is the value of annual unitary payments made in the latest available year for each PFI scheme in operation? What is the Reference Cost Index (excluding Market Forces Factor) position of each trust, where theEngland average equals 100? (Q15)
| 18 |
| 2.3.5 | Could the Department list PFI schemes subject to an increase in theunitary fee, including the increases and explanation of them? (Q16)
| 19 |
| 2.4.1 | Could the Department list all NHS LIFT schemes and their expectedcapital costs? (Q17)
| 20 |
| 2.4.2 | What has revenue spending on GP premises been in each year since 1997-98? Could the Department comment on the consistency of this series? (Q18)
| 21 |
| 2.5.1 | Could the Department tabulate Local Authority Personal Social Services capital expenditure, broken down into maintenance and new acquisitions, and income, broken down into sale of buildings and sale of equipment, from 1997-98 to 2005-06? (Q19)
| 22 |
| 2.5.2 | What Personal Social Services PFI projects have been (a) approved and (b) given ministerial approval? Could details of value, approval date andcompletion date be included? (Q20)
| 23 |
| 2.5.3 | Could the Department compare actual capital spend by social services departments with allocations in each year since 1997-98? Could the Department comment on comparability through the period? (Q21)
| 24 |
| 3.1.1 | How many (a) total doctors (b) consultants (c) GPs (d) total qualified nursing and midwifery staff (e) midwives (f) practice nurses (g) total qualified scientific and therapeutic staff (h) radiographers (i) clinical psychologists (j) total NHS infrastructure support staff (k) clerical and administrative staff and Health Select Committee: Public Expenditure Inquiry 2006 (1) managers and senior managers have been employed by the NHS in each year since 1997, in headcount and full time equivalent terms? Where available, what are the latest quarterly figures? (Q22)
| 25 |
| 3.1.2 | How many GPs (a) joined and (b) left the NHS in each year since 1997? (Q23)
| 26 |
| 3.1.3 | How many (a) doctors (b) nurses (c) midwives and (d) radiographers are projected to complete undergraduate or pre-registration training in each of the next five years? How many are projected to reach retirement age in each of the next five years? Could the Department comment on relative trends? (Q24)
| 27 |
| 3.1.4 | What was total expenditure on (a) agency nurses and (b) other agency staff in each year since 1997-98? (Q25)
| 28 |
| 3.1.5 | What was expenditure on (a) agency nurses and (b) other agency staff in each NHS Trust, Primary Care Trust and Strategic Health Authority in 2003-04 and 2004-05, in £s and as a percentage of turnover? (Q26)
| 29 |
| 3.2.1 | What has the top (discretionary and non-discretionary, and including merit or distinction awards where appropriate) and bottom of the payscale and average full time earnings been for: (a) Nursing and Midwifery Grades D—I (b) Nursing/Midwifery/Health Visitor Consultants (c) House Officers (d) Senior House Officers (e) Specialist Registrars (f) Associate Specialists (g) Staff Grade (h) Consultants (i) General Practitioners and (j) Salaried General Practitioners employed by PCTs been in each year since 1997-98? Why do average full time earnings exceed the top of payscales in some cases? (Q27)
| 30 |
| 3.2.2 | What are the expected costs of Agenda for Change in each year from 2005-06 to 2008-09? Have these estimates changed, and if so, can the changes be explained? (028)
| 31 |
| 3.2.3 | What is the current Agenda for Change assimilation rate? Can the Department comment on this figure? (029)
| 33 |
| 3.2.4 | What are the expected costs of the new consultant contract in each year from 2005-06 to 2008-09? Have these estimates changed, and if so, can the changes be explained? What have consultant earnings been in each year since 2001-02? (Q30)
| 34 |
| 3.2.5 | What are the expected costs of the new GMS contract in each year from 2003-04 to 2006-07? (Q31)
| 35 |
| 3.2.6 | What is the funding for the new pharmacy contract in 2005-06 and 2006-07 and what will be the basis for such funding in subsequent years? Could the Department comment on the provision, and funding, of enhancedand advanced services? (Q32)
| 36 |
| 3.2.7 | What are the expected costs of the new dental contract in each year from 2005-06 to 2008-09? (Q33)
| 37 |
| 3.2.8 | What are the expected costs of the Options for Excellence social care workforce scheme, by year? Could the Department comment on the progress of the scheme? (Q34)
| 39 |
| 3.3.1 | What has NHS expenditure on the purchase of healthcare from non-NHS bodies been in each year since 1997-98? How much activity did this purchase? Could the Department provide a detailed breakdown of these data where available? (035)
| 40 |
| 3.3.2 | Could the Department provide a list of all Independent Sector Treatment Centres (ISTCs) currently in operation, or with contracts already signed, including (a) name and location (b) company running the ISTC (c) services contracted for, by type and volume (by Healthcare Resource Group if possible) (d) value of contract per year, the period of the contract and whether it is on a "take or pay" basis and (e) a comparison with the cost at national tariff prices of providing the same type and volume of services? (036)
| 41 |
| 3.3.3 | What has NHS expenditure on healthcare provided in other EEA member states or Switzerland been in each year since 2002-03? What is it expected to be in future years? (037)
| 42 |
| 3.4.1 | Could the Department detail expenditure and projected expenditure on the National Programme for IT? Can the Department estimate the extent of local additions to NHS Connecting for Health funding? Could the Department comment on any cost overruns and delays? (Q38)
| 44 |
| 3.4.2 | What have the costs of implementing Choose and Book been to date? How does this compare with original estimates? (Q39)
| 45 |
| 3.4.3 | How has the Department deployed the additional funding granted asa result of the Health Committee's report into New Medical Technologies towards improving the management of patients through the use of telecare in liaison with social services? How was the funding for such schemes deployed in the last financial year and how much will it be in the future? Is this money ring-fenced? (040)
| 46 |
| 3.4.4 | How many, and what proportion of, practices are involved in practice-based commissioning (PBC), and what is progress towards the "universal coverage" of PBC? (Q41)
| 48 |
| 3.4.5 | How much is available to PCTs to provide out-of-hours services? What proportion of practices have opted out of providing out-of-hours services? (042)
| 49 |
| 3.4.6 | How much NHS expenditure was paid, or is forecast to be paid, to trusts via the national tariff in each year from 2004-05 to 2007-08? How much activity did this purchase? (Q43)
| 51 |
| 3.4.7 | Can the Department detail the current timetable for the implementation of Payment by Results, explaining any delays? (Q44)
| 52 |
| 3.4.8 | How much extra funding is being provided to NHS bodies to assist with the continued phasing-in of Payment by Results in 2006-07 and 2007-08? (Q45)
| 54 |
| 3.5.1 | What are the expected costs of implementing each NICE recommendation, technology appraisal and clinical guideline in 2006-07? (Q46)
| 55 |
| 4.1.1 | What was HCHS expenditure by service sector and age group in (a) ? 2003-4 and (b) 2004-05? (Q47)
| 56 |
| 4.1.2 | Could a table be provided detailing gross expenditure on HCHS and FHS by sector in each year since 1997-98? (Q48)
| 57 |
| 4.2.1 | Can the Department detail (a) Primary Care Trust allocations (b) distance from target allocation in £000s and in percentage terms and (c) allocations per weighted and unweighted head. of population in each year from 2003-04 to 2007-08 in each Strategic Health Authority area? Can data for individual PCTs be provided as an appendix? (Q49)
| 58 |
| 4.2.2 | What was the average percentage absolute adjustment made to crude Primary Care Trust populations for (a) age structure (b) additional need (c) market forces and (d) other in the 2007-08 weighted capitation formula? (Q50)
| 59 |
| 4.2.3 | What percentage adjustments were made to crude populations for (a) age structure (b) additional need (c) market forces and (d) other for each Primary Care Trust in the 2007-08 weighted capitation formula? (Q51)
| 60 |
| 4.3.1 | What was pharmaceutical expenditure in each year from 1997-98 to 2005-06, by sector and generic/branded drugs? (Q52)
| 61 |
| 4.4.1 | Could the Department detail actual and planned expenditure on supra-regional and centrally commissioned services in each year from 2003-04 to 2007-08? (Q53)
| 62 |
| 4.5.1 | What has net expenditure by central and local government on community care been in each year since 1997-98? Can the data be broken down by residential and non-residential care and include social security and housing expenditure contributing to community care objectives? (Q54)
| 63 |
| 4.5.2 | What was expenditure on NHS Continuing Care in each Strategic Health Authority in the latest available year, in absolute and per 100,000 population terms? Could the Department comment on these data? (Q55)
| 64 |
| 4.6.1 | What was Personal Social Services expenditure on adults by client group and type of provision in (a) current prices and (b) real terms from 1997-98 to 2004-05? Could both client group and type of provision totals be included? (Q56)
| 65 |
| 4.6.2 | Could the Department detail trends in the unit costs of the main social services for adults each year since 1999-2000? How do costs vary between authorities? Could the Department comment on these figures? (Q57)
| 66 |
| 4.6.3 | What grants were available for Personal Social Services in each year since 2003-04? Could the Department comment on these data? (Q58)
| 68 |
| 4.6.4 | Could the Department detail trends in the Personal Social Services Pay and Price Index since 1997-98 and outline the assumptions behind the index? What are the expected financial effects of demographic pressures onPSS over the next five years? (Q59)
| 69 |
| 4.6.5 | Could the Department detail trends in sales and charges as a percentage of gross Personal Social Services expenditure on adults by typeof service (a) nationally and (b) by local authority? (Q60)
| 70 |
| 4.6.6 | What proportion of (a) contact hours of home help/care and (b) supported residential care was purchased by local authorities from the independent sectors, nationally, by region and by local authority, in the latest year for which data are available? Could the Department comment on thesedata? (Q61)
| 71 |
| 4.6.7 | Could the Department comment on the replacement of Formula Spending Shares for Personal Social Services with Relative Needs Formula calculations? (Q62)
| 72 |
| 5.1.1 | How many admissions, removals and decisions to admit were there in each year since 1988-89? What was non-emergency and emergency activity in each year? What was the waiting list, and how many suspensionsand self-deferrals were outstanding, at the end of each year? (Q63)
| 73 |
| 5.1.2 | What were (a) mean and (b) median waiting times for inpatient admission in each year since 1988-89? Could these data be shown in tabularand graphical form? (Q64)
| 74 |
| 5.1.3 | Could the Department detail (a) numbers of First Finished ConsultantEpisodes (FFCEs), broken down into ordinary and day cases (b) admissions by type of admission and (c) episode/spell ratios by Strategic Health Authority in the past three years for which data are available? Could the Department comment on the use of FFCEs rather than Finished Consultant Episodes (FCEs)? (Q65)
| 75 |
| 5.1.4 | How many patients were waiting for inpatient treatment, by time waiting and Strategic Health Authority in commissioner-based form at the last available count? What were the mean and median waiting times in eachcase? (Q66)
| 76 |
| 5.1.5 | In latest quarter for which data are available, how many patients waited (a) over three months and (b) over six months for inpatient treatment by Strategic Health Authority of residence and specialty? (Q67)
| 77 |
| 5.2.1 | How many (a) GP referrals for first outpatient appointment (b) other first outpatient referrals (c) first attendances and (d) other attendances were there in each year since 1988-89? (Q68)
| 78 |
| 5.2.2 | What were (a) mean and (b) median waiting times for outpatient appointments in each year since 1988-89? Could these data be shown in tabular and graphical form? (Q69)
| 79 |
| 5.2.3 | How many new outpatient attendances were there by Strategic Health Authority in the past three years for which data are available? What are these data equivalent to per 1,000 population? (Q70)
| 80 |
| 5.2.4 | Of patients not yet seen following written referral at the end of the latest quarter for which data are available, how many had been waiting (a) less than 13 (b) 13-17 (c) 17-21 and (d) more than 21 weeks, by Strategic Health Authority, in commissioner-based form? (Q71)
| 81 |
| 5.2.5 | Of patients seen following written referral in the latest quarter for which data are available, how many waited (a) less than 13 weeks and (b) more than 13 weeks, by Strategic Health Authority of residence and specialty? (Q72)
| 82 |
| 5.2.6 | Could the Department comment on the progress of the Outpatient Commissioning Dataset? How much has been spent on the project, by year? How much is planned to be spent, by year? When are data likely to be published and in what form? Could the Department comment on the quality of these data? Could the Department comment on the possibility of making diagnosis and procedure mandatory in data submission? (Q73)
| 83 |
| 5.3.1 | How many NHS GP consultations are estimated to have taken place in each year since 1989? (Q74)
| 85 |
| 5.3.2 | Could the Department provide evidence of any shift in activity from secondary to primary care settings? Could the Department comment on these data and the likely impact of such service reconfiguration? (Q75)
| 86 |
| 5.4.1 | Could the Department comment on recent relative trends in waiting lists and times and rates of NHS activity? Could these comparative trends be shown graphically where appropriate? (Q76)
| 88 |
| 5.4.2 | What progress has been made towards monitoring the target of no patients waiting more than 18 weeks from GP appointment to treatment? Have any pilot studies taken place? If so, what were the results? When does the Department expect National Statistics accredited data to be published? (Q77)
| 89 |
| 5.4.3 | What additional mechanisms are in progress to deal with waiting listsand times, and what is expenditure and projected expenditure on these additional mechanisms? (Q78)
| 90 |
| 5.5.1 | By sector, in each year since 1997-98, (a) how many available bedswere there (b) how many beds were occupied (c) what was the occupancy rate and (d) average length of stay? (Q79)
| 92 |
| 5.5.2 | How many (a) general and acute and (b) total beds were available ineach Strategic Health Authority in the latest year for which data are available? How many, and what proportion, were occupied? (Q80)
| 93 |
| 5.6.1 | How many delayed discharges from acute hospital beds were there in the last year, by Strategic Health Authority and broad reason for delay? What proportion of available beds are occupied by patients subject to delayed discharge by Strategic Health Authority? (Q81)
| 94 |
| 5.7.1 | How many consultant episodes of patients with mental illness and how many per 1,000 population were there amongst residents of each (a) Strategic Health Authority and (b) Primary Care Trust area in 2003-04 and 2004-05? (082)
| 95 |
| 5.7.2 | Could the Department update the information given in Tables 3.4.1, on patients under the care of a learning disability or mental illness consultant, including (a) numbers of patients (b) discharges by length of stay, age and destination and (c) beds and residential places available? How many repeat admissions of such patients were there? (Q83)
| 96 |
| 5.7.3 | How many people were admitted to (a) NHS facilities and (b) independent hospitals under the 1983 Mental Health Act in 2004-05, by Trust and type of section? (Q84)
| 99 |
| 5.7.4 | How many patients with (a) mental illness and (b) learning difficultieshave been resident in each high secure hospital in each year since 1997? Are any data available for medium security hospitals and prisons? (085)
| 101 |
| 5.7.5 | Is there any evidence of increasing emphasis on "talking therapies" in NHS mental health treatment? (Q86)
| 106 |
| 5.8.1 | Could the Department comment on trends in (a) NHS star ratings and (b) social services star ratings performance? How many NHS organisations and councils saw a drop in their rating in each year for which data are available? Can the Department comment on any common factors between organisations with a ratings drop? (087)
| 109 |
| 5.9.1 | What were management costs by type of NHS organisation and as a share of total NHS expenditure in each year since 1997-98? (Q88)
| 112 |
| 5.9.2 | Could the Department detail expenditure on management consultants as part of turnaround teams, nationally and by organisation? Could the Department comment on the availability of more general data concerning NHS expenditure on external consultants? (Q89)
| 113 |
| 5.10.1 | What has the NHS financial balance been in each year since 1997-98? (Q90)
| 114 |
| 5.10.2 | What have deficits and surpluses been in each (a) NHS Trust (b) Primary Care Trust and (c) Strategic Health Authority been in each year since 1997-98 for which data are available, in £s and as a percentage of turnover? (Q91)
| 115 |
| 5.10.3 | What steps is the Department taking to improve the ability of NHS bodies to make accurate forecasts of their year-end financial position? What action is being taken to break the typical cycle identified by the Audit Commission of NHS bodies giving little credence to financial information early in the financial year, only to enter into corrective action after finding themselves in danger of overspending later in the year? What was the impact of the publication of mid-year financial position forecasts in 2005-06? (Q92)
| 116 |
| 5.10.4 | Is there evidence of correlation between the 2005-06 financial position of Primary Care Trusts and (a) 2005-06 per cent distance from target revenue allocation and (b) 2005-06 revenue allocation per unweighted head of population? Could these data be shown in graphical form? (Q93)
| 118 |
| 5.11.1 | Could the Department give an explanation as to the level of funding set aside for inflation in 2006-07? In particular, can it give the average pay awards to each (subjective) staff group and the inflation assumptions for non pay including capital charges? (Q94)
| 119 |
| 5.11.2 | Can the Department show trends in components of HCHS and FHS inflation indices in each year since 1997-98 in as much detail as possible? (Q95)
| 121 |
| 5.11.3 | What have trends in (a) the NHS inflation index (b) sub-indices of the NHS inflation index and (c) relative weights given to each sub-index been in each year since 1993-94? What assumptions underlie the construction of the index and any changes in weighting? (Q96)
| 123 |
| 5.12.1 | What progress has been made towards a replacement for the Cost Weighted Activity Index? What assessment has been made of recent trends in NHS productivity? (Q97)
| 125 |
| 5.12.2 | What are the expected redundancy costs of the current re-organisation of Strategic Health Authorities and Primary Care Trusts? (Q98)
| 127 |
| 5.13.1 | What was the total expenditure, grant-in-aid funding and whole time equivalent staffing of each of the Department of Health's Arm's Length Bodies in 2005-06? (Q99)
| 128 |
| 5.13.2 | Could the Department detail and comment on the extent of savings from its own change programme and the review of Arm's Length Bodies? What further savings are anticipated in 2006-07 and 2007-08? What risk assessment has been undertaken to accompany these change programmes and to indicate the limits to further savings? What have the redundancy and relocation costs of these change programmes been? (Q100)
| 129 |
| 5.13.3 | Could the Department detail (a) administrative and (b) programme expenditure on consultants in 2005-06? Could the Department comment on these data and the quality of them? (Q101)
| 131 |
| 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? (0102)
| 132 |
| 6.1.2 | SR 2004, target 2. Why has the gap in infant mortality between "routine & 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)? (0103)
| 133 |
| 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)
| 135 |
| 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)
| 136 |
| 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? (0106)
| 138 |
| 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 10 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)
| 140 |
| 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 Health Select Committee: Public Expenditure Inquiry 2006 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)
| 141 |
| 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)
| 143 |
| 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 theimplementation of the consultant contract? (Q110)
| 144 |
| 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 newarrangements which it already holds with its consultants? (Q111)
| 145 |
| 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 seefor service quality and morale? (Q112)
| 147 |
| 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)
| 148 |
| 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)
| 149 |
| 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)
| 151 |
| 6.3.7 | In the Departmental Report, the Department states that 32 Trusts have now achieved Foundation status, and afurther 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)
| 153 |
| 6.3.8 | The Department expects that the cost of Wave 1 and Wave 2 ISTCsmay 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
| 154 |
| 6.3.9 | How many practices are currently making use of the opportunities tocommission using an indicative budget offered by PBC and what proportion of the total budget available for PBC is managed in this way? How do thesefigures compare with the Department's targets? (Q118)
| 155 |
| 6.3.10 | What incentive do practices have to make use of PBC? (Q119)
| 156 |
| 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)
| 157 |
| 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)
| 158 |
| 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)
| 159 |
| 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)
| 160 |
| 6.3.15 | Data from Monitor has identified bad debts in Foundation Trusts of £28 million 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)
| 161 |
| 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? (Q1125)
| 163 |
| 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)
| 164 |
| 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)
| 165 |
| 6.4.3 | The Human Resources DevelopmentStrategy 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)
| 166 |
| 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)
| 167 |
| 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)
| 168 |
| 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)
| 169 |
| 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)
| 170 |
| 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)
| 171 |
| 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 £8m (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)
| 172 |
| 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)
| 174 |
| 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)
| 175 |
| 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)
| 176 |
| 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)
| 177 |
