Select Committee on Health Written Evidence


Supplementary memoranda from the Department of Health (CP 01A)

  During the session with Department of Health officials on NHS charges on 19 January, the Committee asked for two additional pieces of information in relation to optical services.

  First, they asked for confirmation of the assurances which have been given by the Minister of State for Health Services in relation to the implications of the ophthalmic clauses of the Health Bill. These have been put on the record in Hansard on 11 January.[1]

  Second, the Committee asked for the figures for the real terms increase in expenditure on NHS funded sight tests. These figures are set out in the attached table which is drawn from a recently published Statistical Bulletin for 2004-05 prepared by the Health and Social Care Information Centre. These figures show a 68% real terms increase in expenditure on NHS sight tests between 1994-95 and 2004-05.

Table

GENERAL OPHTHALMIC SERVICES EXPENDITURE, ENGLAND, AT 2004-05 PRICES


£ million

Financial Year
Total gross expenditure[2], [3], [4]
Cost of sight test provision[5]
Cost of glasses provision[6]
1994-95
275.0
112.6
162.1
1995-96
279.7
113.4
166.0
1996-97
286.7
117.4
169.0
1997-98
285.5
121.3
163.9
1998-99
277.4
119.5
157.5
1999-2000
321.1
166.9
153.5
2000-01
321.3
171.5
149.3
2001-02
327.0
176.0
150.3
2002-03[7]
318.6
171.4
146.5
2003-04
328.5
178.0
149.4
2004-05
340.0
189.1
149.7


Re-used with the permission of the:

  Family Health Services Authority Annual Accounts (1992-93 to 1995-96), Health Authority Annual Accounts (1996-97 to 1998-99), Health Authority Audited Summarisation Forms (1999-2000 to 2001-02), Strategic Health Authority Audited Summarisation Forms (2002-03), Primary Care Trust Audited Summarisation Schedules (2002-03 to 2004-05)

  I hope that this provides the Committee with the information sought.

Department of Health

1 February 2006




PATIENT CHARGES FOR MEDICINES IN SOME OTHER EUROPEAN COUNTRIES

GENERAL

  1.  Co-payment systems for medicines vary considerably from country to country within the EU. The different co-payment arrangements are related to the relevant country's health care system, and the country's pricing and reimbursement policies for pharmaceuticals. It is therefore difficult to make direct comparisons between countries.

  2.  Broadly speaking the systems can be divided into (1) countries with cap based systems (Sweden, Denmark, Ireland), (2) countries with a fixed charge (UK, Italy), (3) countries with a percentage based charge (Spain, France), and (4) countries which use a mixture of the three (Germany, Finland).

  3.  However, these are very broad categories, and most systems have an element of other systems in them. For example, in the UK where patients purchase a pre-payment certificate, this places a maximum on the prescription charges that an individual pays in a year. In Denmark and Sweden, patients pay the full cost of their medicines until they reach a threshold and the cap kicks in. The caps usually relate to the maximum amount spent in a month or over a year.

  4.  In addition, most systems operate with reduced co-payments and exemptions for certain groups. Germany and France exempt the chronically ill, while Spain operates with reduced co-payments for the same group. Other countries also have some form of reduced co-payment or exemptions for certain medical conditions and age.


Country
Reduced co-payment and Exemptions

GermanyUnder 18 year olds, chronically ill
SpainChronically ill, over 65 year olds, the disabled, those injured at work or suffering from toxic syndrome
FranceCertain serious diseases, chronic conditions, invalids, expectant mothers, the unemployed, those on low income
IrelandLong Term Illness Scheme—covers certain medical conditions (diabetes, cystic fibrosis, multiple sclerosis)
UKMedical exemptions, over 60 years old, under 16 year olds, people on low income, expectant mothers.

  5.  In all the countries looked at patients must contribute towards their medication, except in the Netherlands where relatively few medicines actually attract a co-payment.

  6.  Below is a more detailed description of each country's co-payment system. All information is based on the IMS publication "Concise Guide: Pharmaceutical Pricing & Reimbursement", published in 2005. There may have been policy changes affecting the co-payment systems in these countries subsequent to the IMS publication, hence, the information may not be one hundred percent accurate.

GERMANY

  7.  According to the 2004 healthcare reform bill, patients have to pay 10% of the cost of their prescribed drugs. However, the minimum patient co-payment per pack is £3.40 (€5) and the maximum is £6.70 (€10). The co-payment can never be more than the price of the drug. Patients are also obliged to pay any difference between the reference price and the actual price of the product dispensed.

  8.  Only the following patients qualify for exemption from co-payments;

    —  Under 18 year olds;

    —  chronically ill patients who have paid out as least 1% of gross family income for medical treatment and services in any full year. Chronically ill persons are defined as those needing to see a doctor at least once every quarter for the same condition, and who also fall into one of the following groupings: patients in nursing care; patients who are severely handicapped or have diminished ability to work; patients in need of continual medical treatment; and

    —  anyone who has paid out at least 2% of their gross income on co-payment charges.

  9.  Social benefit recipients and families benefit from reduced maximum co-payments.

ITALY

  10.  Co-payments differ from region to region.

  11.  The most common systems are:

    —  co-payments per pack—they usually range from £0.70 (€1) to £1.40 (€2), with a maximum of between £2 (€3) to £3.70 (€5.5) per prescription; and

    —  co-payments per prescription—usually £0.70 (€1) per prescription.

  Some regions have no prescription charges.

  11.  In all regions, patients are obliged to pay any difference between the reference price and the actual price to secure a drug priced about the reference price level.

SPAIN

  12.  Patients pay nothing for drugs dispensed in hospitals, 10% for drugs for certain chronic conditions, 40% for the majority of prescription drugs, and 100% for non-reimbursed products and advertisable OTCs.

  13.  There is a maximum charge for the chronically sick of £1.80 (€2.63) per prescription. Pensioners (over 65), the disabled (with more than 33% disability), as well as those who have been injured at work or suffer from toxic syndrome, are all exempted from any form of co-payment. In 2003, these groups accounted for 69% of reimbursed prescriptions.

  14.  Under the reference price system all patients who reject substitution and insist on receiving a medication priced above the reference price are obliged to pay the full price of the drug. In reality, this is largely theoretical, as manufacturers have cut their prices.

FRANCE

  15.  Patients are liable for the non-reimbursed portion of the drug price (0%, 35% or 65%), although 92% of the population takes out complementary health insurance, provided by Mutuelles or commercial insurers, to cover the cost of co-payments.

  16.  Full reimbursement is granted for:

    —  drugs prescribed for the treatment of 30 serious diseases;

    —  the treatment of other chronic conditions;

    —  patients requiring multiple therapies; and

    —  exempt patients: invalids, expectant mothers and the unemployed, and those on low incomes with universal sickness coverage.

  17.  For dugs included in the reference price reimbursement system, patients are required to pay any difference between the reference price and the price of the drug dispensed. Few complementary insurance schemes cover the excess over the reference price.

SWEDEN

  18.  Patients are required to pay the full cost of all reimbursable medicines (except insulin) until they reach a threshold of £63 (SKr 900) over a one-year period from the date of first purchase. Patients then pay a proportion of costs up to £302 (SKr 4,300), above which any additional medicines prescribed are free of charge for the remainder of the year.

  19.  Around 10-15% of the population qualify under this scheme each year. The cost of prescriptions for children under 18 within a family may be added together. Patients are also liable for any excess if they refuse to accept substitution of the prescribed product. This is not included in the annual accumulated total spend.

  20.  Patients are issued with an Apoteket card, which is used to access a database storing information on the reimbursement status of the patients.

DENMARK

  21.  All reimbursable medicines have equal reimbursement status. Patients are required to pay the full cost of all reimbursable medicines until they reach a threshold of £47 (DKr 520) over a one-year period from the date of first purchase. Patients then pay a proportion of costs up to £343 (DKr 3,805), above which any additional medicines prescribed are free of charge for the remainder of the year.

  22.  Patients under 18 years of age are not covered by the lower limit of £47. Instead, a reimbursement rate of 50% applies for all expenditure up to £114, before the rates for over 18s kick in. There are no general exemptions, although the poor and pensioners in financial need can get help paying for their medicine from the local authority.

  23.  Each pharmacy uses the Danish Medicines Agency's nationwide database, the Central Reimbursement Register, which ensures that patients receive the correct reimbursement rate.

  24.  Hospital patients are not required to pay for their medicines.

FINLAND

  25.  Patients are required to contribute the following:

    —  drugs in the basic refund category: £6.70 (€10), plus 50% of the remaining cost;

    —  lower special reimbursement category: £3.40 (€5), plus 25% of the remaining cost; and

    —  upper special reimbursement category: £3.40 (€5).

  26.  The co-payment is valid for all prescriptions in the same reimbursement category collected by the patient at the same time. For instance, if a patient has three different prescriptions for the basic refund category, there is a single charge of £6.70 (€10) and reimbursement is 50% of the total sum exceeding £6.70.

  27.  The annual limit for a patient's expenses on reimbursable drugs was set at £407 (€604.72) in 2004. If this sum is exceeded by more than £11 (€16.82), the patient receives full reimbursement.

  28.  The reimbursement scheme reimbursed 64.5% of medicine expenses in 2003.

IRELAND

  29.  Medical cards, held by around 29% of the population, entitle patients to free medication. A smaller proportion of people (2%) are also eligible to receive free medication through the Long Term Illness Scheme, which covers 15 listed medical conditions, including diabetes, cystic fibrosis and multiple sclerosis. Only drugs for the treatment of the patient's listed conditions are provided without a co-payment.

  30.  Patients who do not qualify for a medical card and are required to pay their prescription drug costs in full can apply for a Drugs Payment Scheme Card on an individual or family basis. Under the scheme, patients contribute up to £52 (€78) a month towards the cost of their prescriptions. Once this threshold is exceeded, the Health Board pays the remainder of the bill. 36% of the population applied for the card in 2003.

NETHERLANDS

  31.  Under the reimbursement scheme, only products listed Annex 1A of the positive list require patients to make a co-payment. (Annex 1A: similar interchangeable products reimbursed according to a reference price system.) Even in Annex 1A patients receive reimbursed medical products free of charge unless the product is priced above the maximum reimbursement level. As manufacturers tend to bring the price of their products down to the reimbursement level to maintain market share by avoiding patients having to pay out-of-pocket, relatively few products attract a co-payment. Patient's co-payment constituted 0.5% of total pharmaceutical expenditure in 2003. Including payment for OTC products, the proportion rose to 3.5%.

Department of Health

February 2006

CHARGING OPTIONS FOR PRESCRIPTION CHARGES, DENTAL AND OPTICAL CHARGES CONSIDERED AS PART OF THE 1998 CSR

PRESCRIPTION CHARGES

INTRODUCTION

  This paper sets out the scenarios that were analysed in relation to prescription charges, dental charges and eligibility for optical services as part of the Comprehensive Spending Review in 1998. Ministers decided to make no change to prescription charges and dental charges as a result of the review. Free sight tests for those aged 60 and over were re-introduced in 1999.

Medical exemptions

    —  Restriction of medical exemption to items intended to treat the qualifying condition—estimated savings of £15-£20 million per year.

    —  Increasing the list of exemptions to include other exemptions—it was concluded that it was not possible to estimate the cost prior to agreement on the additional conditions to be included and an assessment of the medicine utilisation of the groups concerned.

Prescription charge for over 60s as income threshold

    —  Introduce prescription charges for those aged 60 or over with an income above a defined income threshold—the savings would depend upon the threshold above which those aged 60 or over were required to pay charge.

  Low flat rate charge with no exemptions with annual pre-payment certificate charge available at 25 times the prescription charge.

    —  A flat rate of £1 per item with no exemptions would save £120 million.

    —  A £2 charge per item would produce additional charge income of £410 million.

  A medium flat rate charge (eg £4.00) with exemptions for all children up to age 18 and for non disablement pensioners, possibly with a more generous low income exemption, but without automatic exemptions for other exempt groups.

    —  A charge of £4.00 was estimated to produce additional income for the NHS of around £250 million a year.

  Introduce a system of co-payments which linked the charge payable to the cost and/or relative effectiveness of the item dispensed.

    —  The increase or reduction for such a system would depend upon the level of the charge and the exemptions from that charge.

Charge per prescription rather than by item

    —  A charge per script would limit outlay for patients requiring more than one item. It was estimated that this would reduce prescription charge income by £50 million. It was estimated that other costs would result from a change in patient behaviour such as where medicines that otherwise were purchased over the counter would be added to a prescription.

Dental charges

    —  Free dental examinations for all NHS patients—estimated cost £120 million per annum.

    —  Free dental examinations for those aged 60 or more—estimated cost £20 million a year.

Sight tests

    —  Universal eligibility for NHS sight tests—estimated cost £120 million per annum.

    —  Free sight tests for those aged 60 or more—estimated cost £30 million.

Cross cutting issue

    —  Extend exemption for free prescriptions, dental treatment, sight tests and optical vouchers available to 16 to 18 olds in full time education to all young people in this age range.

    —  The cost of this option was estimated to be £5 million per annum.

Review the low income scheme

    —  This was discussed in principle but no details were considered.

Department of Health

February 2006

PRESCRIPTION CHARGES FOR HOSPITAL PATIENTS

  The Committee raised the question of a directive from the Department about out-patient charges and that anyone who had been in hospital less than 24 hours should pay a charge for the drugs they take away with them.

  The position is that no "directive" has been issued. The 1977 NHS Act itself provides that no charge shall be made for a patient who is residing in hospital. We do not have a definition of "residing" in the Charges Legislation but if asked we advise that this would involve an overnight stay. We do not mention "less than 24 hours". If the patient has had an overnight stay, their discharge medication would be free of charge because it was supplied to them while they were still residing in hospital.

  It would be for the Trust to apply the Charges Legislation and to decide if a patient was "residing" at the time medication was supplied to them.

HOSPITAL PARKING SPACES AND INCOME


Total parking spaces
Income from staff Parking
£
Income from visitor Parking
£

England
378,720
15,130,961
62,755,934

  Notes:

  Figures provided on a voluntary basis. 80% of NHS Hospital Trusts responded.

  Source

  Estates Return Information Collection 2004-05.


Trust Name
Total parking spaces available
No
Total parking spaces available for patients/visitors
No
Income from staff
£
Income from visitors
£

New Forest PCT
322
322
Norwich PCT
996
215
48,615
South Gloucestershire PCT
416
296
Havering PCT
553
Kingston PCT
211
164
Bromley PCT
301
52
Greenwich PCT
359
142
Barnet PCT
671
158
South Manchester PCT
166
173
Daventry and South Northamptonshire PCT
204
175
North Peterborough PCT
50
50
South Peterborough PCT
21
21
Tendring PCT
554
Epping Forest PCT
51
49
Southend-on-Sea PCT
283
Central Derby PCT
86
59
Mansfield District PCT
444
287
North East Lincolnshire PCT
88
Newark and Sherwood PCT
64
61
Hillingdon PCT
571
299
Airedale PCT
223
211
Enfield PCT
1,219
550
4,680
Barking and Dagenham PCT
City and Hackney PCT
210
210
Tower Hamlets PCT
218
2
14,003
5,110
Newham PCT
254
229
Haringey Teaching PCT
426
407
Blackburn with Darwen PCT
333
287
North Dorset PCT
486
405
Bournemouth PCT
59
12
Bradford City PCT
290
Bradford South and West PCT
190
207
North Bradford PCT
179
138
Doncaster Central PCT
111
111
Central Manchester PCT
299
Dartford Gravesham and Swanley PCT
397
382
Herefordshire PCT
415
2
Hertsmere PCT
70
Milton Keynes PCT
516
199
North Manchester PCT
219
226
South Hams and West Devon PCT
208
178
1,856
Torbay PCT
143
82
Trafford South PCT
209
143
West Norfolk PCT
256
260
Solihull PCT
462
107
13,646
West Lincolnshire PCT
284
153
Lincolnshire South West Teaching PCT
132
67
Carlisle and District PCT
137
51
Eden Valley PCT
324
324
West Cumbria PCT
518
262
Newcastle PCT
North Tyneside PCT
Hartlepool PCT
50
25
Harlow PCT
94
12
Morecambe Bay PCT
756
North Hampshire PCT
361
360
Isle of Wight PCT
25
25
West Wiltshire PCT
501
South Wiltshire PCT
75
Newbury and Community PCT
273
158
Reading PCT
343
343
Slough PCT
330
330
Wokingham PCT
170
170
Vale of Aylesbury PCT
221
219
Burntwood Lichfield and Tamworth PCT
586
Wyre Forest PCT
169
101
North East Oxfordshire PCT
29
25
Cherwell Vale PCT
123
94
Oxford City PCT
123
62
South East Oxfordshire PCT
153
129
South West Oxfordshire PCT
435
344
North Tees PCT
172
138
Selby and York PCT
641
251
East Yorkshire PCT
352
207
Yorkshire Wolds and Coast PCT
196
132
Eastern Hull PCT
306
306
West Hull PCT
124
119
Eastern Wakefield PCT
207
207
Wakefield West PCT
141
131
2,400
Mid-Hampshire PCT
40
2
Chesterfield PCT
545
541
Gedling PCT
48
Amber Valley PCT
349
343
North Sheffield PCT
32
32
North Lincolnshire PCT
252
252
North Eastern Derbyshire PCT
363
354
Melton Rutland and Harborough PCT
900
884
Leicester City West PCT
190
Doncaster East PCT
193
193
Doncaster West PCT
127
127
Nottingham City PCT
Sheffield West PCT
50
15
Sheffield South West PCT
92
92
South East Sheffield PCT
67
67
Erewash PCT
290
243
Bassetlaw PCT
147
127
Broxtowe and Hucknall PCT
227
174
Greater Derby PCT
226
19
Eastern Leicester PCT
208
Plymouth PCT
878
878
Chorley and South Ribble PCT
226
West Lancashire PCT
358
278
10,821
6,573
Heywood and Middleton PCT
36
36
Salford PCT
170
Trafford North PCT
238
119
Stockport PCT
384
Bebington and West Wirral PCT
136
Southport and Formby PCT
173
Ashfield PCT
130
92
Rushcliffe PCT
174
East Hampshire PCT
388
Portsmouth City PCT
773
381
South West Kent PCT
276
184
Bexhill and Rother PCT
126
Hastings and St Leonards PCT
52
Mid-Sussex PCT
263
263
Bath and North East Somerset PCT
448
339
West of Cornwall PCT
535
388
South and East Dorset PCT
607
207
South West Dorset PCT
402
382
133
11,193
North Devon PCT
250
80
13,000
Exeter PCT
332
313
9,019
7,382
East Devon PCT
650
567
Mid Devon PCT
365
335
Somerset Coast PCT
194
91
4,500
14,600
Mendip PCT
119
Teignbridge PCT
241
163
Southern Norfolk PCT
215
59
Bracknell Forest PCT
92
92
Windsor Ascot and Maidenhead PCT
500
500
Chiltern and South Bucks PCT
119
119
Blackwater Valley and Hart PCT
155
Hyndburn and Ribble Valley PCT
340
282
Burnley Pendle and Rossendale PCT
North Liverpool PCT
56
25
Luton PCT
102
69
Bedford PCT
353
348
Bedfordshire Heartlands PCT
213
158
Huntingdonshire PCT
Welwyn Hatfield PCT
152
52
20,872
North Hertfordshire and Stevenage PCT
191
191
South East Hertfordshire PCT
Royston Buntingford and Bishop's Stortford PCT
280
282
47,906
Maldon and South Chelmsford PCT
153
93
Colchester PCT
1,069
Uttlesford PCT
122
122
Billericay Brentwood and Wickford PCT
213
Thurrock PCT
122
64
Basildon PCT
151
Great Yarmouth PCT
50
43
Watford and Three Rivers PCT
310
200
Dacorum PCT
57
21
St Albans and Harpenden PCT
72
Hammersmith and Fulham PCT
43
Birkenhead and Wallasey PCT
632
506
Cheshire West PCT
337
Central Cheshire PCT
345
Eastern Cheshire PCT
49
Ellesmere Port and Neston PCT
178
Derbyshire Dales and South Derbyshire PCT
101
57
Rotherham PCT
368
368
East Lincolnshire PCT
491
192
14,350
Central Liverpool PCT
491
156
South Liverpool PCT
212
49
Preston PCT
857
857
Fylde PCT
289
Wyre PCT
66
66
Ashton Leigh and Wigan PCT
171
113
5,640
Leeds West PCT
120
31
Leeds North East PCT
144
144
East Leeds PCT
South Leeds PCT
140
34
Leeds North West PCT
211
144
High Peak and Dales PCT
388
388
Blackpool PCT
137
137
Bolton PCT
506
Staffordshire Moorlands PCT
289
138
Dudley South PCT
485
Dudley Beacon and Castle PCT
438
Newcastle-under-Lyme PCT
300
Ealing PCT
414
Hounslow PCT
473
Halton PCT
275
Warrington PCT
535
330
St Helens PCT
350
165
Knowsley PCT
340
120
Oldham PCT
505
148
Calderdale PCT
236
North Kirklees PCT
177
58
Durham Dales PCT
160
130
Darlington PCT
176
23
22,776
Hinckley and Bosworth PCT
155
155
Charnwood and North West Leicestershire PCT
990
South Leicestershire PCT
114
Barnsley PCT
780
Bristol North PCT
384
224
Bristol South and West PCT
387
180
Cambridge City PCT
198
198
South Cambridgeshire PCT
152
152
East Cambridgeshire and Fenland PCT
447
447
Broadland PCT
219
61
North Norfolk PCT
315
94
Chelmsford PCT
51
Castle Point and Rochford PCT
82
Ipswich PCT
48
Suffolk Coastal PCT
87
Central Suffolk PCT
116
Waveney PCT
148
Suffolk West PCT
171
Bury PCT
195
208
Rochdale PCT
South Somerset PCT
118
118
Taunton Deane PCT
122
25
Swindon PCT
292
Kennet and North Wiltshire PCT
844
Brent PCT
180
46
10,201
22,726
Harrow PCT
111
111
Camden PCT
156
Islington PCT
69
Croydon PCT
211
82
Derwentside PCT
22
5
Durham and Chester-le-Street PCT
149
56
6
6
Easington PCT
24
Sedgefield PCT
120
60
Gateshead PCT
113
113
South Tyneside PCT
206
116
Hambleton and Richmondshire PCT
245
193
Craven Harrogate and Rural District PCT
886
456
Scarborough Whitby and Ryedale PCT
281
225
Sunderland Teaching PCT
560
224
Middlesbrough PCT
401
401
Langbaurgh PCT
385
385
East Elmbridge and Mid Surrey PCT
East Surrey PCT
60
40
North and East Cornwall PCT
372
372
Central Cornwall PCT
284
209
Poole PCT
96
50
Cheltenham and Tewkesbury PCT
170
West Gloucestershire PCT
310
62
Cotswold and Vale PCT
535
352
Southampton City PCT
757
757
Maidstone Weald PCT
259
67
Medway PCT
426
310
Swale PCT
419
285
Guildford and Waverley PCT
753
North Surrey PCT
878
306
Surrey Heath and Woking PCT
427
193
Adur Arun and Worthing PCT
368
149
Western Sussex PCT
384
121
Kensington and Chelsea PCT
126
36
9,180
Westminster PCT
86
12
2,562
9,712
Lambeth PCT
144
57
Southwark PCT
200
54
Lewisham PCT
276
133
Wandsworth PCT
604
309
Tameside and Glossop PCT
486
486
Huddersfield Central PCT
96
South Huddersfield PCT
114
Ashford PCT
184
Canterbury and Coastal PCT
227
East Kent Coastal PCT
367
Shepway PCT
72
Eastbourne Downs PCT
189
Sussex Downs and Weald PCT
408
257
Northamptonshire Heartlands PCT
527
257
Northampton PCT
177
5
Fareham and Gosport PCT
559
Eastleigh and Test Valley South PCT
55
44
South Birmingham PCT
677
Shropshire County PCT
649
166
Walsall PCT
1,103
293
South Sefton PCT
241
103
Richmond and Twickenham PCT
104
51
Sutton and Merton PCT
798
262
North Somerset PCT
94
92
Rugby PCT
26
26
Crawley PCT
Horsham and CHanctonbury PCT
288
Coventry PCT
North Stoke PCT
836
46
5,259
22,610
South Stoke PCT
446
Oldbury and Smethwick PCT
157
165
Rowley Regis and Tipton PCT
144
144
Wednesbury and West Bromwich PCt
Telford and Wrekin PCT
0
0
East Staffordshire PCT
68
Cannock Chase PCT
117
South Western Staffordshire PCT
223
12
North Warwickshire PCT
1,051
1,042
South Warwickshire PCT
532
Redditch and Bromsgrove PCT
376
206
1,233
44,931
South Worcestershire PCT
570
338
16,929
Wolverhampton City PCT
666
370
North Birmingham PCT
121
Heart of Birmingham Teaching PCT
447
Eastern Birmingham PCT
448
Redbridge PCT
200
Waltham Forest PCT
276
109
Royal Surrey County Hospital NHS Trust
1,162
451
Weston Area Health NHS Trust
868
334
272,529
East Somerset NHS Trust
518
183
12,500
103,893
United Bristol Healthcare NHS Trust
1,030
252
137,214
284,256
South Devon Health Care NHS Trust
1,650
350
80,555
337,764
Bradford Teaching Hospitals NHS Foundation Trust
540
696,000
861,000
Southend Hospital NHS Trust
1,072
231
548,369
Royal Free Hampstead NHS Trust
394
148
116,370
267,506
The Royal National Orthopaedic Hospital NHS Trust
589
528
22,200
North Middlesex University Hospital NHS Trust
The Hillingdon Hospital NHS Trust
1,877
374
444,383
North East London Mental Health NHS Trust
739
Kingston Hospital nHS Trust
797
Avon Ambulance Service NHS Trust
291
Essex Ambulance Service NHS Trust
5
Gloucestershire Ambulance Services NHS Trust
196
15
Mersey Regional Ambulance Service NHS Trust
228
225
Staffordshire Ambulance Service NHS Trust
89
2
South Yorkshire Ambulance Service NHS Trust
245
30
Taunton and Somerset NHS Trust
1,263
387
210,407
350,093
Royal National Hospital for Rheumatic Diseases NHS Foundation Trust
22
West Dorset General Hospitals NHS Trust
848
Nuffield Orthopaedic NHS Trust
443
90
16,952
133,286
Walsall Hospitals NHS Trust
1,355
250
48,000
380,000
Wirral Hospital NHS Trust
2,358
1,104
St Helens and Knowsley Hospitals NHS Trust
1,699
797
281,214
The Cardiothoracic Centre Liverpool NHS Trust
155
Royal Liverpool Childrens NHS Trust
1,025
819
The Mid Cheshire Hospitals NHS Trust
1,733
Christie Hospital NHS Trust
653
245
54,464
138,567
Lincolnshire Ambulance and Health Transport Service NHS Trust
331
Northern Devon Healthcare NHS Trust
1,000
309
72,578
238,858
Bedford Hospitals NHS Trust
1,113
836
24,444
152,431
Ealing Hospital NHS Trust
628
164
189,957
Luton and Dunstable Hospital NHS Trust
1,053
406
914,352
York Health Services NHS Trust
1,119
437
76,516
380,026
Scarborough and North East Yorkshire Health Care NHS Trust
1,012
869
195,000
Harrogate and District NHS Foundation Trust
331
120,499
302,101
Airedale NHS Trust
1,403
590
Nottingham City Hospital NHS Trust
2,000
800
192,369
748,004
Sheffield Children's NHS Trust
215
Queen Elizabeth Hospital Kings Lynn NHS Trust
1,082
621
93,330
372,119
Royal United Hospital Bath NHS Trust
1,145
437
114,090
599,288
Poole Hospitals NHS Trust
1,462
267
232,790
390,499
Heatherwood and Wexham Park Hospitals NHS Trust
1,944
585
475,000
Milton Keynes General Hospital NHS Trust
1,274
465
74,403
337,733
Basildon and Thurrock University Hospitals NHS Foundation Trust
1,368
1,039,481
Essex Rivers Healthcare NHS Trust
1,475
South DOWNS Health NHS Trust
730
Frimley Park Hospital NHS Foundation Trust
1,298
340
101,828
683,271
Dorset Health Care NHS Trust
634
12
Royal Bournemouth and ChrisTchurch Hospitals NHS Foundation Trust
1,905
598
476,708
Cumbria Ambulance Service NHS Trust
192
South Tyneside NHS Foundation Trust
49
79,246
290,005
Royal Cornwall Hospitals NHS Trust
2,483
732
63,043
474,301
Aintree Hospitals NHS Trust
2,368
375
145,000
587,000
Clatterbridge Centre for Oncology NHS Trust
318
97
Liverpool Womens NHS Foundation Trust
Walton Centre for Neurology and Neurosurgery NHS Trust
298
74
30,096
84,952
Barking Havering and Redbridge Hospitals NHS Trust
3,214
718
1,013,029
Barnsley Hospital NHS Foundation Trust
368
47,000
313,000
Queen's Medical Centre Nottingham University Hospital NHS Trust
2,415
794
352,751
636,804
The Rotherham NHS Foundation Trust
1,076
1,076
234,922
Chesterfield Royal Hospital NHS Foundation
Trust
272
40,203
352,249
Bedfordshire and Hertfordshire Ambulance and
Paramedic Service NHS Trust
352
West Middlesex University NHS Trust
810
Queen Elizabeth Hospital NHS Trust
640
351
115,087
413,377
Bromley Hospitals NHS Trust
971
453
356,866
Whipps Cross University Hospital NHS Trust
1,071
326
350,000
Leeds Mental Health Teaching NHS Trust
863
393
West Yorkshire Metropolitan Ambulance Service NHS Trust
601
Papworth Hospital NHS Foundation Trust
135
Peterborough and Stamford Hospitals NHS
Foundation Trust
James Paget Healthcare NHS Trust
1,503
498
458,187
Ipswich Hospital NHS Trust
1,804
432
West Suffolk Hospitals NHS Trust
1,275
1,225
412,000
188,000
Cambridge University Hospitals NHS Foundation Trust
997
276,152
1,151,556
Queen Mary's Sidcup NHS Trust
854
316
2,000
148,000
Royal Berkshire Ambulance Service NHS Trust
281
197
Somerset Partnership NHS and Social Care Trust
536
Royal Devon and Exeter NHS Foundation Trust
Nottinghamshire Healthcare NHS Trust
2,391
543
Southampton University Hospitals NHS Trust
3,194
1,178
368,705
1,405,556
Dorset Ambulance NHS Trust
96
50
Sheffield Teaching Hospitals NHS Foundation
Trust
Wiltshire Ambulance Service NHS Trust
Portsmouth Hospitals NHS Trust
2,367
1,096
1,119,602
Royal Berkshire and Battle Hospitals NHS Trust
1,774
432
98,300
689,000
Oxfordshire Learning Disability NHS Trust
155
84
Two Shires Ambulance NHS Trust
280
Guy's and St Thomas' NHS Foundation Trust
252
418,152
641,272
The Lewisham Hospital NHS Trust
278
40
20,004
253,563
St Mary's NHS Trust
219
54,000
Mayday Healthcare NHS Trust
St George's Healthcare NHS Trust
1,159
516
181,199
605,276
Cornwall Partnership NHS Trust
449
418
West Country Ambulance Services NHS Trust
515
21
South Warwickshire General Hospitals NHS Trust
1,051
362
487,574
Mid Staffordshire General Hospitals NHS Trust
1,315
508
63,168
451,639
University Hospital of North Staffordshire NHS Trust
3,329
1,062
114,998
521,998
Burton Hospitals NHS Trust
997
412
403,876
Good Hope Hospital NHS Trust
965
235
89,057
528,000
Northern Lincolnshire and Goole Hospitals NHS Trust
2,423
925
East Cheshire NHS Trust
1,287
Countess of Chester NHS Foundation Trust
504
14,198
370,378
Calderstones NHS Trust
493
129
King's College Hospital NHS Trust
703
Sherwood Forest Hospitals NHS Trust
1,647
Plymouth Hospitals NHS Trust
2,143
676
146,000
700,000
West Midlands Ambulance Service NHS Trust
500
University Hospitals Coventry and Warwickshire NHS Trust
2,492
1,599
267,019
Hampshire Ambulance Service NHS Trust
324
The Whittington Hospital NHS Trust
115
105
32,114
15,634
West London Mental Health NHS Trust
1,502
878
37,459
Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust
620
620
29,970
The Royal Wolverhampton Hospitals NHS Trust
1,797
411
637,513
Hereford and Worcester Ambulance Service NHS Trust
Coventry and Warwickshire Ambulance NHS
Trust
City Hospital Sunderland NHS Foundation
Trust
1,200
135,455
238,387
Hereford Hospitals NHS Trust
491
173
George Eliot Hospital NHS Trust
1,241
312
92,000
227,000
Birmingham Women's Health Care NHS Trust
547
40
23,457
53,073
North Staffordshire Combined Healthcare NHS
Trust
849
Norfolk and Norwich University Hospital NHS
Trust
2,876
914
470,000
518
South Manchester University Hospitals NHS Trust
2,399
573
380,000
700,000
Salford Royal Hospitals NHS Trust
2,087
417
415,716
641,978
Trafford Healthcare NHS Trust
744
Northgate and Prudhoe NHS Trust
541
525
Greater Mancehster Ambulance Service NHS
Trust
457
Bolton Hospitals NHS Trust
1,742
401
17,273
Lancashire Ambulance Service NHS Trust
390
20
Tameside and Glossop Acute Services NHS Trust
1,074
777
105,846
398,467
Norfolk and Waveney Mental Health Partnership NHS Trust
981
981
East Anglian Ambulance NHS Trust
472
Winchester and Eastleigh Healthcare NHS Trust
1,418
437
87,000
532,000
Swindon and Marlborough NHS Trust
1,381
453
138,000
674,000
North Hampshire Hospitals NHS Trust
1,301
336
217,854
Dartford and Gravesham NHS Trust
1,185
Dudley Group of Hospitals NHS Trust
2,132
186,671
Newham Healthcare NHS Trust
687
216
69,000
Barts and The London NHS Trust
446
32
61,097
Tavistock and Portman NHS Trust
103
6
35,000
North Cumbria Acute Hospitals NHS Trust
1,404
611
73,595
113,096
North Cumbria Mental Health and Learning
Disabilities NHS Trust
354
271
Newcastle North Tyneside and NorthumberLand Mental Health NHS Trust
193
Kettering General Hospital NHS Trust
1,142
600
214,979
Northampton General Hospital NHS Trust
1,780
660
33,417
434,131
Oxfordshire Mental Healthcare NHS Trust
700
220
8,154
38,350
Oxfordshire Ambulance NHS Trust
69
22
Salisbury Health Care NHS Trust
1,887
490
31,116
304,084
Northamptonshire Healthcare NHS Trust
1,094
1,094
Great Ormond Street Hospital for Children NHS Trust
Doncaster and Bassetlaw Hospitals NHS
Foundation Trust
893
63,560
205,617
Moorfields Eye Hospital NHS Foundation Trust
Lincolnshire Partnership NHS Trust
757
329
Medway NHS Trust
1,692
488
182,000
804,000
Queen Victoria Hospital NHS Foundation Trust
122
46,240
Oxleas NHS Trust
1,462
1,084
Kent Ambulance NHS Trust
285
Worthing and Southlands Hospitals NHS Trust
1,041
360
92,807
649,733
Surrey Ambulance Service NHS Trust
Royal West Sussex NHS Trust
1,141
448
18,000
520,000
The Royal Marsden NHS Foundation Trust
195
50,000
180,000
Sussex Ambulance Service NHS Trust
53
1
Birmingham Children's Hospital NHS Trust
468
69
91,389
Royal Liverpool and Broadgreen University
Hospitals NHS Trust
1,607
139
252,079
225,432
Mid Essex Hospital Services NHS Trust
2,126
715
64,282
624,063
Chelsea and Westminster Healthcare NHS Trust
360
160
78,893
267,517
Hammersmith Hospitals NHS Trust
1,043
166
498,751
277,875
Hinchingbrooke Health Care NHS Trust
943
301
76,607
288,332
The Princess Alexandra Hospital NHS Trust
558
212
39,995
318,164
Homerton University Hospital NHS Foundation Trust
South West London and St George's Mental
Health NHS Trust
1,278
Heart of England NHS Foundation Trust
2,758
574
285,360
997,519
Isle of Wight Healthcare NHS Trust
1,129
1,129
56,000
250,000
Gateshead Health NHS Foundation Trust
289
88,400
277,800
Leeds Teaching Hospitals NHS Trust
3,974
809
819,029
661,824
North Essex Mental Health Partnership NHS
Trust
790
760
South Staffordshire Healthcare NHS Trust
988
Wrightington Wigan and Leigh NHS Trust
1,670
417
129,280
461,830
Royal Orthopaedic Hospital NHS Trust
344
293
University Hospital Birmingham NHS Foundation Trust
590
117,000
1,500,000
Barnet Enfield and Haringey Mental Health NHS Trust
1,188
728
London Ambulance Service NHS Trust
1,042
78
University College London Hospitals NHS
Foundation Trust
Cambridgeshire and Peterborough Mental Health Partnership NHS Trust
1,143
1,143
Pennine Care NHS Trust
1,243
1,022
Royal Brompton and Harefield NHS Trust
695
145
50,000
Leicestershire Partnership NHS Trust
901
901
Suffolk Mental Health Partnership NHS Trust
260
175
County Durham and Darlington Priority Services NHS Trust
822
762
The Newcastle upon Tyne Hospitals NHS Trust
3,840
1,258
426,098
1,039,136
Gloucestershire Hospitals NHS Foundation Trust
Northumbria Health Care NHS Trust
2,432
1,054
325,002
Derby Hospitals NHS Foundation Trust
23
Oxford Radcliffe Hospital NHS Trust
3,697
1,049
132,664
1,261,758
Surrey Hampshire Borders NHS Trust
254
Ashford and St Peter's Hospitals NHS Trust
1,790
565
642,590
East Kent NHS and Social Care Partnership Trust
506
Surrey Oaklands NHS Trust
250
250
Surrey and Sussex Healthcare NHS Trust
1,267
293
527,378
Gloucestershire Partnership NHS Trust
618
221
6
6
South Tees Hospitals NHS Trust
2,574
5 Boroughs Partnership NHS Trust
615
655
Morecambe Bay Hospitals NHS Trust
2,116
634
74,369
352,370
Tees East and North Yorkshire Ambulance Service NHS Trust
80
72
Central and North West London Mental Health NHS Trust
280
South London and Maudsley NHS Trust
1,059
East Midlands Ambulance Service NHS Trust
660
Bedfordshire and Luton Community NHS Trust
555
North West London Hospitals NHS Trust
2,604
819
247,155
1,154,337
Humber Mental Health Teaching NHS Trust
777
744
7,684
North Bristol NHS Trust
3,495
895
526,560
North East Ambulance Service NHS Trust
78
13
Barnet and Chase Farm Hospitals NHS Trust
1,890
749
7,279
1,100,922
Avon and Wiltshire Mental Health Partnership NHS Trust
2,136
1,211
Epsom and St Helier NHS Trust
1,849
542
1,037,500
East Kent Hospitals NHS Trust
3,165
991
111,000
1,319,113
North Tees and Hartlepool NHS Trust
2,434
944
245,790
860,043
Tees and North East Yorkshire NHS Trust
1,700
1,333
Southport and Ormskirk Hospital NHS Trust
1,470
566
206,000
656,200
Hampshire Partnership NHS Trust
1,090
1,021
Central Manchester and Manchester Children's University Hospitals NHS Trust
3,676
686
701,161
385,249
Mersey Care NHS Trust
2,437
1,435
Lancashire Care NHS Trust
715
Pennine Acute Hospitals NHS Trust
4,595
3,083
338,631
1,114,564
North West Surrey Mental Health NHS
Partnership Trust
87
318
West Sussex Health and Social Care NHS Trust
564
4
191
5,342
South of Tyne and Wearside Mental Health NHS Trust
494
457
Hull and East Yorkshire Hospitals NHS Trust
3,094
3,094
8,500
753,601
United Lincolnshire Hospitals NHS Trust
3,699
1,302
1,104,542
University Hospitals of Leicester NHS Trust
4,049
1151
Maidstone and Tunbridge Wells NHS Trust
2,439
1,243
315,000
West Hertfordshire Hospitals NHS Trust
730
845
East and North Hertfordshire NHS Trust
2,142
734
148,818
483,840
Stockport NHS Foundation Trust
719
144,983
301,849
East London and The City Mental Health NHS Trust
260
96
South Essex Partnership NHS Trust
937
Worcestershire Acute Hospitals NHS Trust
2,544
876
Worcestershire Mental Health Partnership NHS Trust
652
375
Hertfordshire Partnership NHS Trust
1,167
Buckinghamshire Mental Health NHS Trust
353
381
Devon Partnership NHS Trust
615
North Cheshire Hospitals NHS Trust
1,839
602
430,000
Berkshire Healthcare NHS Trust
277
240
38
Calderdale and Huddersfield NHS Trust
1,637
496
66,673
207,406
Cheshire and Wirral Partnership NHS Trust
1,090
524
East Sussex Hospitals NHS Trust
2,079
550
648,000
East Sussex County Healthcare NHS Trust
683
Doncaster and South Humber Healthcare NHS Trust
803
778
Mid Yorkshire Hospitals NHS Trust
2,974
887
30,000
125,000
South West Yorkshire Mental Health NHS Trust
1,192
540
1,896
9,588
Brighton and Sussex University Hospitals NHS Trust
1,550
1,068
36,000
446,849
West Kent NHS and Social Care Trust
1,013
774
Sandwell and West Birmingham Hospitals NHS Trust
3,025
1,020
130,500
894,210
Blackpool Fylde and Wyre Hospitals NHS Trust
2,672
872
121,000
419,000
Derbyshire Mental Health Services NHS Trust
815
334
Lancashire Teaching Hospitals NHS Foundation Trust
2,760
917
225,276
744,610
County Durham and Darlington Acute Hospitals NHS Trust
2,873
1,006
125,280
159,065
Buckinghamshire Hospitals NHS Trust
2,532
743
484,452
690,052
East Lancashire Hospitals NHS Trust
2,605
1661
90,730
120,270
Birmingham and Solihull Mental Health NHS Trust
1,589
Bolton Salford and Trafford Mental Health NHS Trust
865
10
Shrewsbury and Telford Hospitals NHS Trust
1,750
1,328
654,000
Northumberland Care Trust
350
280
Bradford District Care Trust
681
681
Manchester Mental Health and Social Care Trust
Camden and Islington Mental Health and Social Care Trust
65
Witham Braintree and Halstead Care Trust
137
37
Sheffield Care Trust
681
681
Sandwell Mental Health NHS and Social Care
Trust
463
252
Bexley Care Trust
108
108

378,720
156,031
15,130,961
62,755,934






1   HC Deb, 11 January 2006, col 721W. Back

2   Expenditure is on a resource or accruals basis. Back

3   Revalued to 2004-05 prices using GDP deflators (December 2005). Back

4   Includes; cost of grants to supervisors of ophthalmic optical graduate trainees, not counted in the cost of sight tests or the cost of glasses provision. Back

5   An estimated proportion of total expenditure based on more detailed breakdown of costs available in same year's cash monitoring data. Comprises fees paid to OOs and OMPs, including payments for domiciliary visits, help given towards private sight tests and employers' superannuation contributions. Back

6   An estimated proportion of total expenditure based on more detailed breakdown of costs available in same year's cash monitoring data. Comprises the cost of vouchers and repairs and replacements. Back

7   The consistency of data may have been affected by the changeover in accounting responsibilities from Strategic Health Authorities to Primary Care Trusts from 1 October 2002. Cost of sight tests and glasses estimated, assuming same proportions as in 2001-02. Back


 
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Prepared 18 July 2006