Public Expenditure on Health and Personal Social Services 2009 - Health Committee Contents

4.  COMMISSIONING

4.1.1  Can the Department break down total NHS expenditure by each of the 23 Programme Budgeting categories in each year for which such data is available? Can the Department detail progress, and any plans, in respect of collecting and using this data? (Q27)

Answer

NHS expenditure by Programme Budgeting category

  1.  Estimated NHS expenditure on each of the 23 programme budgeting categories for the financial years 2003-04, 2004-05, 2005-06, 2006-07 and 2007-08 are provided in table 27.

2.  The data included in the table can also be found in the Department of Health Resource Accounts and Departmental Report for financial years 2003-04 to 2006-07, and on the Department's programme budgeting web page for 2007-08.

3.  Expenditure is calculated using annual PCT and SHA programme budgeting returns and annual accounts data from the Department of Health, its arm's length bodies within the resource accounting boundary, PCTs and SHAs.

Data quality and progress to date

  4.  The principal mechanism for ensuring accurate data is the Programme Budgeting Guidance Finance Manual, which outlines a structured approach to producing reliable data. This guidance, issued on the Department's website advises the NHS how to provide programme budgeting data.

  5.  Refinements are made to the programme budgeting data collection annually, as a result of both changes to underlying data sources, and through identifying improved methods for calculating expenditure at programme level. As a result of changes to the data collection methodology, like-for-like comparisons between years are no longer straightforward.

  6.  Significant changes were made in 2006-07, due to a move to a new currency for the calculation of reference costs data, the introduction of new programme budgeting categories and a change in the way non-admitted patient care costs were calculated. This was also the first year for calculation of programme budgeting costs for the re-configured PCTs.

  7.  In 2007-08, a new method of data transfer from healthcare provider to commissioner was introduced, which resulted in improvements in data quality and a reduction in the time taken by organisations to transfer the data.

  8.  In consultation with NHS organisations, the Department has made further changes to the data calculation methodology in the 2007-08 and forthcoming 2008-09 guidance.

  9.  Programme budgeting returns are not currently audited, but are subject to SHA review prior to submission. The SHA review is supported by the Department through the provision of analytical tools which allow them to benchmark expenditure data from their PCTs in terms of national and regional averages, prior years data and trends.

Progress on use of data

  10.  The Department is committed to providing more timely programme budgeting data to PCTs to support World Class Commissioning competency 6 (prioritise investment) and competency 11 (make sound financial decisions).

  11.  As part of this, the Department is working with the NHS Information Centre for Health and Social Care to provide a selection of programme budgeting data, more quickly, more frequently and at practice, as well as PCT, level. As of July 2009, data on elective in-patients, non-elective in-patients and family health services prescribing are available on NHS Comparators showing both activity and expenditure. The Department is now investigating the possibility of including outpatient data by programme budgeting category on NHS Comparators.

  12.  Programme budgeting cost, activity and outcome data are also available to NHS organisations using interactive map software provided on the National Centre for Health Outcomes Development website, which was updated to include data for new PCT configurations in autumn 2008.

  13.  The Department continues to support NHS colleagues in the use of data by presenting programme budgeting material to NHS colleagues in SHAs and PCTs, and has continued to focus on engaging with directors of finance, commissioning and public health. By creating awareness and ownership, finance directors should become more accountable for the figures produced by their finance division and directors of commissioning should demand better quality data for use in commissioning healthcare.

  14.  Evidence shows that PCTs are increasingly using programme budgeting data in planning, and decision-making, for example:

— Commissioners at Milton Keynes PCT used programme budgeting data to identify that spending on diabetes services was high while standards of care were poor. This helped them decide to carry out a full review of diabetes care that has led to improvements in community services.

— Seven PCTs from the central London area have established a programme budgeting network, bringing together both finance and clinical leads, with the aim of developing a joint framework for performance measurement using programme budgeting costs linked to output and outcome measures. The framework will be used to inform each PCTs annual Commissioning Strategy Plan.

— North Yorkshire and York PCT has produced a report, structured around programme categories, which maps out where all the money in the North Yorkshire and York PCT was deployed in the last financial year, the health outcomes and inequalities observed, and suggestions for future plans. It suggests a series of improvements that might be made at each step in the patient journey for each programme.

Future plans data

  15.  The Department is committed to improving both the quality of programme budgeting data and the support available to PCTs in using the data to support efficient, effective and equitable health investment.

  16.  The Department will set up a Data Quality Advisory Group to support future development of programme budgeting data. Future developments include the proposed move to a commissioner-based return using tariff rather than reference costs and continued improvements to the calculation methodology to reduce the amount of costs identified as "miscellaneous—other".

  17.  In tandem with this, a number of PCTs are developing systems which will allow them to prepare and monitor in-year budgets at programme level. The Department is working closely with these organisations to support this and to develop process and guidance which can be then be used nationally. This work also supports the proposed change to tariff based data collection in 2009-10.

  18.  The Department has commissioned the Association of Public Health Observatories (APHO) to produce a series of programme budgeting fact sheets for each PCT. APHO will also be releasing a tool which will enable PCTs to compare expenditure with selective health outcome indicators. The fact sheets and tool will be useful for PCT boards to identify where they may be outliers.

Table 27

NHS GROSS EXPENDITURE BY PROGRAMME BUDGETING CATEGORY

						£ million
Programme budgeting code	Programme budgeting category	2003-04	2004-05	2005-06	2006-07	2007-08
1	Infectious diseases	977	1,615	1,258	1,301	1,333
2	Cancers and tumours	3,386	3,773	4,303	4,352	4,964
3	Disorders of blood	827	944	1,051	1,035	1,237
4	Endocrine, nutritional and metabolic problems	1,515	1,599	1,895	2,133	2,429
5	Mental health disorders	7,386	7,905	8,539	9,126	10,279
6	Problems of learning disability	2,273	2,356	2,596	2,494	2,856
7	Neurological	1,570	1,779	2,120	2,987	3,438
8	Problems of vision	1,203	1,303	1,356	1,382	1,599
9	Problems of hearing	301	319	322	330	422
10	Problems of circulation (CVD)	5,715	6,188	6,362	6,898	7,228
11	Problems of the respiratory system	2,752	3,072	3,469	3,540	3,802
12	Dental problems	2,369	2,425	2,760	2,644	3,017
13	Problems of the gastrointestinal system	3,165	3,526	3,973	3,852	4,099
14	Problems of the skin	1,070	1,214	1,335	1,553	1,698
15	Problems of the musculoskeletal system (excludes trauma)	3,137	3,577	3,769	3,531	4,085
16	Problems due to trauma and injuries (includes burns)	3,187	3,591	3,853	2,992	3,075
17	Problems of the genito-urinary system (except fertility)	2,809	3,098	3,508	3,755	3,646
18	Maternity and reproductive health	2,570	2,617	2,930	2,932	2,951
19	Conditions of neonates	655	776	786	802	955
20	Adverse effects and poisoning	483	599	708	756	834
21	Healthy individuals	1,108	1,158	1,341	1,482	1,729
22	Social care needs	1,484	1,612	1,745	1,720	2,069
23	Other areas of spend/conditions
23a	—  general medical services/personal medical services	5,005	6,377	7,308	7,257	7,483
23b	—  Strategic health authorities (including WDCs)	4,020	4,045	3,818	3,514	3,877
23x	—  Miscellaneous (3)	8,633	6,452	9,081	11,825	14,078
	Total gross operating cost	67,601	71,922	80,185	84,193	93,183
Source:
Commissioning Analysis and Intelligence, DH
(Programme Budgeting data for financial years 2003-04 and 2006-07 are published in the annual Department of Health Resource Accounts and Departmental Reports).
(Programme Budgeting data for financial years 2007-08 are published on the Department of Health Programme Budgeting Website).
Footnotes:
1.  Expenditure by programme budget is calculated using PCT and SHA programme budgeting returns together with accounts data from the Department's resource accounting bodies.
2.  Changes to underlying data and refinements in calculation methodologies mean that like for like comparison between years is not straightforward.
3.  For the financial year 2007-08, the programme budgeting miscellaneous category included expenditure incurred by the following bodies: Department of Health, Primary Care Trusts, Strategic Health Authorities, NHS Purchasing and Supply Agency, NHS Business Services Authority, The Health and Social Care Information Centre, National Institute for Health and Clinical Excellence, NHS Litigation Authority, National Treatment Agency for Substance Misuse, National Patient Safety Agency, NHS Institute for Innovation and Improvement.
A specific and detailed breakdown of miscellaneous costs by individual body is not available.
The Department of Health own costs accounted for 54% of the expenditure included within the miscellaneous category for 2007-08. Some of the Department of Health costs included within this category are: Grants and other support to local authorities, Grant in aid funding for non-departmental public bodies and non-consolidated special health authorities, Department of Health spend on medical, scientific and technical services, Department of Health grants to voluntary bodies, Department of Health research and development expenditure, Welfare Food costs and European Economic Area Medical costs.

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Prepared 20 January 2010