Annex
List of 18 weeks pilot sites
Aintree Hospitals NHS Trust
Blackpool, Fylde and Wyre Hospitals NHS Trust
Bromley Hospitals NHS Trust
Central Manchester & Manchester Childrens's Hospitals University
NHS Trust
East Lancashire Hospitals NHS Trust
Gateshead Health NHS Trust
Guy's & St Thomas' NHS Foundation Trust
Harrogate and District NHS Foundation Trust
Luton & Dunstable Hospital NHS Trust
Mayday Healthcare NHS Trust
Morecambe Bay Hospitals NHS Trust
Royal Orthopaedic Hospital NHS Trust
Royal Surrey County Hospital NHS Trust
Royal United Hospitals Bath NHS Trust
Sherwood Forest Hospitals NHS Trust
St George's Healthcare NHS Trust
Stockport NHS Foundation Trust
Surrey & Sussex Healthcare NHS Trust
University College London Hospitals NHS Foundation Trust
Wirral Hospitals NHS Trust
Somerset Coast PCT
Bromley PCT
Craven, Harrogate & Rural District PCT
Newark & Sherwood PCT
List of the tests piloted
Magnetic Resonance Imaging
Computorised Topography
Non-obstetric ultrasound
Barium Enema (from July)
DEXA Scan (from July)
Audiology—pure tone audiometry
Cardiology—echocardiography
Cardiology—electrophysiology
Neurophysiology—peripheral neurophysiology
Respiratory physiology—sleep studies
Urodynamics—pressures & flows (from July)
Colonoscopy (from July)
Flexi sigmoidoscopy (from July)
Cystoscopy (from July)
Gastroscopy (from July)
Cardiology—diagnostic cardiac catheters/angiography (April
to July)
GI Physiology—Manometry (April to July)
Nurse and GPSI-led endoscopy (April to June)
All other endoscopy (April to June)
All other diagnostic tests or procedures (April to June)
Physiological Measurement—Breath Tests (July)
Physiological Measurement—Balance Tests (July)
Physiological Measurement—Event Monitoring in ECGs (July)
Endoscopy—ERCP (endoscopic retrograde cholangiopancreatography)
(July)
Endoscopy—Colposcopy (July)
Endoscopy—Hysteroscopy (July)
Endoscopy—Laparoscopy (July)
Imaging—Nuclear Medicine (July)
Q (209)
NHS
Foundation Trust sector set-up cost.
Answer
1. Monitor, the Independent Regulator of
NHS Foundation Trusts, was established under the Health and Social
Care (Community Health and Standards) Act 2003 on 5 January 2004.
Its grant in aid from the Department of Health for the period
January to March 2004 was £3.414 million. This expenditure
is accounted for in Monitor's 2004 Annual Report which can be
found at www.monitor-nhsft.gov.uk
2. Each NHS foundation trust is responsible
for covering the cost of its own application. The Department of
Health does not keep a central record of these costs, but does
provide support to NHS trusts going through the foundation application
process. Trusts receive support on their applications from consultants
and specialists contracted by the Department, as well as a cash
payment from the Department towards their costs. The cash payments
made by the Department to the 32 current NHS foundation trusts
are attached.
Cash support payments
|
| Wave & Group |
NHS Foundation Trust Group
| Backfill
Funding £
|
|
| Wave 1 "Group 1": Authorised from 01-Apr-04
| Basildon and Thurrock University Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 1": Authorised from 01-Apr-04
| Bradford Teaching Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 1": Authorised from 01-Apr-04
| Countess of Chester NHS Foundation Trust |
250,000 |
| Wave 1 "Group 1": Authorised from 01-Apr-04
| Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 1": Authorised from 01-Apr-04
| Homerton University Hospital NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 1": Authorised from 01-Apr-05
| Moorfields Eye Hospital NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 1": Authorised from 01-Apr-05
| Peterborough and Stamford Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 1": Authorised from 01-Apr-05
| Royal Devon and Exeter NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 1": Authorised from 01-Apr-05
| Stockport NHS Foundation Trust |
250,000
|
| Wave 1A "Group 1": Authorised from 01-Apr-05
| The Royal Marsden NHS Foundation Trust |
250,000 |
| Wave 1A "Group 2" Authorised from 01-Jul-05
| Cambridge University Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 2" Authorised from 01-Jul-05
| City Hospital Sunderland NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 2" Authorised from 01-Jul-05
| Gloucestershire Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 2" Authorised from 01-Jul-05
| Guy's and St Thomas' Hospital NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 2" Authorised from 01-Jul-05
| Papworth Hospital NHS Foundation Trust |
250,000 |
| Wave 1 "Group 2": Authorised from 01-Jul-04
| Sheffield Teaching Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 2": Authorised from 01-Jul-04
| Derby Hospitals NHS Foundation Trust |
250,000
|
| Wave 1 "Group 2": Authorised from 01-Jul-04
| The Queen Victoria Hospital NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 2": Authorised from 01-Jul-04
| University College London Hospitals NHS Foundation Trust
| 250,000 |
| Wave 1 "Group 2": Authorised from 01-Jul-04
| University Hospital Birmingham NHS Foundation Trust
| 250,000 |
| Wave 1A "Group 3": Authorised from 01-Jan-05
| Barnsley District General Hospital NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 3": Authorised from 01-Jan-05
| Chesterfield and North Derbyshire Royal Hospitals NHS Trust
| 175,000 |
| Wave 1A "Group 3": Authorised from 01-Jan-05
| Gateshead Health NHS Foundation Trust (authorised
5 January)
| 175,000 |
| Wave 1A "Group 3": Authorised from 01-Jan-05
| Harrogate Healthcare NHS Foundation Trust |
175,000 |
| Wave 1A "Group 3": Authorised from 01-Jan-05
| South Tyneside Healthcare NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| Heart of England NHS Foundation Trust |
175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| Frimley Park Hospitals NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| Lancashire Teaching Hospitals NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| Liverpool Women's Hospital NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised from 01-Apr-05
| The Royal Bournemouth and Christchurch NHS Foundation Trust
| 175,000 |
| Wave 1A "Group 4" Authorised on 1 June 2005
| Rotherham General Hospital NHS Foundation Trust
| 175,000 |
|
| Total | |
7,100,000
|
|
3. We see these costs as being an investment in a model
that ties local people into decision making to ensure trusts are
better placed to deliver the modern health services that local
people need as well as developing the skills needed to ensure
much more rigorous financial management within the health service.
Q (221) and (352) Provision of information on the cost
of independent providers other than the ISTCs.
Answer
1. The table below shows the latest published reference
cost data for activity carried out by the private sector. This
information is collected under the activity type headings by the
commissioners of the activity from the private sector. Given these
broad headings it is not currently possible to breakdown activity
costs being carried out by the independent sector treatment centre
programme as opposed to other private sector health providers.
Private Sector NHS activity costs 2003-04
|
| Activity Type | Cost £
|
|
| Admitted Patient Care: Elective | 144,871,648
|
| Admitted Patient Care: Non-Elective (Emergency)
| 543,991 |
| Non Admitted Patient Care: Accident and Emergency
| 92,834 |
| Non Admitted Patient Care: Audiological Services
| 276,864 |
| Non Admitted Patient Care: Community Services
| 8,482,107 |
| Non Admitted Patient Care: Direct Access |
3,911,971 |
| Non Admitted Patient Care: Day Care Facilities
| 167,178 |
| Non Admitted Patient Care: Day Care—Reg. Adm.
| 77,364 |
| Non Admitted Patient Care: Mental Health |
165,784,907 |
| Non Admitted Patient Care: Outpatients |
10,232,622 |
| Non Admitted Patient Care: Outpatients Maternity
| 4,102 |
| Non Admitted Patient Care: Paramedics | 88,196
|
| Non Admitted Patient Care: Specialist Servives
| 7,198,506 |
| Non Admitted Patient Care: Ward Attendances
| 341,110 |
|
| Total | 342,073,402
|
|
Source: NHS Reference Costs 2003-04
2. The following table shows the cost premium, the additional
cost over, of work commissioned from the independent sector in
2003-04, the latest available data.
Cost premium of work commissioned from the Independent
Sector by the NHS in 2003-04
|
| Premium (£m)
| Premium % |
|
| Mental Health | 27
| 19 |
| Admitted patient care | 22
| 18 |
| Other | -19
| -38 |
|
| Total | 30
| 10 |
|
Source: NHS Reference Costs 2003-04
Q (232) Reinstatement of data collection to answer HSC's
public capital questions.
Answer
1. DH will reinstate an annual data collection exercise
to provide information to the committee on public funded capital
schemes.
Q (239) PFI contracts—how many operational PFI schemes
have bed occupancy surcharge clauses.
Answer
1. There is no "surcharge" for bed occupancy
per se. Additional patients mean there is a requirement
for additional services, for which the private sector are paid
additional money.
Q (241) Share of NHS capital spend financed by PFI declines
from 29.4% in 2006-07 to 23.5% in 2007-08 (no table ref quoted).
Explanation.
Answer
1. The percentage depends on the number of schemes reaching
financial close in any particular year, their capital value and
the build periods. This means that there will be occasions when
the figures show that spending is lower than a preceding year.
2. The overall proportion of NHS capital expenditure
attributed to PFI is normally relatively constant at around 30%.
Q(265) Additional work on measuring productivity in the
NHS
Answer
A copy of the report Healthcare Output and Productivity:
Accounting for Quality Change can be accessed at: www/dh/gov.uk/assetRoot/04/12/67/04124267.pdf
Q (292) Cost of 18-week waiting target
Answer
1. The estimated cost of delivering the 18-week waiting
target made at the 2004 Spending Review was:
|
| Policy initiative | 2006-07 (£m)
| 2007-08 (£m) |
|
| Reducing waiting times and new models of care
| 1,000 | 1,900
|
| Access diagnostics | 400
| 800 |
|
| Total | 1,400
| 2,700 |
|
2. Costs beyond 2007-08 will form part of the Comprehensive
Spending Review (CSR) 2007.
Q (340) NHS foundation trust deficits
Answer
FINANCIAL PERFORMANCE
OF NHS FOUNDATION
TRUSTS
1. Numbers of NHS foundation trusts
Since April 2004 Monitor (the Independent Regulator of NHS
Foundation Trusts) has authorised 32 NHS foundation trusts:
|
| Number | Authorisation date
|
|
| 10 | 1 April 2004
|
| 10 | 1 July 2004
|
| 4 | 1 January 2005
|
| 1 | 5 January 2005
|
| 6 | 1 April 2005
|
| 1 | 1 June 2005
|
|
The figures for financial performance on which Monitor reports
cover only the period from authorisation. The 2004-05 figures
therefore include 10 NHS foundation trusts for a full year and
a further 15 for a part year. The 2005-06 update figures cover
32 NHS foundation trusts.
2. Financial performance 2004-05
Monitor's "Review and consolidated accounts of NHS foundation
trusts 2004-05" was laid before Parliament on 22 November
2005.
The consolidated accounts show that NHS foundation trusts
had a surplus for the year of £60.3 million before dividend
payments on public dividend capital (see note 4 below). After
dividend payments there was a deficit for the year of £36.9
million. This was approximately 1% of income (£3,377 million).
Given the size of the surpluses and deficits involved in
most cases it is doubtful how helpful it is to analyse how many
trusts had surpluses and how many deficits. For the record:
12 NHS foundation trusts had deficits for 2004-05—five
of those were of less than £1 million. 6 NHS foundation trusts
had surpluses for 2004-05—five of those were of less than
£1m. The remaining 7 NHS foundation trusts broke even.
3. Financial performance 2005-06
On 16 December Monitor published an update on the performance
of NHS foundation trusts for the year to date.
The half-year update shows that NHS foundation trusts had
a deficit of £2 million before exceptional items and £3
million after exceptional items (see note 5 below).
16 FTs had deficits of which 11 were of £1 million or
less.
16 FTs had surpluses of which 9 were of £1 million or
less.
4. Public dividend capital
NHS foundation trusts make payments to government on the
public dividend capital which they have in their balance sheets.
As NHS foundation trusts are autonomous organisations it is worth
noting that they continue to make these payments. In 2004-05 the
PDC dividends totalled £97 million; in the first six months
of 2005-06 they were £84 million.
5. Exceptional items
NHS foundation trusts are subject to a different accounting
regime to non-foundation trusts. Their accounting regime is closer
to the approach used for commercial organisations. One of the
changes relates to the treatment of impairments (which arise when
the value of an asset is written down). For foundation trusts
these are deducted from the income and expenditure account.
The 2005-06 update figures are therefore shown pre- and post-
exceptional items (which are mainly impairments). The pre-exceptional
items figure provides a better basis for comparison with the rest
of the NHS.
6. Deficits in NHS foundation trusts
NHS foundation trusts have a number of freedoms. This includes
the freedom to generate surpluses or, if they consider it appropriate,
incur deficits. Given this it is of doubtful benefit to compare
the proportion of NHS foundation trusts with deficits with the
rest of the NHS.
Monitor scrutinises NHS foundation trusts to ensure that
they remain compliant with their terms of authorisation, including
assessing whether they continue to be financially strong. The
regulatory regime for foundation trusts ensures that financial
problems are identified quickly and that Boards take rapid and
appropriate action to address those problems. It is encouraging
that the three foundation trusts who had the most significant
financial problems in 2004-05 (Bradford, Royal Devon & Exeter
and Peterborough) have all made substantial progress towards eliminating
their deficits.
Q (362) Nurse training in ISTCs
Answer
1. Where the NHS activity is transferred to the ISTC,
NHS training will also transfer—this will include the transfer
of NHS training for nurses.
2. Training for nurses (and consultants) will take place
in the following ISTCs:
Brighton
Portsmouth
Burton
East Cornwall
York
South-west Oxford
Nottingham
Maidstone
London
Bedfordshire and Hertfordshire
3. Plans are also in place to make training available
in all of the Wave 2 contracts.
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