House of Commons Health Committee
Public Expenditure on Health and Personal Social Services 2005
Memorandum received from the Department of Health containing Replies to a Written Questionnaire from the Committee
Oral and written evidence
Ordered by The House of Commons to be printed 6 December 2005
HC 736 Published on 5 May 2006 by authority of the House of Commons London: The Stationery Office Limited £27.00
The Health Committee
The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies.
Current membership Rt Hon Kevin Barron MP (Labour, Rother Valley) (Chairman) Mr David Amess MP (Conservative, Southend West) Charlotte Atkins MP (Labour, Staffordshire Moorlands) Mr Paul Burstow MP (Liberal Democrat, Sutton & Cheam) Mr Ronnie Campbell MP (Labour, Blyth Valley) Jim Dowd MP (Labour, Lewisham West) Anne Milton MP (Conservative, Guildford) Mike Penning MP (Conservative, Hemel Hempstead) Dr Howard Stoate MP (Labour, Dartford) Dr Doug Naysmith MP (Labour, Bristol North West) Dr Richard Taylor MP (Independent, Wyre Forest)
Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk.
Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom
Committee staff The current staff of the Committee are Dr David Harrison (Clerk), Eliot Wilson (Second Clerk), Christine Kirkpatrick (Committee Specialist), Ralph Coulbeck (Committee Specialist), Duma Langton (Committee Assistant) and Julie Storey (Secretary).
Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 6182. The Committee’s email address is [email protected].
Witnesses
Thursday 1 December 2005 Page
Sir Nigel Crisp, Permanent Secretary and NHS Chief Executive, Mr John Bacon, Group Director of Health and Social Care Services Delivery, Mr Richard Douglas, Director of Finance and Mr Andrew Foster, Director of Workforce, Department of Health Ev 1
Tuesday 6 December 2005
Rt Hon Patricia Hewitt, a Member of the House, Secretary of State for Health, Sir Nigel Crisp, Permanent Secretary and NHS Chief Executive and Mr Richard Douglas, Director of Finance, Department of Health Ev 34
List of written evidence
Page
1 Public Expenditure Questionnaire 2005 Ev 54 2 Supplementary memorandum from the Department of Health Ev 313
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Health Committee: Evidence Ev 1 Oral evidence
Takenbefore the Health Committee
onThursday 1 December 2005
Members present:
Mr Kevin Barron, in the Chair
Mr David Amess Dr Doug Naysmith Charlotte Atkins Mike Penning Mr Paul Burstow Dr Howard Stoate Mr Ronnie Campbell Dr Richard Taylor Anne Milton
Witnesses: Sir Nigel Crisp, Permanent Secretary and NHS Chief Executive, Mr John Bacon, Group Director of Health and Social Care Services Delivery, Mr Richard Douglas, Director of Finance, and Mr Andrew Foster, Director of Workforce, Department of Health, gave evidence.
Q1 Chairman: Good morning. I apologise that we cancer, coronary heart disease, and you are seeing are a few minutes late starting. Could, I, Sir Nigel, waiting lists falling very, very fast indeed. That is the just ask you to introduce yourself and your biggest challenge and 50% went on that. Then 20% colleagues. went on training and capital, so investment for the Sir Nigel Crisp: Certainly. I am Nigel Crisp. I am the future. Then big increases in doctors; number of Chief Executive of the NHSat the Department of doctors in training up 60%, number of nurses in Health. On my right is Mr Douglas, who is the training up 34% and so on, so big investment for the Director of Finance. On my left is Mr Bacon, who is future, and indeed, if you look at any of our major Director of Delivery, and finally Andrew Foster, hospitals you will see a building going up in the car who is Director of Human Resources. park at the moment in terms of significant capital. Then on top of that, about 30% went on pay for existing staV, and that is about recruitment and Q2Chairman: Thank you very much indeed for retention, making sure that we have the staV we need coming along and helping us with this first evidence for the future, and indeed, also, as part of that—and session of our inquiry into the public expenditure that is partly how we have attracted other staV,of question. I wonder if I could just start the course—also bringing improvements and changes in proceedings by asking you a question about NHS staV roles and diVerent ways of working and so on, spending, which has doubled since 1977. What has and finally a balancing figure of about 5%. the extra funding bought, and has it been spent wisely? Sir Nigel Crisp: If I start with the first bit, about what Q3 Chairman: A massive amount, as you rightly say, it has bought, if you look at the total new spend, in terms of increase. How do we know we are getting almost 50% of it—the figure you have at the moment value for money for this increase? is 48%—is on new activity, new staV, new drugs. So, Sir Nigel Crisp: There are three ways, I think, of for example, within that, if I take the staV first, we looking at value for money. The first one is just the have increased the number of staV in the NHSby eYciency of the operation. What I think is 190,000 in this period, of direct hands-on patient interesting there is to look at things like length of carers, so people directly working with staV. In that stay in hospital and delayed discharges, getting I include those important groups who are often people out of hospital. Length of stay, for example, forgotten, like nursing auxiliaries, care assistants in the last year went down half a day; we are getting and so on, who are in direct support of doctors and people through the system more quickly. Delayed nurses. So a very big increase in staV, a very big discharges are now a third of what they were in 2000, increase in activity throughout the NHS. We tend to so we are actually, thanks to excellent work in social think in terms of hospitals very often, half a million care, may I say, as well as the Health Service, making more operations a year than there used to be, but sure that we have got those down, and we do a lot of actually, if I look at primary care, I see much more benchmarking against world best practice to make activity in primary care, the new mental health sure that the way we are delivering services fits. So community teams and so on. We could talk about all part of value for money, the real test is how this that activity. On drugs, for example, we now have compares with world best practice. Secondly, on 2.5 million people a year receiving one class of drugs overheads, we have kept a very tight control on called statins, and the total amount of drugs being overheads, so, for example, management costs have prescribed at the moment, keeping people out of fallen from 5% to 4% in this period, so 4p in every hospital, for example, went up 25 million in the last pound is spent on management whereas five years year. So huge numbers there, and the result from ago it was 5p in every pound, but we have also done that is that you are seeing death rates falling on things like introduce a new shared venture with 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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Xansa of sharing back oYce functions, so tackling treatment on grounds of cost and fast-tracking the overheads. Thirdly, the other big area is reducing appraisal process. That eVectively brings forward a costs through procurement. For example, at the cost from future years that would have been built moment, better purchasing of drugs and other things into our projections for NICE appraisals. What we is saving us about £700 million a year. All of those are looking at with PCTs as part of the planning things are about driving value for money as well as process for next year is to what extent we can quality in the system. reprioritise other areas to ensure that we can fund them, but generally our approach is, as soon as we Q4 Chairman: Per capita spending is quite diVerent get a new commitment, to find a source of funds around the UK. Scotland is about £200 more per for it. annum per capita than England, and Wales is somewhere in the middle. Does that show in better Q7 Chairman: All the speculation is that in three health care in Scotland? years’ time we are going to be looking at NHS Sir Nigel Crisp: I am afraid I would have to do a expenditure a little bit closer to that of GNP. Under complete analysis, but you will actually look at those circumstances, does it not give you any things in England and you will see a number of concern, the current situation, being able to sustain things where I suspect we are further ahead than these types of add-ons, as it were? Scotland, in terms of things like waiting lists and so Sir Nigel Crisp: Perhaps I can pick up the first bit of on, but I think there are a number of diVerent that and pass it on to the Director of Finance. The reasons for that, including the traditions, and indeed first point is that this first period of the NHSplan has the starting points of the two nations. been about growing capacity. Sitting in the Select Committee’s meeting in 2000, a lot of the debate was Q5 Chairman: Are things measured diVerently or are about the fact that we are very low in terms of priorities diVerent? nurses, doctors and so on compared to other Sir Nigel Crisp: I can only speak for England, as you countries, and so the big drive initially was about understand, and there are diVerences in the way in capacity growth. We will not see the same build-up which the NHSis organised in the two territories of staV numbers, for example, over this next period. and there are diVerences in the way in which The real issue is, now we have the capacity, now we priorities have been given. have the people in training, now we have the new capital, how eVectively we can use that to get value Q6 Chairman: Could I move on a little bit. We have for money as well as quality. That is the big challenge had several announcements recently about increased which we face in managing the services now. funding for various projects. Some of them will come along a little bit later in this evidence session, Q8 Chairman: Could I just ask you on that, are you things like PET scanners and mental health services, going to meet your eYciency targets that were set by which you have mentioned already. I wonder if I the Gershon Report? could ask you how far this additional spending has Sir Nigel Crisp: I am very confident, on the basis that been allowed for in the three-year Spending Review on our first monitoring of it, we have achieved £1.7 allocations? billion of the targets, which is £200 million ahead of Sir Nigel Crisp: Can I actually ask Mr Douglas to the plan at that stage. So we are ahead at this stage. pick that up, as the Finance Director? There is a lot to go for because we have only £1.7 Mr Douglas: With any potential new commitments billion towards £6 billion, so there is a fair bit still to that the Department makes we discuss them with go, but so far so good. But it will require consistent Ministers, assess the costs and try to identify a demanding management attention and a lot of work source of funding. Most of these were identified at on that. the time of the Spending Review. If we go back to Spending Review 2004, the most recent one, there Q9 Dr Naysmith: Mr Douglas, you just outlined have only been probably two to three significant various additional spendings that might or might announcements that were not part of our Spending not have been funded and allowed for. One of the Review discussions when we did our original commitments that we had in the Choosing Health planning. The main ones were the three manifesto White Paper was £300 million for sexual health commitments around strengthening clinical services. How does that fit into what you are governance following Shipman, behavioural talking about? therapies for people with mental health problems, Mr Douglas: The figures that were included in the and increasing the investment in palliative care Public Health White paper were all part of the services. They were all part of the Labour party Spending Review discussion, so we factored in what manifesto. They were identified as costing in the we planned to do in terms of increased investment in region of £250 million a year, which we would fund public health. from the reduction in the administrative and management costs following on from the reconfiguration resulting from Commissioning a Q10 Dr Naysmith: But it specifically said for sexual Patient-Led NHS. So we identified a cost with health services, the £300 million, did it not? Ministers and identified a source of funds for that. Mr Douglas: That would have been part of the The only other significant one recently has been the overall figure that we had within the public health announcement about Herceptin and not refusing document. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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Q11 Dr Naysmith: It was in the document at £300 Q17 Dr Naysmith: So we have no results? million. Mr Bacon: We will have year-end results but of Mr Douglas: Yes. course, mid-year we do not have a clear view as to what the first year’s results will be. I think our actual first deliverable target is the end of 2006, so we will Q12Dr Naysmith: I understand from a number of be tracking progressively through on that. That is PCTs—that comes more from the spending side the way we have been tackling all of the objectives than the commissioning side—that the money is not that we have agreed with our Treasury colleagues as being spent on that; it is being spent on other things. our PSA targets. Mr Douglas: There was an allowance within the PCT allocation specifically for spend to support the Q18 Mr Burstow: Can I just come back to the Public Health White Paper. We did not ring-fence question the Chairman was asking about whether or the resources specifically for that. We identified them not all the items that have been announced in terms and said, “This is the money you should be of increased expenditure and new commitments spending”. actually are fully funded? Our advisers have taken us through some of these figures and we saw the figure Q13 Dr Naysmith: What happens if they do not for this year in terms of extra growth is £6.5 billion. spend it? We understand NHSinflation to be at about 4%, Mr Douglas: It will depend, critically, on whether which is £2.8 billion oV of that. That leaves £3.7 they deliver what they should be delivering from billion in the pot. We have Agenda for Change, we that money. have the Consultants’ Contract, we have the General Medical Services contract, we have various other things like pharmacy NHScommitments. We know, Q14 Dr Naysmith: If they are not spending it on for example, on Agenda for Change, I think it is, sexual health services, they will not be delivering. there is a substantial cost overrun of £900 million. Sir Nigel Crisp: We monitor not so much on the Are you really saying that all of these items—sorry. increase of money but on the output and the Sir Nigel, you shook your head fairly violently at achievement of the services, because that is more that point. important. If we are thinking in terms of value for Sir Nigel Crisp: At the figure of £900 million. money, actually, if we can get the services cheaper, that is a very good thing to do but, as Mr Douglas Q19 Mr Burstow: There is no overrun on costs on has said, our approach is that, in terms of the Agenda for Change? amount of money that PCTs have, we have made Sir Nigel Crisp: We think there may be, but nothing sure that there is £300 million—presumably, if that like that order. is the right figure—in that for sexual health services. They then have to make local decisions about Q20 Mr Burstow: So what do you think it will be? spending, but we will monitor them on the Sir Nigel Crisp: We do not yet have a proper figure achievement of the sexual health target. on it, but very, very much less than that.
Q15 Dr Naysmith: That is what I was just going to Q21 Mr Burstow: My understanding was that the come to. How are you going to monitor the fact that figure of £900 million was a figure from the when we looked at sexual health services, we came Department. It obviously would be useful to get across a really terrible situation in many parts of the clarity on that. country, and my information is that it has not got all Mr Douglas: No, we do not have a final figure for that much better? That is what the £300 million was Agenda for Change cost overruns. It will not be specifically put in there for. anywhere near £900 million. We have done some Mr Bacon: With any of the objectives of developing initial work around a number of trusts just to test out services, the approach we have adopted in recent what has happened. We need to further validate that times is to pick a marker measure to judge whether and quality-assure it, but it is nowhere near £900 the services are improving. The power we have million. found is to pick something which is relatively easy to Mr Foster: We have taken a sample of 28 trusts and measure and that we can track over time against we have looked at what we know to be the direct cost base, and in the sexual health target we have made overrun and made an estimate of the indirect costs. the objective there around two things: teenage What I mean by direct costs is the degree to which pregnancy rates and access to sexual health clinics, people’s salaries have increased, and what I mean by V timing access, and those are the things that we will indirect costs are, for example, where sta have been track over time to judge whether the investment is given additional annual leave, then there is the cost V V being correctly made in terms of delivering outcome. of replacing those sta when they are o . But, as What we do not do these days is to track all sorts of both my colleagues have said, I do not know where individual lines of spending. you got the figure of £900 million from. That is way, way above what we are looking at. Mr Douglas: I think I may be able to identify it Q16 Dr Naysmith: That is fine. So what are the potentially. The £900 million—or I think it is £950 initial results? million—is the allowance that we made within the Mr Bacon: The first year of this tracking is this year. allocations for the additional cost of Agenda for 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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Change, so when we made the allocations, clearly, Sir Nigel Crisp: But some of the things that have we knew that Agenda for Change would cost money, already happened will have benefits further down and our estimate of the cost in 2005–06 was £950 the line. I mentioned the shared services joint million. Any overrun would be an amount on top of venture we have with Xansa, which is about actually that figure. reducing the costs of a lot of the administrative process in finance and so on, sitting behind organisations. To date, only 60 NHSorganisations Q22 Mr Burstow: So the £950 million is covered are using those services. As more do, we will within the existing budget, but there is an exercise generate more savings from that sort of process. So looking at 28 trusts to see how much there is of a real we are pleased that we are ahead of the game at this overrun. When will you have the figures for the moment, but not remotely complacent about the real overrun? fact that actually, to get the next £4 billion will Mr Foster: At the end of the year, because this is the require a lot of detailed work, but there are detailed first full year of implementation. plans to make that happen.
Q23 Mr Burstow: Back to the main part of the Q25 Mr Burstow: Can we have sight of the detailed question, are you telling the Committee today that plans? within that envelope of increased resources available Mr Douglas: Yes, I am sure we can provide those to to the NHSin this year, that all of the very long list the Committee. I should say on the things that have of initiatives that I have mentioned plus the various been achieved so far, big numbers have come out of initiatives that have been announced in 21 separate the renegotiation of things like the pharmaceutical press releases in the last few months, announcing all contracts, some of the national contracts, so those sorts of goodies that are coming along, will in fact be are the areas you can grab reasonably quickly in contained within that £3.7 billion that I was terms of eYciency savings. The big numbers for us mentioning after you take oV inflation? to deliver are around the productive time of staV, Mr Douglas: Our planning assumptions are that which is around primarily process improvements they can all be contained within that. When we and really deriving the benefit from the pay contracts looked at the allocations, we looked at the costs of that we have just talked about. They inevitably everything we were planning to do, including what spread over a number of years, so you do not capture we expected in terms of eYciency savings, because that benefit straight away. one of the items that was not included in your list Sir Nigel Crisp: But the examples there again are was how much we need to generate in terms of things like length of stay, which we talked about eYciency savings for the NHSto help fund all these earlier. things. The cashable element, the element of eYciency that can be applied then to spend, is about Q26 Dr Taylor: I want to go back to the £300 million 1.7%. So in addition to that, we would always look for sexual health because first it was announced, as for eYciency savings to help fund the full list of it was, for sexual health. Then we gathered it was items. part of the money that had already been given to the PCTs. Was this not a classic example of really what is a government tactic, of announcing new money Q24 Mr Burstow: On eYciency savings, £1.7 billion twice when it is really just the same money? achieved so far, and that sounds like cause for Sir Nigel Crisp: I think the initial question was about celebration, but can we be clear: in terms of the whether we had accounted for this in the Spending overall target the Department has from Gershon, it Review and whether we had then had subsequent would be surprising if the savings that had been decisions. In the Spending Review discussions, we achieved were not the easier ones, the more concrete assumed some fairly large numbers for investment in ones. The list of things that have been set out as public health areas, but at that point of the Spending Gershon savings for the Department, some of them Review we did not know precisely how we were are really quite nebulous in terms of precisely how going to spend it. So actually, at the point when we you are going to achieve them. Are there detailed made the decision that we were going to spend £300 plans that we can see for each of the Gershon saving million on sexual health, that is the pot it came from, proposals as to how much they would be realised if you like. That is the process you go through: you and on what sort of timescale? identify public health and then you identify how you Mr Douglas: Yes. We have a programme that sets a are going to spend it. trajectory across the next three years for how much we will save each year against each of the Gershon Q27 Dr Taylor: Would it not be a lot more open if headings that we agreed. So we have an agreed you said that this was £300 million that had already amount for procurement, an agreed amount for been given to PCTs and that you wanted them to shared services, an agreed amount for productive spend on sexual health, rather than saying to the time, that is all then given a trajectory across the sexual health people, “Here’s £300 million” which three-year period. That is then reviewed by the OYce they never actually got? of Government Commerce, the Public Sector Sir Nigel Crisp: No, I do not think that . . . I do not Productivity Panel, who questions us on our plans have exactly what we said at the time or have the for achieving it. So we have plans that sit behind all timing quite right in my mind but in the process of those savings. which Mr Burstow just talked about, which is the 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster annual budgeting process where we do exactly what Q31 Mr Campbell: So it is available if, as you have you did, which is look at the available money for the just said, the patients agree that it has not been future year and then look at the new commitments through clinical licensing? It is available in all areas? that we make within it, we in that year made a Sir Nigel Crisp: Subject to local decision-making commitment and made an allocation that was for about whether they agree that that should be sexual health. What we do not do then is to micro- available there, but remember, this is an unlicensed manage the NHSon precisely how it spends all of its drug, unlicensed for that application, and one that budgets. We actually recognise that this needs to be has not gone through the full process. a local service as well as a national service. Q32Anne Milton: Just for clarity, Sir Nigel, the Q28 Dr Taylor: But you should not then tell the decision as to whether somebody gets a drug is being sexual health people that there is £300 million made by unelected PCTs? How PCTs spend their specifically for them. money, one of the concerns at the moment is that the decisions as to who gets what treatment is being not Sir Nigel Crisp: We told the PCTs. Let us be clear made by politicians but by PCTs. Is this a concern what we actually said. We said to the PCTs that for politicians? Is this a concern for employed staV? “Part of the deal that you have for how you have to Sir Nigel Crisp: The principal mechanism we have is spend your money in this forthcoming period is on NICE, which you are probably aware of, which is sexual health, and this is the amount we put in the the process by which we actually within the system budget”. That is how we do it. We talk to the PCTs evaluate new technologies, new therapies, and they and explain what it is they are expected to do. then make a recommendation, or they take a view as to whether the NHSshould be doing it, and the view Q29 Mr Campbell: I have a brief question in regards that NICE takes is the one which we then expect to the money you were talking about before. How everyone in the NHSto follow. Sothere is a clear does that square with the new drugs coming on the national decision. market, particularly the breast cancer drug, and many others of course, that are not available because Q33 Anne Milton: We are talking at slightly crossed of cost? purposes. If money is not ring-fenced for sexual Sir Nigel Crisp: Again, I am not quite sure if health or for Herceptin, then the decision as to what Mr Burstow’s list includes the fact that we do to fund, ie what treatment is available at any recognise that there will be new drugs approved by particular area is made by PCTs, not by politicians. NICE during the course of the year and therefore— Sir Nigel Crisp: The specific local decisions are made it may be that you have that in your inflationary locally. Of course they are. figure there—we make an assumption about what new drugs are going to be coming and make an Q34 Anne Milton: So they are not made by allowance for that in terms of our overall budget. politicians. Sir Nigel Crisp: But there are national priorities, and Q30 Mr Campbell: So the money will be there if a we monitor PCTs on delivering the decisions made drug becomes available? We read in newspapers all by politicians, if you like. the time “Drug not available”. It is there, but it is not available to the patient. You are telling us that you Q35 Anne Milton: That is right. Take Herceptin or have a sort of surplus of money but you are being take sexual health; decisions are being made by paid cautious about that, and I appreciate that, but if the staV, not by politicians as to what they will fund and money is available, why are these drugs not available therefore what is available in any one area. when people need them? Sir Nigel Crisp: The decision made by politicians is Sir Nigel Crisp: The level of assessment that we very clear, that in every area we shall have the targets make at the beginning of the year is necessarily our which Mr Bacon referred to. There is nothing local forward look as to what we think will be the future about that. You have to make sure that by the target cost. During the course of the year that may shift a dates you are providing the services that we are bit, may it not, because you do not necessarily know talking about. The specific way you do that and the particularly what an independent body like NICE specific balance and maybe the timing of that is, will say? On the particular issue of Herceptin, this is, quite rightly, done locally as opposed to nationally. as you may be aware, a drug that has neither gone We are not micro-managing every aspect of through the NICE process, nor is it licensed for the expenditure, but we are determined that there are particular application, and our normal ruling for very clear national standards and those are the drugs in those cases is that where the clinician and decisions taken by politicians. the patient are in agreement that they understand all the risks and they understand that this is not a drug Q36 Chairman: Sir Nigel, could I just ask you about that applies to everyone, and they understand it is the overall expenditure increases that we have had? not licensed and that it has not been fully evaluated, Does the Department have a fallback position if the then that is a decision which is rightly made by the increases in these services and in these costs are not clinician and the patient, subject to the PCT agreeing met by budgets. If there is eVectively a shortfall, that they will be able to fund it. would you have a fallback position there? 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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Sir Nigel Crisp: I will, again, ask Mr Douglas to say period starts very explicit planning guidance, which a little bit more, but basically, there is the NHS says, “These are the things that we want you to budget and then there is a wider group of budgets, achieve over the three-year run” and they would be and our responsibility is to make sure that the whole as narrow a range as we could do, because we want vote, which you vote, which covers the whole range some clear national things that are of high of budgets is in balance. importance, and then as much local discretion to Mr Douglas: Looking forward, we set a three-year meet the needs of local people as we can.Sowedo budget for the NHSoverall, so on the back of the not seek to prescribe absolutely everything that they Spending Review, we will commit to a three-year should do. There is a clear balance between national budget for the NHS. We will set aside on top of that objectives and local objectives. During the course of within the central area of the Department an element the next few months, as soon as we are able to, we of unallocated money. So we will set aside some give them the three-year spending assumptions so unallocated provision that could deal with new that they can then bring those two things together, commitments, because we could not say what would and give to us at SHA level a clear three-year plan happen in two years’ time, so we make an assessment which aligns the objectives we have set, their local about unallocated provision. If it is then found that aspirations and the financial plan. We sign that oV there are new commitments that need to be met, we at the beginning of the three-year period and we can apply that unallocated provision. The other track that with our SHA colleagues and they track thing we can do is reprioritise within our overall with their primary care trusts, and we can monitor budget set either in the NHSor in the Department. progress against that both in financial terms and in So we could say, if something significantly new target terms and of course, if people were moving oV arrived, we would have to cut another area of plan either financially or in terms of the objectives, spending. What we cannot do is to go back on the we expect our SHA colleagues to intervene and to overall settlement that we have from the Treasury. get back on to plan, and if that is happening across We have a fixed amount for three years and it is our the whole health economy, we would intervene and responsibility to live within that. get back on to plan. But the deal, as Sir Nigel has said, is that we set out a clear set of three-year Q37 Chairman: Probably not in my lifetime here in objectives, a clear set of three-year spending Parliament, but in my political lifetime, when there assumptions and we seek, except for exceptional was a major deficit nationally within NHSfunding, circumstances, not to vary that, and if we have to probably in 1976, we had a situation where budgets vary it, we would make it very explicit as to how we were cut across the board and that was the fallback would accept it. position of the Department at that time. Do you see Sir Nigel Crisp: The one target we changed in the any type of scenario like that—I do not mean in first three years was to introduce a new target for scale, but in terms of reaction by the Department if MRSA. That was in response to very clear public there is a shortfall in the budget? concern about that, so we actually introduced the Sir Nigel Crisp: No, I do not. One of the things that target for MRSA last year in the mid-point of the we did four years ago, I think, for the first time, is plan, but that is, I think, the only substantial change actually set three-year budgets for the NHSso they we have had. could plan, and also three-year targets. The commitment we made to the NHSis “We want you Q40 Chairman: The problem in a sense is that not to manage this locally because that is the right thing everything is targeted and there are people working to do. This is the money you have got over the next in areas of the NHSwho may feel that they might three years, and these are the things we expect you to suVer if there is a budget deficit of some sort—not a do with it”, whether it is sexual health services, catastrophic one but they might suVer because they whatever it is. We have actually managed to keep to are not targeted, whereas people who are targeted that. That is why from time to time we will be asked Y will be the priority that you and SHAs will be these di cult questions about “Have you made looking at. What do you say to that? some change in the allocations?” or whatever. There Sir Nigel Crisp: No, we are concerned with quality is a very clear paper setting out our intention, but we overall as well. recognise that, bar absolute catastrophe of some Mr Bacon: Again, if I can just respond to you, cataclysmic sense, actually, our deal with the NHSis Chairman, there was a period when we first got into “You get three-year budgets. That gives you the the business of setting targets that we had a plethora chance to plan ahead, and these are the things we are of them, and we used to track every one. I think in looking for from you”. the original NHSplan there were something over 350 separate things that we were looking to do. We Q38 Chairman: You presumably have some sort of felt and the Service strongly felt that there was a plan for this within the Department? much more advantageous approach which said, Sir Nigel Crisp: Yes. It is published. “Let’s be very clear about what the absolute headline targets that the Government wishes to achieve Q39 Chairman: Is that something we could see? are . . . but then let’s allow local people to determine Sir Nigel Crisp: Yes, a very clear plan actually. amongst the other objectives which things are Mr Bacon: I can just briefly outline the planning particularly important for them”. That balance we process that we have. Leading into the three years, think has been very, very beneficial indeed in terms we publish in the summer before the three-year of delivering the key objectives but allowing as much 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 7
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster local discretion as possible. Of course, if you take as well, and get more emphasis on healthy eating and that approach, what you cannot then do is to seek to so on, which Choosing Health, the White Paper we prescribe lots and lots of separate things because talked about earlier, was doing. I absolutely accept that system will not work. We think this has been a this is one area where we are behind target and where much more successful system. we need to give renewed emphasis. Sir Nigel Crisp: That is also why we have the Healthcare Commission. That is the management Q42Dr Stoate: If you will pardon the expression, the process which Mr Bacon has described, which is the proof of the pudding is in the eating, and particularly management process you will find in most big talking about health inequalities and dietary organisations, tackling a certain number of things at inequalities, but your target specifies a 10% a time, not trying to do too much at a time, trying reduction in health inequalities by 2010 and yet your to get it in balance, but we also have the Healthcare Department has admitted that it is getting worse. Commission, whose responsibility is for oversight of Are you going to abandon that target? Do you see quality more generally. So in some of the areas you any possibility of achieving that target by 2010? may be thinking about, like learning disabilities, for Sir Nigel Crisp: Maybe colleagues might want to example, we have recently had a Healthcare answer. Certainly, we are not abandoning it. That Commission look at those services, even though we would be a great mistake, to abandon the intention do not really have any targets in that area, because to tackle probably the hardest health issue. Let us it is fantastically important that, whilst we may talk not pretend that this is the same as trying to tackle in management terms about priorities, we know that the number of heart bypasses or whatever. You can everything in health care is a priority. see how to do that, you can get on and straightforwardly do it, but in health inequalities Q41 Dr Stoate: I am particularly concerned about there are very many factors at play, and that is why the appalling health inequalities we still face in this we have a developed strategy with other government country. As you are no doubt aware, life expectancy Departments, because this is also about housing and can vary by up to nine years across regions and about all kinds of other things as well, is it not? But across social classes. We have huge inequalities in at the moment, apart from getting the money in the smoking, in teenage pregnancy, in infant mortality, right place, which is fantastically important, and in suicides, almost anything you can think of, yet some particular gains in areas like cardiovascular despite the huge amounts of money that this disease, we do not yet have the momentum around Government has put into the health system, your this that we have to get, and that is where we have Department has admitted health inequalities are got to get to. widening and will continue to widen, and that all the targets that have been set as far back as 2002 have Q43 Dr Stoate: I do entirely accept that you have been slipping. Surely this is a pretty desperate real problems with health inequalities, and certainly situation. What on earth is going on, with all this the Health Service is not the only mediating eVect on extra money going in, and yet health inequalities, health inequalities—of course it is not—but why set which are, I believe, a shame on this country, a target of 10% by 2010, which strikes me, to say the actually getting worse? least, as optimistic? Sir Nigel Crisp: Dr Stoate, firstly, can I say I Sir Nigel Crisp: Can I just make one other point, absolutely take the point about the importance of which is that health inequalities in this country, by health inequalities but I also take the very important international standards, are not significant. If you point as well how diYcult it is to deal with, and it is look at all the ratings of our Health Service not necessarily just purely a health issue either. The compared with other health services, you will see things that we have done, firstly, very importantly, that actually, we are starting from a position where in these allocations we were just talking about, we health inequalities are not as bad as most of our changed the allocation formula last time to take competitor countries. more account of health inequalities, so that still more money was channelled to the 88 PCTs which register on the health inequality scale. So the most Q44 Dr Stoate: Are you talking about Europe? You important thing we thought to do was actually to get are saying health inequalities in Holland, Germany, more money that recognised that need. There are a Spain . . . whole series of other things going on, and if you Sir Nigel Crisp: If you look at the ratings of—we can actually take one area, which is cardiovascular provide the information for you. disease, we are now seeing the gap narrowing in that area. That has not fed through yet into life Q45 Dr Stoate: We would like that, because we have expectancy, which is actually what the target is, and the highest teenage pregnancy rates in Europe, we the reason it is narrowing is because actually, this is have one of the highest cardiovascular disease rates something that you can get hold of. We actually run in Europe, we have one of the highest asthma rates the cardiovascular service with GPs and with in Europe, so I fail to see how you say that health hospitals and we can actually make sure we are inequalities are not greater here than they are in targeting the right people and measuring that. But to many other European countries. If you have facts actually change the life expectancy target, which is and figures on that, I would like to see them. what it is, you need not only to be able to get that Sir Nigel Crisp: Let me come back with information result in cardiovascular disease but in everything else on that. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 8 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Mr Bacon: I was going to add to what Sir Nigel has problems, there may be a whole series ofdiVerent said. You are quite right. We have set an ambitious reasons for them, in particular localities. Sometimes target. We have done that in the past in other areas it is actually about historical reasons and about of our activity and we have delivered those structures of services and things like that. In some ambitious targets. So we do not shy away from cases we are not seeing people perhaps following as setting ourselves ambitious targets. What we will be best practice as we can, and therefore part of what doing very intensively now is taking the same we are doing this year is actually getting alongside forensic approach to delivering this target as we have those people who are particularly in trouble and done with the ones that we have successfully done making sure that we bring them the help to get them over the last three to four years. If you look at our up to the standard of other people. The actual overall objectives for the NHS, the 20 things we have overall deficit in gross terms, in proportion terms, is said we want them to do, over half of those are pretty small but we are taking it extremely seriously, related in one form or another to addressing this because we do not want it to grow and to continue overarching target of health inequalities. We are as a problem. But that is the broad picture of the trying to apply some of the same tools and deficit. It is not everywhere, and indeed, many of the techniques to delivery here that we have done top-performing organisations are hitting all their successfully in other areas. As Sir Nigel has said, this targets and achieving financial balance or surplus. is intrinsically more diYcult, because many of the levers you need to pull in order to achieve this are not Q48 Charlotte Atkins: So you do not put it down to directly under our control. So we are working very poor management at local level then? actively now with our colleagues in local Sir Nigel Crisp: There may be some instances of that, government, etc, to see how we develop the levers to but I think what has already come out in today’s deliver this. But we do not apologise for setting discussion is that this is a diYcult management task ambitious targets. We think that is right, that people are facing in terms of additional money particularly in this crucial area, and we are very, very coming in but additional demands being put on the focused now on how we are going to deliver those. service.
Q46 Dr Stoate: Just finally, Chairman, how do you Q49 Charlotte Atkins: Is there any correlation see the NHSintegrating across other government between the places where there are deficits and Departments? Clearly, these health inequalities are particular geographical locations or types of often the result of poverty, unemployment, poor population served? housing, poor education and all the rest of it, so what Mr Douglas: I do not think in terms of particular active steps is the NHStaking to integrate with these populations served, no. The majority of the deficits other Departments to attack what is, after all, a very have tended to be broadly, if you draw a line from widespread problem? the Wash down to Bristol, usually on the right of Mr Bacon: We have been developing with local that. They tend to be more in the South and East of government colleagues over the last little while local the country. That does not mean there are not area agreements, which specifically target areas of deficits anywhere else, and it does not mean inequalities, so that we can take a joint approach to everywhere in that part of the country is in deficit, them. We have set up things like the Children’s but broadly speaking, if you looked at a Trusts, which again are looking to bring together the geographical pattern, that is broadly what you resources of health and local authorities to focus in would see. a way which we have not done in the past. This is really very much about identifying the things that V Q50 Charlotte Atkins: I have to say that that is not are going to make a di erence, and then working what I see, sitting, as I do, in North StaVordshire. with colleague bodies such as local authorities to Quite a few deficits there, deficits not helped, I have really focus not only our money but our clinical and to say, by the Secretary of State making statements managerial attention on achieving the objectives. about Herceptin to a very overspent local PCT, saddling them with an extra £40,000 over a two-year Q47 Charlotte Atkins: You told us about all the period because eVectively they were told that they extra money going into the NHS. How come we are needed to fund Herceptin for a particular lady over a having so many deficits reported? What do you see period of time, despite the fact that they were already as the main causes of those deficits? overspent. Do you accept that where you have a Sir Nigel Crisp: If you look at where the money has situation like that, where a PCT or a hospital trust is gone—and, as I said, it has achieved all those things overspent, when you rightly say you have to pull we are talking about—if you actually look at the back on these deficits, this can help increase health deficits, and I take last year, for example, where inequalities quite significantly, because there is just there was a net deficit of £250 million, the first thing not the give there to pull back on particular services, to note is that slightly more than 70% of NHSparticularly given the priorit ies that the Department organisations were not in deficit, were in surplus or itself is going for in terms of strokes, cardio issues break-even, and 28% I think were in deficit, but it and so on? was not even spread evenly with those 28%. 5% of Sir Nigel Crisp: Our starting point where there is an organisations, 33 actually between them contributed organisation that has a financial problem is to start half the growth deficit. So this is quite focused in talking about how they are managed and organised, terms of where the problems are. If you look at those and in the first place, we have a very well tried and 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 9
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster tested document called “10 High Impact Changes” all organisations would be in that position. As it in health care which you may have seen, which is best happens, more than half of them are not in that practice in ways of organising and managing position, so our objective then is to work with the services, which have been tested out by the NHS, organisations, particularly the very challenged ones, have been learned in the NHS, in literally hundreds the 33 that Sir Nigel talked about, to help them of organisations, and our first stop is to say, “Well, through that issue. We provide both the tools and are you implementing all of these?” Our second stop techniques through the “10 High Impact Changes” is to say, “And what about things like these shared for instance. We also provide intensive support services, back oYces?” which I talked about a through teams of experts that we can put into those moment ago on Xansa. “Are you doing things like organisations and help them manage either a specific that? Are you making sure you are not spending issue like A&E or waiting lists or a more general unnecessarily on back oYce type services?” Then issue around the way the hospital is managed. So thirdly, “Are there some particular local reasons what we have to do first of all is to be content that why you’ve actually got a problem?” I know your we have set a deliverable objective, which we think area a little bit, and sometimes, for example, we have, and secondly, where organisations to a thinking of Stoke in particular, the two hospitals in greater or lesser degree are not performing, give Stoke, and necessarily the fact that you have them the help, encouragement, tools, techniques and diYculties working across two sites, for example, real support to help them manage out of it. That is and things like that. So there are some indigenous what we are doing and of course, as you would local reasons sometimes why people find it hard to expect, the bulk of our eVort goes into the 5% implement best practice, and we need to understand roughly of organisations that are really struggling. that, but that is our approach: what is it that high- performing organisations are doing that people Q53 Anne Milton: It is not an entirely flat playing locally who are in trouble may not be doing? field, is it? Because spending per head is not the same throughout the country. One of the concerns that I Q51 Charlotte Atkins: You also mentioned and a lot of people from places in the South East historical debts and historical under-funding of have is that the people who consume health care are particular areas. Do you take that on board? the older people. They are not necessarily the people Sir Nigel Crisp: Maybe I will ask one of my within the policies in health but you can get into a colleagues to deal directly with managing people’s vicious circle because relatively speaking they have recovery. less funding and they suVer from long-term, chronic Mr Douglas: In terms of the historical debts, it is problems. In areas like SuVolk and Sussex there are very much the same as the overall over-spending for huge deficits in services. Could I take slight an organisation. We have got to look at how quickly exception, Mr Bacon, to your word “performance”. an organisation can take its over-spending out. So If you talk to the staV working in the health service, we do not always push to a position for every to suggest that they are under-performing in areas organisation that you must get everything back in like this would begin to be very oVensive. They feel one year, because for some organisations that would they are performing as best as they possibly can in a not be practically possible. So we try to give them very diYcult climate. some breathing space, but what we have also got to Mr Bacon: I was not intending to suggest that at the take into account is that any organisation that over- delivery of patient care level people were not spends is taking money from somewhere else in the working extremely hard. system, because we have a fixed pot of money, so someone else has to under-spend to fund that. We Q54 Anne Milton: The only people who can under- cannot just set aside historical problems that are V V perform are the sta , so presumably you are e ectively money owed to someone else. suggesting that some staV are under-performing. Mr Bacon: Clearly it is the case that in our Q52Charlotte Atkins: That would be fine if the organisation, as in any other industry, some trusts and the PCTs were actually in control of their organisations deliver a better level of performance spending. If we are talking about admission to by the way they are organised, managed, hospital, payment by results, a whole range of issues, geographically located than others. Why would we those particular organisations are not necessarily in be any diVerent from that? We cannot make the control of the money partly because of PFI schemes, assumption that all 600 of our statutory bodies will new contracts, a whole range of things, which are not be as operationally eYcient and managed as well as determined by them locally but determined by the every other one. NHScentrally. Sir Nigel Crisp: May I come back on two points? Mr Bacon: As Sir Nigel has mapped out, it is quite Firstly, absolutely all of us take the point—and I am diYcult to take a generic view here because of the outandaboutintheNHSeveryweek,Imeetnurses, diVerent circumstances applying in diVerent places, I meet people who are working in the NHS—that but what we do know is that the majority of NHS people are working hard, they are working eVectively. organisations are managing both to live within their I understand the point you are making. We are talking resources and to deliver their objectives and that here about whether the organisation is delivering what tends to be where a health economy, if I can put it the organisation has signeduptodo.Onyourfirst that way, works well together. We have not set the point about how much money goes to diVerent areas, Service an impossible objective here. If we had, then I suspect we have a complex formula which does take 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 10 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster account of age and does take account of inequalities. Q58 Anne Milton: So you do not accept the fact that There will always be discussion about whether it takes there will be service restrictions. enough account or not. You, as a group of Sir Nigel Crisp: There may be some areas where, if they parliamentarians, will be a cross-section, I have no are well ahead of the number of patients they were doubt, about whether we have that right. But we do planning to treat, they may have to slow down and take a lot of independent advice, using independent treat some people next year—if they are ahead, but not methods, which then makes recommendations to try if they are behind. to get that as right as we possibly can do. Q59 Mike Penning: Sir Nigel, if you have visited Q55 Anne Milton: Do we take account of what South-West Hertfordshire recently—and I know the services cost? Secretary of State has refused to come because she is Sir Nigel Crisp: Market forces, yes we do. Mr Douglas too busy—my NHSprofessionals would be gob- could tell you a bit more about it, if you want. smacked at what you have just said, because there are Mr Douglas: There are a number of elements in the £10 million cuts upfront in services. Operations are formulas: the overall population count; age-related V being cancelled, wards are getting closed and people’s need—that at di erent ages you consume more health lives, in my opinion, are being put at risk. What services; a general need element; and, on top of that, worries me about the complacent way you have the cost of services taking into account something discussed this this morning, is that it is people’s lives we called the “market forces factor”—which basically are talking about. You seem to be blaming individual triestoassessthediVerent cost pressures that people V trusts and PCTs, etcetera, but not looking at face because they are in di erent places geographically yourselves at all. Are you convinced that everything in the country, so the South East/London tends to be that your Department has done is right, that the more expensive. Elements of the formulas try to pick V formula is spot on, that you have not made a mistake up on all these di erent things. As Sir Nigel said, we there? If you look at the area of the country which has have a committee that reviews the formulas for us, that suVered historically, perhaps the formula is wrong takes academic evidence to support it, and then they there, but you have not indicated that at all this make recommendations to the Secretary of State. morning. If you have made any mistakes at all, it is always someone else and not your Department. Q56 Anne Milton: But, when all is said and done, you Sir Nigel Crisp: I do not think that is fair on a number accept the fact that you know there will be reduced of levels. I am sorry if we have not talked more about services—in some areas significantly reduced individual patients, but I have to say that is not where services—to people who need health care because of the conversation has gone. these budget deficits. Sir Nigel Crisp: I am not sure I do accept that. In proportionate terms, these budget deficits are pretty Q60 Mike Penning: We talk about “businesses” but small. All the evidence is telling us, on the level of these are people’s lives we are talking about here. service, measured through activity levels across the Sir Nigel Crisp: I entirely agree with you. That is why country as a whole and, indeed, at a local level, is that it is very important that we do the sort of things people are hitting their targets, if you like, for looking which Mr Bacon talked about, which is to look very after patients. That does not mean to say that in some sensitively when we are working with people at what particular areas it will not be extremely diYcult. I do the local circumstances are, what is happening, and absolutely accept that. But, nevertheless, the things we what impact this has on people. Because we well have said, like the continuing decline in premature understand this is about something that is mortality, the continuing decline in waiting lists, the extraordinarily important to people in their lives. continuing increase in activity around the country, are continuing everywhere. Q61 Mike Penning: Exactly. Turning round and saying this is only a tiny proportion of the budget Q57 Anne Milton: That slightly flies in the face of what and this is only a small area of the NHS—when it is I have read in the PCT Board papers, which is that one aVecting people in real life instances—to be of the causes of the deficit is due to over-performance dismissive about the size of the deficit, I think was in the NHS. Presumably, therefore, the answer for wrong. some areas which have got big deficits is to reduce your Sir Nigel Crisp: Again, I apologise if that is the performance; that is, to provide less. impression I have given. I know the Chief Executive Sir Nigel Crisp: We are back to this word and Chair of your local large hospital group. I have “performance”. The only point I would make is that met with them and I understand what they are the agreement we have in budgetary terms is: You will doing. I have not seen the latest figures for that do this and achieve these results for this amount, and area— then it is over to you locally as to how you manage that. If for some reason you are seeing a big increase in emergency patients—which some areas of the country Q62Mike Penning: There are cuts— certainly are—then that means you are going to have Sir Nigel Crisp: I do not mean the financial ones, to balance that by adjusting how you manage but: Are they treating more patients than they were everything else, but our expectation and the evidence last year? Are the waiting lists continuing to fall? Are is that there is enough money in the system for people their heart services and their cancer services to deliver on all the things which we measure. continuing to grow? 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 11
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q63 Mike Penning: Well, you are closing the cardiac Q70 Mike Penning: I did not say there was one single unit, so that would be diYcult. one, I said common factors. Could you share that Sir Nigel Crisp: Well, where are the patients? analysis with the Committee? Could you provide that to us? Mr Douglas: We could provide you with an analysis. V Q64 Mike Penning: They will be shipped o to It may be that the simplest one is to show the deficits someone else. against their position compared to their target Sir Nigel Crisp: Are the patients getting treatment? allocations.
Q65 Mike Penning: The point I would like to come Q71 Mike Penning: That is not what we want. We do back to—I do not want to get too localised or my not want a simple analysis because there are people Chairman will pull me up—is this: Are you 100% here who can analyse it for us. If you could share the confident that this blame game needs to go down to analysis that shows why the PCTs are in deficit. them and does not sit anywhere within your own Mr Douglas: We will share the analysis. Department? We have heard nothing this morning about your own Department having any deficiencies Q72Dr Naysmith: Sir Nigel, we know that is part of at all. the job of SHAs to advise trusts which are in deficit Sir Nigel Crisp: I am not in the business of on recovery. It would be useful if you could explain allocating blame. to us what that should be in practice and how it will work. Added to that, you have been saying quite a lot “We do this” and “We do that” implying that Q66 Mike Penning: That is what you have done things happen from the centre as well. It might be successfully this morning. interesting to have an explanation of how this is Sir Nigel Crisp: I was trying very deliberately not to, meant to work in practice. but to say there are some areas which might have Mr Bacon: I think I described earlier the planning Y di culties for a whole variety of reasons and that process we go through. That process requires each of they may well include things like, as I have said, the our statutory organisations, trusts and PCTs to do a point about trying to run two hospitals. Again, this business plan for each year which demonstrates is an issue in a number of areas and it is harder to do what they will achieve in terms of service delivery that. In terms of ourselves within the Department, I and their financial position. One of the tasks for our have no doubt there are things we could do to SHA colleagues is to ensure that each of those provide more help in those circumstances, and that organisations for which they are responsible has a is precisely why we are putting in external teams to viable plan for the year. They then track against support people and to help them with that. We have that. We then track at SHA level. If they detect that started doing that and we will be doing that more— organisations are not on plan, part of their job is to analyse and to understand why that is and to work with those organisations in terms of helping to Q67 Mike Penning: External teams being external resolve that. That could either be through straight consultants which cost an awful lot of money. management or it could be by identifying areas of PriceWaterhouse is— weakness that need strengthening or it could be by Sir Nigel Crisp: Some may be, but, where we have identifying help that is needed to reorganise or to had issues like this before, we have brought in teams make more productive a particular function. That is which also include clinicians, because a lot of the going on constantly between our SHA colleagues issues will be clinical, about how services are and the PCTs. We monitor at SHA level and if we delivered and so on. But this is actually about detect that a health economy, an SHA area, is not supporting people to manage this. I think there is being successful or if there were individual perhaps more we can do to do that. organisations within it that were really seriously seen to be oV-plan, then we can and do work with the Q68 Mike Penning: I think you need to look at your SHAs to understand that and then agree a plan. In formulas as well. Have you done an analysis to the last few weeks, I have seen a number of the SHAs establish the factors underlining the deficits within directly and gone through the situation in their the PCTs and the trusts? localities, understood what their plans are to correct Mr Douglas: I do not think you will find a single them, and in one or two cases have said, “I am not common factor. satisfied with that. I want you to look at other things” or “I want to oVer you this help”. That is a constant iterative process that goes on during the Q69 Mike Penning: But you have done no analysis. year, obviously targeted at those places which we Mr Douglas: We have done analysis. We look at the feel are having the most diYculty in delivery. individual organisations; we compare them with what their position is against average unit cost; we Q73 Dr Naysmith: So there are some places where look at where they are on their allocation formula; there were deficits last year and these deficits have we look at where they are in terms of performance increased this year rather than improving. Could targets. But I do not think you will find one single that possibly mean that Strategic Health Authorities common factor that comes through for every could be held to account in having failed in their organisation deficit. duty? 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 12 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Mr Bacon: When we have a trust that is seriously in Q76 Dr Naysmith: I have a couple of slightly deficit—and we would confess, as we said earlier, diVerent but related questions. Is this double-deficit that there were 33 organisations that contributed regime, whereby trusts inherit their previous year’s over half the deficit, so mathematically that deficit, a fair one? Or is it too punitive? Because demonstrates they have serious problems—one of presumably there will be a reason for it and not all the things we would do with our health authority of them will be due to management failures that we colleagues is to see whether we felt that to correct were talking about. that in one year was a sensible thing to do, given the Sir Nigel Crisp: No. Let me, again, be clear, I do not imperative of patient care. We might agree a plan think these are necessarily to do with management which was not exactly in balance if we felt that failures. However, with the regime that you have just people needed time to recover. I do not know outlined where the deficit stays there, you need to whether my colleague Mr Douglas would want to pay it back next year—just as the NHSas a whole add to that. has to pay back the £250 million deficit that was Mr Douglas: No. I think that is correct. incurred last year. But that is, I have to say, good financial discipline. The only way in which we moderate that at all is by the sort of discussion that Q74 Dr Naysmith: I want to get into an area that Mr both my colleagues here have talked about saying, Douglas and I have had exchanges about before at “Well, maybe you cannot pay it all back in one go”. this Committee. There are reports that some But, if people are going to be in control locally and Strategic Health Authorities are advising bodies for make decisions locally, then accountability needs to whom they are responsible who are in surplus and rest there as well. moving surpluses from bodies that are in surplus to organisations that are in deficit—which reminds me Q77 Dr Naysmith: I am very much in favour of this, of something that used to happen and is supposed and it is better, I think, than the system before where not to happen in the National Health Service any people could transfer money around the system more. This is a form of brokerage, is it not? Is it without making it open and accountable, which it is happening? now—which is perhaps the reason why we are Mr Douglas: There are diVerent elements to this. At getting these figures. the start of a year, organisations can agree what we Mr Douglas: It is more transparent. The impact of call planned support, so that, if there is a programme that is that you are tending to have more for recovering an organisation and another organisations showing a deficit. The net figure will organisation within the SHA agrees to provide some not necessarily change in terms of the size of the help, then they can give that planned support at the deficit but more organisations will show them start of the year. We do not allow the transfer of because there is not the opportunity for those deficits resources and money during the year, so, if the to be masked. support is not planned, there should not be any Sir Nigel Crisp: May I make one other point on this, movements: deficits should stay basically where they Chairman? Our target as an organisation is to be fall. That is the view we take, as the only way you can zero—neither overspent or underspent—at year get organisations to address problems is to leave the end. On £70 billion, this is quite diYcult. With 600 deficits there. That is the overall approach on separate units of account, in any year you will brokerage. You will have in some cases within the always have some over and some under. We will try Strategic Health Authority, one organisation to make sure we are always the right side of the line, making a deficit, and the Strategic Health Authority and, indeed, it is very important that we do, but you then agreeing with another organisation that they will always get some kind of spread, and you will be will make a surplus to allow the whole Strategic aware that in the past we have been criticised for Health Authority to balance. The resources will not underspending as well as for overspend. The move between the organisations but the Strategic advantage now is that the underspend you can carry Health Authority as a whole will then balance. forward but the disadvantage is you carry forward the overspend too.
Q75 Dr Naysmith: So it is not in contravention to the Q78 Dr Naysmith: For interest’s sake, what happens Department’s stated policy, which is “to ensure that if NHSbodies do not recover their financial local bodies report their actual financial position, position? What are your ultimate sanctions in that with deficits remaining where they have been situation? I know you have talked a little bit about incurred and not being masked with brokerage and going in and managing it and sending in teams, but other financial support.” It is in complete what is the ultimate sanction? compliance with that, is it? Sir Nigel Crisp: I suppose the starting point is that Mr Douglas: The only element where there is we have to understand why. Do we have a problem allowance for movement of funds is around this area here that is absolutely structural in some reason and of planned support and that is explicitly shown in the some way that the whole NHShas to take some accounts. On the face of the accounts, if an responsibility for? We have had the odd example in organisation has only achieved a balanced position the past, typically with things like terrorism or because it has been given planned support, that is wherever, where we have actually released the separately identified in the accounts so that regime because people have incurred costs, because everybody can see it. their first task is to look after patients and therefore 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster the NHSshould take some responsibility. Solet us not just, frankly, a bong that goes into the system understand what the position is and then let us have midway through the year to hide a problem. But I a plan that is appropriate for dealing with that. If can provide the Committee with a list of planned you mean the point about: “Let us suppose at the support. end of the year the organisation still ends up in deficit”, then that has to be covered by a surplus Q82Mr Burstow: In providing that note, could you from somewhere else and if the NHSends up in provide some historical context, so we can see what deficit that has to be covered by an underspend the trends are as well. somewhere else in the work of the Department. Mr Douglas: Yes.
Q79 Dr Naysmith: Is it possible for an individual Q83 Mr Burstow: Sir Nigel, you mentioned that if part of the National Health Service to be insolvent? the NHSoverspends overall—and last year it Mr Douglas: We would not get to a position where overspent by £250 million—elsewhere in the we would allow an individual institution to be Department has to pick up the tab for that. Where, insolvent without first having been through the full elsewhere in the Department, has the tab been range of recovery activities that we have. If patients picked up for the £250 million? and the public still wish to use an institution, if that Mr Douglas: EVectively, we would slip a number of institution is still getting activity through and people budgets across the whole range of departmental are still using it, I could not envisage a situation activity. It is not that you would have identified a where the organisation would become insolvent single budget; we would have looked to slow down because we would have put in the support and other on a number of diVerent areas. help to allow it to deliver what was required within the resources available. Q84 Mr Burstow: Could you give us the highest slippages that you are allowing to meet the £250 Q80 Dr Naysmith: Has anyone ever come close? million? Could you give us a list of the biggest items Mr Douglas: I do not think I would say that anyone that are slipping? It would be helpful to have that. has come close to being insolvent, because if they are Mr Douglas: On this there will be lots of ups and insolvent they would not be able to pay their bills, downs. would not be able to pay their debts. If an organisation were in that position, we would look to Q85 Mr Burstow: It is lots of little bits of cuts? find some way of helping them in the short term, Mr Douglas: There were lots of ups and downs on until they could recover. Organisations have had the budget—so some things that will increase, some very large deficits, though, because we have allowed that will go down. But I will try to produce them to continue in a way that in a normal world something that makes sense. would mean they had become insolvent. Q86 Mr Burstow: There are not two or three things Q81 Mr Burstow: I wonder if I could get a couple of that you can identify. numbers oV you either now or later on. You are Sir Nigel Crisp: There was not a one for one. talking about planned support and numbers of NHS Mr Douglas: There was not a one for one. organisations that receive that during the course of Mr Burstow: No, I accept that from what you are the year. You have told us there are 600 units of saying, but it would be useful to get some sense of accounting in the NHS; you have told us that 28% where the £250 million has been concentrated most have deficits—which would mean about 168 within the Department. organisations with deficits on that basis. Of the Chairman: Could I move on now. organisations that have break-even positions, I Mr Amess: Chairman, we are getting from these four certainly know from my own PCT that it broke even gentlemen this morning what I would best describe on 31 March last year and then it had a historic as a smokescreen. This is a softening up exercise deficit on 1 April this year, and therefore it has had before your boss comes to give evidence to the planned support or some other method of brokerage Committee on Tuesday. Before I get on specifically that has given it support. That issue of money to waiting lists, there was some earlier talk about moving around the system is still there, is it not? I unlicensed drugs. I am not going to pursue it now wonder if you could tell us how many organisations but I cannot help mentioning that just as we broke put their accounts to bed on 31 March this year in up for the summer recess the vaccination for break-even position and then woke up on 1 April tuberculosis changed, and I have very good advice with their inherited deficits which they have just that we are now using an unlicensed product for moved from one year to the next. How many this—so that is something certainly I will be putting organisations are in that position? to our politicians. But I have to say to the four of you Mr Douglas: In terms of identifying those who have that the Committee regards it as a gross discourtesy planned support, I would have to come back to you that a number of the questions which we asked you with a note on that, but I can give the Committee a were not answered in full. I do not know whether note on which organisations broke even that had someone in the Department was given the task of planned support to help them achieve that break giving us the information and they thought, “Well, even. The key thing about planned support is that it they are a bit daft the Health Select Committee”. I is something that is agreed right at the start of the have to tell you we are not as daft as some of us year, possibly some time into the previous year. It is might look. In question 3.8.11 we asked for a set of 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
figures on patient admissions, broken down by in- because people are getting more treatment quicker, patient and day cases, plus a commentary. The closer to home. There are higher patient satisfaction Department did not provide us with tables of figures, levels as well. In Manchester they are using the except in one case, and the commentary amounts to system sensibly for things like dermatology and one very short, totally unsatisfactory paragraph—it orthopaedics—and that is very important—but they does not refer to data at all—and a second are trying to get increases in cardiac referrals, paragraph refers briefly to one series only. Whatever because they are concerned, again for reasons of explanation the Committee is going to get now, we inequality, which we have discussed earlier, that not insist that this is put right in time for Tuesday when as many people in that population are seeing your boss comes to give evidence. Sir Nigel, you are cardiologists as are seeing them in some other parts in charge, you are the Chief Executive. of the country. So there are some reasons why the Mike Penning: Paid a lot of money to do that. whole process of activity has changed. And none of that is waZe. The figures on Manchester are Q87 Mr Amess: Will you put this right in time for extremely clear as a simple example of some of the Tuesday? It was a gross discourtesy. changes happening in the NHS, changes we are Sir Nigel Crisp: Firstly, let me absolutely assure you trying to make happen. there was no discourtesy intended. I had not realised you were unhappy with some of these answers. I now Q89 Mr Amess: The four of you are civil servants. I do realise and we will go back and look at 3.8.11 and am concerned about the way that politicians and provide you with a longer and more detailed answer, Government Ministers use these figures. A direct if that is what you are looking for. question: Do you agree that there are less people Mike Penning: There may be some more as well, being put on these waiting lists? Sir Nigel. Sir Nigel Crisp: If that is the figure—and I am sorry, Mr Amess: Excellent, we will draw a line underneath I cannot quite find it at this moment—then that that, then. would . . . Certainly last year there would have been Mr Burstow: Could you provide a list of the others because there were less referrals. we are unhappy about as well.
Q90 Mr Amess: So there are less people going on to Q88 Mr Amess: Yes. According to our advisers, who the lists. are always the seekers of truth in these matters, the Sir Nigel Crisp: Let us look at the figures. There were Committee has grave concerns about the waiting list less referrals from GPs last year . . . Sorry, it was just figures. In fact, I regard them as a fiddle. The number about flat last year as a national figure, so you would of people waiting for treatment and the average have less. waiting time have both fallen, but the number of people placed on waiting lists each year has dropped between 1997 and 2005, and yet at the same time the Q91 Mr Amess: The advisors have told us we do not number of patients admitted from waiting lists is seem to have the detail. Can you share with the virtually the same in 2004 as it was in 1997. As I say, Committee some details about exactly how the we are not daft. You can waZe on in reply to this for general practitioners then are dealing with their five or 10 minutes, but this is a fiddle. If you are patients. Do we have any figures on their lists? It has putting less people on to the lists . . . For ministers to been passed down to someone but all I ever do is parrot that the waiting lists are going down, this is spend time with very, very challenged general ridiculous. Can we have some honesty and integrity practitioners. Do we have some figures on how many in this and some straight talk and not waZe. This is people they are seeing? a fiddle. Sir Nigel Crisp: There are some very clear figures on Sir Nigel Crisp: The straight answer is: no, it is not. things like the Manchester programme. As you are probably aware, the Audit Commission do spot checks on waiting lists around the country and they confirm to us that the information is Q92Mr Amess: You have Manchester well improving, and that is what the Audit Commission rehearsed, which is more than the Chief Medical are there for. So it is not a fiddle. If you are asking OYcer had when I put a question to him last week. us a separate question, which is: Why are we seeing That is fine about Manchester, but overall in the less referrals to hospitals from GPs?—which we have country. done for the last year—then I would refer you to Sir Nigel Crisp: Overall in the country, one of the places like Manchester, for example, where they things we are starting to draft—although the have set up an excellent service called Tier 2, which information is not as good as we would like it to be— is saying that in certain specialities, dermatology, is how many procedures are now done in orthopaedics, for example, it is better for the patient, outpatients—which is another reason why there and quicker as well, for them to be seen in the first would be less on the waiting lists—or, indeed, in place by a specialist nurse dermatologist or a GP general practice than there used to be. That over the with a special interest in dermatology. If you look at last few years has been going up steadily. That is why the figures for Manchester, which I did yesterday, activity levels have been . . . You have to look at the instead of their referrals from GPs to hospitals going whole system and not just hospitals. If GPs are doing up, on a trend of 3%, I think, a year, they are actually more, then they will be retaining more in the coming down, on a trend of 2% a year. That is community. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q93 Mr Amess: Where will the Committee get these recently of the rate of cataract operations going back figures from? from 1997 up to 2004, where in fact the rate of Sir Nigel Crisp: We will publish them the next time increase is fairly constant and 2001–02 and 2002–03 we produce our half-yearly results, which will be was about 25,000, and the same for 2003–04. So it is very shortly. We published them last in May, in my very hard to say that the involvement of private Chief Executive’s report. sector involvement in cataract surgery has in fact made that much diVerence. We have the figures for Q94 Mr Amess: Last week we heard from the Chief that. I do not think I have, or I am not aware where Medical OYcer that he came that close to resigning to find, the figures in other specialities, particularly on a particular issue on which he was at odds with orthopaedics. Is there any evidence that the the Government. You are aware that the letter that increased involvement of the private sector in you sent out to the people managing the National orthopaedics has actually made diVerence? Where Health Service caused absolute uproar and mayhem. would I find that? Have you come close to resigning? Mr Bacon: I would like to answer that in two ways Sir Nigel Crisp: No, I have not. I also considered really. The first demonstration is that we have that we manage this through eVectively and properly achieved our waiting list targets for orthopaedics over the next period and that is what I intend to do. and for cataracts, and, indeed, for all other Dr Stoate: Hear, hear. specialities. Cataracts is running well ahead of the original target. Q95 Mr Burstow: On that point, do you have any regrets about the letter and the way it was received Q99 Dr Taylor: And that is due to NHSsta V? within the NHS? Mr Bacon: I think that is due to a combination of Sir Nigel Crisp: What my Secretary of State said, I things. I think the NHSsta V have worked extremely agree with—not the bit about reconfiguration, well and have looked at the way they organise the where, as you know, there has been a lot of pressure delivery of elective surgery and it is undoubtedly the for change in PCTs for a long time, and at that time case that the vast majority of the achievement has there were already 47 that had shared management, been delivered by the NHS. Where we have seen an but on the bit about provider services. I think we advantage from involving the private sector, both in were too prescriptive. orthopaedics and in cataracts, is in tackling pockets of real shortage and diYculty that will enable us to Q96 Mr Amess: Sir Nigel, I am very happy that we deliver the targets. On orthopaedics, for instance, we have cleared the air and you have been very positive. acquired 25,000 episodes per year from the private Sir Nigel Crisp: That is why I have replied. So am I. sector which were specifically targeted at areas of the Mr Amess: Just to go back to question 3.8.11, if it country which we felt were not likely to meet their had been answered properly then you would have objectives. So, whilst this has been very much at the the national figures available and then you could margin, it has been very carefully targeted. In have said yes or no to my question. I think you have ophthalmology, we have taken a rather broader rather been let down in that regard. view, and we have had mobile ophthalmology in from the private sector, for instance, which has Q97 Mike Penning: Someone else needs to check enabled us to crack the really diYcult issues to the position. ensure we deliver the targets for the whole Sir Nigel Crisp: As I have said before, if you were not population and not just those that were able to do so happy with the answers that were given, it would through NHSresource. But it is at the margin. We have been useful to get advance notice of that, but fully accept that. we will come back to you and we will give you those Dr Taylor: That is very helpful, to know it is at the figures and we will try to make sure that we give them margin and that it is local pockets that you have to you by next Tuesday, in time for that. gone onto. Before I move on to some questions Chairman: Could I thank you for that. Obviously about manpower, I really want to ask for an next year it would be better if we got more answers explanation, before we have the Secretary of State to questions that were sent directly to you. Could I next week, as Mr Amess did, because we are bound move on now. to be tackling the Secretary of State about Herceptin. Table 3.5.2., if I am honest, is about the Q98 Dr Taylor: I want to explore the Secretary of most confused table I have ever seen. It is headed State’s statement that reduction in waiting times has Estimate Cost of NICE Guidance. It does not really been largely due to increased involvement of the allow me to make the diVerence between NICE private sector. The only thing we have figures on, guidelines and NICE appraisals, one of which is which does not bear that out, is with cataract meant to be mandatory and the other only operations. We know that the number of cataract recommendations. Footnote 3 to the table says operations performed in 2003–04 by the NHSwas “Recommended % NICE has approved the use of over 300,000 and by the private sector in roughly the technology” and there is no mention of any that same period it was certainly less than 20,000. single one thing that is recommended in the 92 items The other argument that is put forward is that the that are listed. There is no diVerentiation in this list involvement of the private sector is actually making between what are technology appraisals and what the NHSwork harder, but that really is not borne are guidelines, so, if I may say so, it is an absolutely out by the list that I think you have given us very useless table. We would love to have a proper table 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster for next week, so we can tackle the Secretary of just about flat, so almost no increase to the drugs bill State, because the whole question of Herceptin and at all. They are oVsetting savings in other areas to at NICE is very important. least cover some of the additional costs that have Mr Amess: Hear, hear. come through on the contract.
Q100 Dr Taylor: Thank you. Having got that oV my Q103 Chairman: Will that be passed down to each— chest, going on to manpower costs and shortages. Mr Douglas: That is already there eVectively in the This is really a further attempt to explore the deficits, baselines of PCTs. which I think are largely hidden because there are episodes of creative accounting. The fact that many Q104 Chairman: That will be passed down for the trusts are faced with plans to make pretty draconian shortfall on an individual trust basis. savings for the year 2006–07 suggests that many, Sir Nigel Crisp: It is worth saying that the general many more than the 28% are really on the balance. point is, just as we did not get the figures right for the I want to try to explore the cost of the consultant consultant contract—and there are some other contract. Tables 1.2.2(a) and 1.2.2(b) tells us that in issues on the GP contract which I know you are the year 2002–03 consultant earnings were just going to come onto—we also under-estimated the about £2.5 billion, and, for the year 2003–04, the savings we were going to make from our drug increased cost, because of the consultant contract, negotiations, and those go directly to PCTs because was £133 million. For the year 2003–04 we would they are paying for the drugs, so they are actually expect the total cost of consultant earnings to be paying less, and actually these are pretty much in those two figures added, which is about £2.67 billion. balance, those two figures. Is that what it worked out at? I am trying to get at Chairman: Thank you for that. whether the estimates of this particular contract were accurate. Because it keeps being thrown at me, and I suspect some of us, that in fact the Department Q105 Dr Taylor: The GP contract. I know you have underestimated the Agenda for Change we have given us some figures and perhaps you could explain mentioned—the GP contract, the consultant that. I do not think you saved on the GP contract. contract—and this is one of the huge reasons why so Mr Douglas: We are delivering a lot more from the many PCTs are in deficit or avoiding it by creative GMScontract than we planned to do, but, because accounting. we are delivering a lot more, the GMScontract will Mr Douglas: I think we go back in some ways to the cost us more as well. So, largely due to earlier question about whether there are things the overachievement on the quality and outcomes Department got wrong. On the consultant contract, framework, we will be spending around £300 million our latest estimate of the figures is that it has more on the GMScontract than was originally probably cost us in the region of £90 million more planned. But we have got a lot for that. than we anticipated. When we said by 2005–06 it would have cost us £250 million, our latest estimate Q106 Dr Taylor: About £300 million more, but you is that it has probably cost us in the region of £340 are getting something for it. million for a whole variety of reasons. This is one of Mr Douglas: Getting a lot for it. the areas where I would have to say in the end that Sir Nigel Crisp: Patients are getting a lot for it, is the the forecast we produced has not proved to be real point. absolutely correct. Q107 Dr Taylor: All right. Q101 Dr Taylor: So what was the figure? Mr Douglas: On both of those contracts we need to Mr Douglas: The consultant contract figures. We look not just at the costs of these but at the benefits have done quite a lot of work with the NHSabout we have got from it as well and the extent to which actual costs around this. We were getting we have potentially saved other costs in the system information that at one time suggested it was costing for the contracts as well. about £150 million more than we had anticipated, and we reflected that last year in the tariV payment, Q108 Dr Taylor: Coming on to the out-of-hours in the way we calculate the tariV payment for trusts. service, from memory I think the prediction was that Having done further work, we now believe it has cost quite a large proportion of GPs would agree to take us around £90 million more than we expected for the on the out-of-hours service, and in fact it has turned consultant contract. out to be a very, very much smaller proportion than was expected. I gather from the answer you have Q102Chairman: Where will the £90 million come given us that it is very diYcult to separate the exact from for this shortfall in your estimate? cost of out-of-hours services, but can you give us any Mr Douglas: It eVectively has to be met from all the feel? I remember in this Committee that when John savings within the overall budget. So we have on the Hutton was in the hot seat he told us he was renegotiation of the PPI (the pharmaceuticals expecting the out-of-hours service to cost about £300 contract) eVectively released between £300 and £400 million more than the existing arrangements. Can million a year that would not have been planned for, you give us any feel about how that has panned out? so last year the prescribing growth was about 6% Mr Bacon: The straightforward answer, as John against what we would normally expect to be 9%. Hutton said to you before, is that we know how This year we would expect prescribing growth to be much we allowed into the system, which was slightly 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster over £300 million. We have not—and it would be Q116 Dr Taylor: Does it balance it, roughly? quite diYcult to do—collected precisely how much is Mr Foster: We have not, as has been answered actually being spent to compare. earlier on, got the answer to that question.
Q109 Mike Penning: Why is it diYcult? Q117 Dr Taylor: The other suggestion that is being Mr Bacon: Because we are talking here about 8,500 made by the Secretary of State is that even though practices and the whole of the country and we simply with the contract the Government has agreed that do not collect data at that level of granularity. GPs do not have to work on Saturdays, it is going to be suggested they should be doing Saturday morning Q110 Mike Penning: Taxpayers’ money is being clinics. Where is the cost of that going to come from? spent in other ways. Mr Foster: The current position, as I think John Mr Bacon: Local organisations will know, but we Hutton announced last year, is that we expect each have not collected at that level of granularity. PCT to ensure there is access to general practitioners Forgive me but there is a plethora of numbers we on Saturday. That is not necessarily access to “your” could collect at that level of granularity, but the general practitioner. What we might do will be the overhead bureaucratic cost of doing so would be subject of proposals which may be in the White tremendous, because we are talking here about the paper which we are expecting to launch shortly, way in which 8,500 practices have decided to having done the consultation. We have not yet organise it. We know that, prior to introducing the moved to any firm proposals on that. changes, very few GPs actually delivered out-of- hours: virtually all of them were contracted into some form of cooperative or some form of service Q118 Dr Taylor: When is that White Paper coming where they did not directly do that. We know now out? That is what we would love to know. that, roughly speaking, the same number of GPs, Sir Nigel Crisp: Somewhere around the turn of the less than 5%, do their own out-of-hours and services year is where I think we are. are contracted for at PCT level. I am sure, if you wanted us to, we could collect that data, but we have not currently done so. Q119 Dr Taylor: Before or after Christmas? Sir Nigel Crisp: I am not yet entirely sure. Q111 Dr Taylor: Before, if GPs were covering out- Charlotte Atkins: During the recess. of-hours care as part of a cooperative, they did not get paid extra for that. That was part of their existing Q120 Dr Taylor: Do you think GPs—and I will not contract. say with their 9 to 5 job, because I think it is 8 to 6.30 Mr Bacon: Part of their existing contract was to now—are paid higher than they should be? provide out-of-hours. They could locally sub- Mr Bacon: I think the method of paying them more contract it to somebody else. accurately reflects the value they add to their population. Q112Dr Taylor: Yes, but if they were doing it themselves, they were paid as part of their standard pay. Q121 Dr Taylor: What an answer! Mr Bacon: It is part of the contract for delivery. Part Mr Bacon: It would be rather diYcult for me to of the contract was to provide 24-hour cover for speculate on whether they are paid too much or patients. Part of the change in the process—I think too little. to the benefit of both general practitioners and patients—is that that is no longer part of their Q122 Dr Naysmith: Is it not the case now that they requirement. We recognise that by the provision of are the best paid—and I know it is diYcult to find the £300 million. equivalence—in Europe for the service they provide? Mr Foster: You made the point yourself: it is Q113 Dr Naysmith: It is bound to be more expensive, extremely diYcult to compare. You are not is it not, if GPs are not themselves forming comparing like with like. There is no country that cooperatives? has a system like ours with the roles and the Mr Bacon: Not necessarily. responsibilities the primary care practitioners take on, not just in delivering services but in organising Q114 Dr Naysmith: It is likely to be, shall we say. services on behalf of patients. So it really is very Mr Bacon: I agree, if it is being provided by another diYcult to answer that question. organisation specifically set up to do so, then it could be. Mr Foster: Could I add to this. Where a GP decides Q123 Dr Naysmith: But there are such things as not to provide out-of-hours services, they have to primary care physicians which may or may not be forego earnings of £6,000 a year, which then goes identical—well, they are not identical, we know that, into a pot to buy those services elsewhere. but they are similar—and in that kind of league our GPs do work very hard. Q115 Dr Naysmith: Which would probably, I Sir Nigel Crisp: Anecdotal evidence suggests that is suspect, be more expensive. right. We have not done a study on it but that Mr Bacon: Not necessarily suggests that they are well paid. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 18 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q124 Dr Taylor: Finally, going back to out-of-hours Q129 Mike Penning: Can you assure the Committee care, the £300 million that John Hutton suggested that you are not using bank staV as a screen to that must have been based on some sort of analysis. indicate that you are not using as many agency staV? Could we have sight of that analysis, whatever it Because they are both the same in real terms, are was. they not? Sir Nigel Crisp: I am sure we can look that up. Mr Foster: No. The particular pressure that the Working Time Directive brings is on doctors. Q125 Chairman: I have just a couple of questions on Although we do transfer some of the workload to consultation. You mentioned, I think, Birmingham, advanced nurse practitioners, the particular issue where it came out that people would like to see a GP has been to address the working hours of doctors at the weekend. Was it “a” GP or was it “their” GP in training. at the weekend? Mr Bacon: It has rarely, if ever, been the case—and Q130 Mike Penning: The second part of the question certainly not in recent times that you could expect to I asked you is this: You clearly use bank staV as well see your GP at the weekend, so I think you have to as agency staV—and to the layperson they are compare what we are now oVering and what we may basically the same thing: they are people who are propose not with some sort of halcyon day of this brought in—have you had an increase in bank staV? but with what was practically the position before we Mr Foster: Yes. introduced the contract changes. It is practically impossible to take the view that your GP will be Q131 Mike Penning: While you have had a decrease available 24/7, 365 days of the year. It has always in agency staV. been the case that you would have to in certain cases. Mr Foster: Yes, indeed. Out-of-hours/weekends, you would see an available GP. That is still the oVering. It is just practically not Q132Mike Penning: That is exactly where the possible to expect to see your GP whenever you want correlation goes. them 365 days a year, 24 hours a day. Mr Foster: That is exactly what we would want to achieve because bank staV are ordinary NHSsta V, Q126 Chairman: On that specific, I think you are voluntarily doing extra time at a normal NHSrate, right. But is it putting the cart before the horse to whereas agency staV are paid very substantially have the consultation and everything the year after higher. the new GP contract had come in? Sir Nigel Crisp: A very significant part of the GP Q133 Anne Milton: Could I come in here. I should contract was specifically about the precise clinical earlier, but I did not, Chairman—my apologies— care that is being oVered by GPs, so actually it is the have declared an interest, because my husband does monitoring of cardiac patients or the monitoring of work for a PCT. What about NHSProfessionals? people with diabetes and interventions there. That is Mr Foster: NHSprofessionals has played a valuable where that was geared towards. role in enabling us to achieve what has been described, to have more sophisticated operations of Q127 Chairman: There was an issue about time or bank staV, not just within an existing NHS when they would work, and whether they gave up organisation but the ability to share bank staV the option, as it were—which has always been between neighbouring organisations. It has had the around—to work at the weekend. ability to do that, which has brought down the Sir Nigel Crisp: Yes. expenditure on expensive agency staV. Mr Douglas: But it is also the case that the GP contract is reviewed on a regular basis—as indeed it Q134 Anne Milton: There was some scandal about a is being done so now—so it has the flexibility to year ago about NHSProfessionals contracting sta V respond to new policy direction. from the agencies. Mr Foster: It is not a scandal at all. NHS Q128 Mike Penning: You can imagine the reaction Professionals eVectively operates as an agency and of GPs if you reversed it back. That would certainly its first port of call is to oVer staV from existing be very interesting. Could we move on to the banks. If there is then a demand that it cannot wonderful European Time Directive. With the satisfy, it goes to agencies with whom it has a European Time Directive coming into force and contract, and it has brought down the contracts that other changes which will reduce the hours it pays to agency staV as well. presumably of what most people can work, will there be an increase in agency staV required within the Q135 Anne Milton: My understanding was that the NHS? trust who is employing the NHSProfessional sta V Mr Foster: I am very pleased to say that the latest set would then be paying more money than they would of figures we have on agency staV shows the first have done if they had employed the staV directly significant reduction that there has been in recent from the agency themselves. times, and that is against the background of us Mr Foster: No. achieving compliance with the Working Time Directive. So, no, I do not think there is any evidence Q136 Anne Milton: Because they are having the costs that the Working Time Directive causes increases in of the agency and NHSProfessionals. agency staV. Mr Foster: No. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 19
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q137 Anne Milton: That is not the case. Sir Nigel Crisp: Yes, well, that may be the reason Mr Foster: I do not know which individual case you there, but it may also be that there are problems are talking about, but the general rule is that there within the organisation and some instability within is a standard price at which NHSorganisations buy the organisation so they may be using more agency extra capacity from NHSProfessionals and that staV. I do not know the answer. I am sorry price is not varied. NHSprofessionals then has to Mr Bacon: As my colleague, Mr Douglas, said, we purchase those staV, as I have said, either from adjust the allocations to health communities by a existing NHSor, where it cannot, from agencies, but market forces factor which seeks to reflect the at a lower price than hitherto. market condition in that particular area. In Central London the premium, I think, is something like 30%, is it not, Richard, above the basic to reflect mainly Q138 Anne Milton: NHSProfessionals will always the employment conditions. Where you get cost NHSless than employing people directly from imbalances in the labour market you are bound to agencies. have to look at short-term solutions around agency Mr Foster: That is not exactly what I said. NHS staV, and those have happened more in the south Professionals has a set price, agencies can vary their than they have in the north. We have addressed that price up and down, and there have been some through two ways. One is significantly to expand the examples of agencies trying to eVectively get back number of training places we have and therefore the into the market by reducing their prices, but then number of people coming into the work force, very that is what you want, is it not? significant numbers in the nursing areas. The second is by establishing NHSProfessionals, which seeks to give more control to our utilisation of bank and Q139 Mike Penning: Can I move up and back V slightly into the areas where trusts are in deficit, agency sta particularly in high cost areas. I think which I am sure you will be pleased to come back to. Dr Naysmith would remember this from his Bristol Is there a correlation between the amount of agency experience where the balance of market supply and staV which are used within the NHSand deficit demand were quite seriously against us in Bristol; and we have done a lot of work, have we not, to trusts—in other words, where trusts are in deficit do redress that and now we find that the agency costs they use more agency staV than they do elsewhere— have come down and that health economy is because it seems from evidence that we have that operating much more stably. they do and, if so, why? Mr Douglas: I would not be able to say whether there is a correlation—I have not done the statistical Q143 Dr Naysmith: There was also probably a analysis on it—but a lot of the organisations with management issue which contributed to it, taking deficits, I know, do employ high levels of agency both explanations that have been given? staV, but I would be quite happy to do the statistical Mr Bacon: We have, as you know, in answer to one work to see. of earlier questions, directed some of our very best management talent to Bristol now so that you now have a combination of things, and these things have Q140 Mike Penning: It would not be very diYcult. to be seen holistically, but I would not disagree that Kensington and Chelsea, which I understand is one there is a correlation—although we will try and of the greatest employers of agency staV, has a £14.5 prove it statistically—between high cost labour million deficit, so it has not been very diYcult to find, markets where supply and demand we are able to but would you think from your experience, Sir balance and the financial impact on trusts, and part Nigel, that that is a possibility? of what we have been doing is seeking to address Sir Nigel Crisp: I think purely anecdotally that that. I think there are some good illustrations sounds right. around the country of where we have been Mr Foster: It is certainly the case that where Mr successful. Douglas earlier on drew his line from the Wash to Bristol there is a similar line about high prevalence V Q144 Mike Penning: You do not think it could have use of agency sta , with more in the south. something to do with the morale of full-time Sir Nigel Crisp: Yes, more in the south, so there may permanent staV not knowing whether they are going be a correlation there. to have a job tomorrow and so they are moving into areas where it is more stable? For instance in south- Q141 Mike Penning: Why would you think that west Herts the chief executive there told me recently correlation is there? Sir Nigel I was putting that to, that unless he made the £10 million cuts he would in particular. You are in charge. not be able to pay the wages at the end of the fourth Sir Nigel Crisp: Yes, but Mr Bacon may know more quarter. You are not really going to feel stable in V of the detail of this. Why would I think that? I your employment and perhaps move o to another V suspect that if you look at that particular area it is job, which is one of the reasons why you need sta probably harder to recruit in that particular area in that particular area? than some other areas. Mr Bacon: I think we have to look at this against the background of an NHSwhich has added something in excess of 200,000 to its workforce over the last five Q142Mike Penning: The major deficit is what I am to six years; so this is not an industry or a service interested in. which has been cutting back on its staYng. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 20 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q145 Mike Penning: I think you have become a answers that have been supplied around politician here for a second. That is not the question radiographers, we see that the number of I asked. Where we have instances of deficits in trusts radiographers is going up by, I think it is, 4,267 over and where trusts are likely to make staV redundant the next five years, but the numbers, just on the that impacts on the individuals? figures around retirement, who are leaving is 1,280. Sir Nigel Crisp: I am afraid it does, and I could What this does not tell us and what I want to try and imagine that there could be a correlation that you get underneath and get you to give me some sense of are talking about in some areas, and I am sure if Mr what the Department’s forecasts are in terms of Carver is telling you that that will be the position in increased need is whether the additional 2,987 your area and it is important we get rid of it. radiographers that will come into the workforce Mike Penning: We will tackle that with the Secretary over the next five years is suYcient (a) to address the of State on Tuesday when I expect that sort of shortages that are currently in existence and (b) to in answer from her, not from civil servants, to be fact meet the very significant increased demands honest with you. around scanning and other matters that the Department is pressing on at the moment? Q146 Mr Burstow: I just wanted to ask a couple of Mr Foster: That is exactly the basis of those figures. questions about workforce planning and manpower We look forward in terms of activity planning to see issues. Looking at the estimates for healthcare what extra requirements are imposed, for example professionals completing training and particularly particularly by the 18-week target that we are looking at the various projected new graduates each working to in 2008 where it is acknowledged that year which is set out in table 1.1.5, it does not appear diagnostics is going to be one of the most important V to be very reassuring when they are looked at against bottle-necks we have to solve; so e ectively that table 116, which shows the numbers of retirements creates a demand figure. Then we have an existing and one looks also at information that has been workforce, and we know about the rate of people provided in terms of vacancies and unfilled posts, coming into it from training and from returning to and so on. Can you give us some idea of where, for practice, we know about the age of it and its example, we are in respect of midwifery and propensity to retire, we also know our capacity to radiography in terms of meeting the existing need recruit from overseas is somewhat less in and the forecast needs of the NHSin terms of those radiography than in some of the other professions, workforce groups? and so the figures that you have in front of you are Mr Foster: You have correctly identified two of the the result of all those calculations. occupational groups where we have had most workforce pressures, and in each case we have got Q148 Mr Burstow: So these projected new graduates dedicated plans to address those. The numbers of each year are after taking into account attrition trainees of midwives have gone up by 60% since during training and people not actually entering into 1997, the numbers of trainee radiographers has gone the NHSworkforce. These are the ones you actually up by 90% particularly in response to those think will wind up working in the NHS? shortages and, in addition, we have got specific Mr Foster: That is correct. In addition to that, this return to practice schemes for people who have left has been one of the major areas of workforce re- the NHSfor whatever reasons, (such as to have engineering where we have been creating the role of families) to bring them back and they have been very radiographers assistant, which is somebody who has successful. The midwifery figures are actually one of got a set of skills which enables them to carry out the best successes that we have had in recent times. The latest year for which figures are available, which certain tasks that were formerly carried out by is the workforce census of September 2004, show radiographers, thus freeing up their time to carry out that that year has been the biggest growth in more complex tasks. It has been one of the particular midwifery numbers in recent times. There was a successes, the five-stage career pathway for growth of 900 full-time equivalent midwives in that radiography. year. I am sorry, a 900 head-count and 400 full-time equivalents. Indeed, the latest vacancy survey that Q149 Mr Burstow: You are telling us that the figure we have had shows the vacancy rate for midwives of 2,987 additional diagnostic radiographers, I think running at its lowest (1.8%) since we have kept this is, by 2009, 2010 is going to be suYcient to meet records in this particular way. I do not have the exact all the current planned and expected additional corresponding figures for radiographers in front of activity that the NHSis going to need to deliver on me, but they are showing a similar trend and I would its 18 weeks? be happy to let you have those. Mr Foster: That is the best available plan we had at the time we did a long-term workforce plan. From Q147 Mr Burstow: Just looking at the two tables that my involvement in long-term workforce planning, I you supplied information, the additional would be the first to tell you that things change and information you have given us today, it would be obviously we would revisit that on an annual basis. helpful to have that tabulated as well. Trying to get Indeed the number of training commissions that we a clear picture of how workforce issues go forward is will be ordering about now will be the ones that will one of the issues I want to come on in a minute be starting training in September 2006 who will be because the data collections here seems to be coming out in 2009; so we are constantly reviewing changing, but when we look, for example, at the those workforce plans. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 21
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q150 Mr Burstow: That brings me on to the other to is that because we are increasingly moving toa issue, which is around data collections, which is mixed economy of provision in healthcare large something which has been highlighted as a bit of a parts of the workforce already are outside of the concern in terms of whether the Department is NHSfamily and potentially more so in the future. collecting the right information to enable it to look That must make your task of planning for workforce into this rather murky future and adequately plan needs more complicated. Do you believe you and be able to inform members of this House as to currently have suYcient information that captures whether or not we are getting value for the money that complexity? that is going in. What I wanted to particularly point Mr Foster: We do not have suYcient at present, but to was that there are a number of things that you we are currently putting into place arrangements for used to collect you have stopped collecting in order eVectively the new workforce planning world where to achieve eYciencies. I think in the Annual Report there will be the ability to set up local data collection you talk about a 20% reduction in data collection. I arrangements with both the private sector and with know, for example, the NHSConfed has been social care, further data collections, I should say, pressing you about an issue, but they talk about than we have at present. “smart reporting” as being, if you like, what they want to see, not necessarily overall less reporting. I Q152Mr Burstow: I think the last thing I wanted to notice also that the King’s Fund have claimed that pick up on was again an issue about the question large swathes of mental health workforce data, for around commercial confidence. There is an issue example in the voluntary and private sectors, are here which I raised with Mr Bacon, I think, a couple unaccounted for and can only be ascribed in relation of weeks ago but it is also relevant to this issue of to the services for which they are employed. Do you meaningful workforce planning, because a lot of believe currently, in terms of your job as the person information now is being labelled as “commercial in responsible for human resource planning, that the confidence” and it is not always accessible to NHSdoes collect the information necessary for you Members of Parliament, let alone members of the to make really meaningful and reliable forecasts general public. Are you concerned that in a way that about workforce needs? is being used in an abusive way that actually means Mr Foster: The principal workforce data collection that it is not possible to get at whether or not the that we currently use is the annual September organisation is performing in a satisfactory way and census, and, as you will have seen from the table, the delivering value for money for the public and does it workforce data collections that we have get in the way of workforce planning? discontinued are the collections of medical Mr Foster: In so far as you are directing the question workforce numbers which were being collected on a at me, I would say, no. I have no shortage of quarterly basis precisely because there were targets problems that come across my desk and this is not set for GPs and consultants and we were monitoring one that has ever come across my desk. our progress towards those targets which have all now been completed; but I think that conceals a Q153 Mr Burstow: Perhaps we can come on to the wider question that you are asking about the Y list of problems you have coming across your desk. di culty of workforce planning when you are Perhaps you could give us a list of those! working across sectors, and what we have here is Mr Foster: Workforce planning! what used to be called workforce development Mr Bacon: I think you are right, we had an exchange confederations but were bodies which had on this the last time I was here, and I think I said to stakeholder arrangements at local level in order to you at the time that we seek to observe as closely as do cross-sectoral planning with social care and the we possibly can the Freedom of Information Act but private sector, and we recognise that with the also against the confidentiality requirements of increase provision from the private sector we are public contracts, and that is often quite a diYcult going to have to strengthen those arrangements. One course to steer. Explicitly relating to the point that particular thing that I would draw your attention to V you were addressing to Mr Foster, the contracts that for NHSsta is that we are currently rolling out you were particularly interested in, which I think V something called the “Electronic Sta Record”. This were the independent sector treatment contracts. is a common software system for recording not just workforce numbers but all of the details about the Q154 Mr Burstow: It was more Allianz medical, workforce. We have currently reached but yes? approximately 20% roll out. By the time that is Mr Bacon: That is essentially part of the same completed in about 2008–09, we will have instant programme. That is a relatively small element of our data warehouse access and a much more business—it is less than 1% of the activity of the sophisticated ability to provide national workforce NHS—so, in terms of its overall impact on the information. workforce statistics, I suspect it is not easily significant at the moment. Q151 Mr Burstow: I think it would be useful if we could have a note on that, because it might be Q155 Mr Burstow: To finish oV on that (and it is something we might want to come back to. I just useful you have made reference to that), the thing want to come back to what the King’s Fund have that I am particularly vexed about is the access to the been reported as saying around the mental health key performance information that comes from those workforce. The point, in a way, that you are alluding contracts. I have asked questions in which a previous 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 22 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster minister of state responsible for this area declined to Sir Nigel Crisp: We will get back to you. provide information on grounds of commercial confidentiality. It was hard to see how providing the information about the performance of the Q160 Chairman: We have been led to believe that organisations delivering on the scanning contracts there is. It just struck me, in terms of forward should be deemed to be commercially confidential, planning as a politician and arguing about health because it goes to the heart of determining whether matters, that we should be able to get some sort of the public are getting value for the money that they measure? are putting into those contracts. Has there been any Sir Nigel Crisp: It is specifically classes of drugs you further reflection upon whether or not the position are talking about. that was taken at that time in giving those answers was the right position in the light of what you have told me today about of freedom information? Q161 Chairman: Various classes of drugs, yes. The Mr Bacon: As I have said, we look both in the number of NHSprescriptions for various classes of general policy sense and on an ad hoc basis at each drugs. It is not about the individual drug, which request either through FOI or from your good somebody may feel is commercially confidential or selves, and we would be as liberal as we can in the not in terms of probably a manufacturer or producer interpretation of the commercial confidentiality and of drugs, as opposed to just seeing what the general FOI requirements. I think we can say our trend is in prescribing to see whether or not department has a pretty good record in the initiatives are working in terms of healthcare? generality of freedom of information, but this is in Sir Nigel Crisp: Let us look at that again. I am sorry; very, very sensitive territory commercially and I take I would not want to mislead you by guessing. very careful advice from our lawyers and my commercial people. Our predilection is to make as much information available as we possibly can. Q162Chairman: Could I move on to the issue of the Sir Nigel Crisp: Absolutely. national programme for IT. We hear or read on quite a regular basis now that the cost of this is approximately £6.5 billion. Is that what is thought? Q156 Mr Burstow: Could you possibly revisit the Sir Nigel Crisp: I can ask Mr Bacon to answer in questions I have asked about this and see whether or more detail, but the contracts we let were for £6.2 not you could be a little bit more liberal (with a small billion. They were let at the beginning of last year. “l”) in terms of releasing information about performance, not about what I would regard as commercially sensitive but just about how the Q163 Chairman: Is that the full cost if implementing contract is performing from the point of view of the it locally and nationally? punter in the street in terms of the service they are Mr Bacon: As Sir Nigel has said, the £6.2 billion, actually getting? I think we should be entitled to which is the value of the national procurement have that information. programme, includes both the products themselves Sir Nigel Crisp: We will re-look at that. I cannot give and provision for local implementation and training you the answer, but we will look at it. in some respects. We would expect, and, indeed, the Wanless Report, I think, made this point quite clearly, that the overall expenditure on IT in the Q157 Chairman: I think there is a further restriction NHSwould progressively increase because we are in this area in terms of commercial in confidence in progressively a more information dependent service, relation to the NHSprescription service and the not just for management but, much more classes of drugs, not necessarily the individual drug importantly, for patient safety and for the concerned. Why is that not available? convenience of patients using a flexible service. We Sir Nigel Crisp: I am not sure if I know the answer to do expect that number to increase. The NHS that, and I do not know if any of my colleagues do. currently spends, and it is quite diYcult to track actually and forgive me for elaborating slightly, but we track the spend on administrative IT but much of the IT is built into scientific and technical machines Q158 Chairman: It would seem to me that, whilst it that we do not track specifically, so it is quite diYcult may not be a target, it would be a measure of what to get an exact figure, but of the order of a billion a has been dispensed up and down the country of how year is spent now by the NHSon IT and either public health initiatives or acute initiatives are progressively that will transfer into support for the actually working out. It would be a measure; it may national programme for IT. I know we have talked not be a terribly accurate one. Is there an issue about at this Committee and in other places about the commercial in confidentiality? overall costs of the national programme in the past. Sir Nigel Crisp: I am sorry, I just do not know. It is not that we are evasive, it is because it is quite diYcult to track all the transfers of costs that will happen over a ten-year run, but, to confirm your Q159 Chairman: Would you mind getting back to us point, the central contracts are at £6.2 billion, as Sir on that? Nigel mentioned. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 23
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q164 Chairman: Is that paid for directly centrally? Q169 Chairman: Are any PCTs or other providers Mr Bacon: Yes, the £6.2 billion is managed by a going to suVer financially because of this current central programme which I am the senior situation? responsible oYcer for, and the contracts are let at Mr Douglas: They should not suVer because of it. national level. We should have arrangements in place in all the SHAs eVectively for fall-back systems that allow them to operate without SUS PBR working. I have Q165 Chairman: Some of the things that are being been through this in quite a lot of detail with the paid for now on this annual £1 billion in the NHS, it Strategic Heath Authority finance directors at my is vital that that equipment has the ability to talk to last meeting with them, and what they are all doing anything that has happened nationally. How do you check that that is the case? is looking at managing their own local systems to Mr Bacon: Again, part of the national contract, operate this, so it should not lead to a significant which is called local service providers—there are five problem in any PCT. clusters across the country—over the life of this programme progressively the local systems will be replaced by standard systems coming through the Q170 Chairman: My last question on this one is in LSP contracts which, of course, will be compatible relation to the issue of Choose and Book. It first with other aspects of the programme. We will have, went live in 2004. The uptake was extremely low and we admit, a very diYcult transition period where remains so. When are the numbers of patients using because historically the NHShas not had a this system going to reach the original levels that centralised approach to this, we have many suppliers were predicted for the system? all of whom have had their system tailored to local Mr Bacon: We appeared before the Public Accounts use, so the transition period is very diYcult and Committee on this subject about three weeks ago, many of the diYculties you read about are explicit in and we can confirm the issues that were raised there. the ones you have mentioned where we are having to We do admit that the implementation of Choose and interface systems to existing system, and that will Book as a system, largely because of the integration progressively ease as we are implementing the new issues that I mentioned earlier, not because the core local service provider contracts. system does not work, it does, are about a year behind. This will not, as we said to the PAC, threaten our ability to deliver our actual promise, which is to Q166 Chairman: Is this the secondary user service? enable individuals to choose a hospital from initially Mr Bacon: The secondary user service runs oV the a minimum of four and to book their appointment back of the core standard; so this is not actually the remotely. What it does mean is that we will not be secondary user service, no, that is a data service able to use the best technology to do it at the time we which uses the data we collect for the management of patients and the management of the service for other made the promise, which is from 1 January. What we purposes, which Richard Douglas, I am sure, could expect to have done is to have caught up with this by explore with you more. a year later, i.e. next December rather than the current December. What is encouraging is that we are seeing really quite rapid growth now in the Q167 Chairman: That is not the product of this? number of bookings having taking place. We are Mr Bacon: No. now up to over 7,000 a week from a position where, I think, the total we have done in August this year was about 250—we are now rattling through over a Q168 Chairman: Have you any problem with that thousand a day—so we are seeing real progress in the service? implementation, but I would be the last to say this is Mr Douglas: There are a number elements to the Y secondary user service. One of it is called secondary not going to be a di cult implementation for all the user service PBR—without getting into too many reasons I have mentioned earlier and also for some initials it is SUS PBR—which is the system to help of the individual data issues around accuracy of data Payment by Results work. It eVectively sends data in existing systems that we need to correct. So, good from providers to PCTs by HRG at its simplest. We progress in the last three or four months, but we were planning to use that eVectively for the second confess, as we did recently, that we are about a year half of this year to manage the introduction of PBR. behind on the overall implementation of Choose and We are not using it, not because of problems with Book as a system. SUS PBR itself but with the data that is going into it. The quality of the data currently going into SUS PBR is not suYciently accurate to support Payment Q171 Dr Naysmith: Can we move to targets for a by Results. What we have got is local systems, minute or two? One of the things I want to ask is eVectively, that will be allowed to operate for the since introducing the 13-week target for maximum next four months until the next financial year. We out-patient waiting time performance seems to have will run those in parallel with a shadow SUS PBR slipped a little bit? and then have the full system operative when Sir Nigel Crisp: On the 13-week? Payment by Results is extended next year. It is later Dr Naysmith: Thirteen week, yes. Do you expect to than we hoped, but it is not to do with the system, it meet the December target? is to do with the data quality issues. Chairman: It is 18 weeks. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 24 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q172Dr Naysmith: No, it is 13 weeks. our proposals and asks for comments so that the Mr Bacon: We have two waiting list targets. We have service has a chance to think about the way in which two headline waiting list targets in the general sense, we define these targets so that we can refine them and then some subsidiary targets in specific before we actually have to deliver them. specialties, but I think the point you are referring to are the two December 2005 targets of a maximum Q175 Dr Naysmith: You have definitely got a draft 13-week wait for out-patient and a maximum of six definition now? months for in-patient. We are, as we have done with Mr Bacon: Yes, it is out for consultation. every other of our waiting list targets in recent times, tracking that down very closely week by week over Q176 Dr Naysmith: Can we see a copy of it? the whole health system, and we are confident Mr Bacon: Absolutely, yes. By all means. because the numbers and the way we track it suggests to us that we will be as near as damn it to Q177 Dr Naysmith: Have you got a deadline for the target. Inevitably when you are talking about finalising this? literally tens and tens of thousands of these, there Mr Bacon: I have not got the exact date. It is early may be the odd one or two that slip through, as has in the New Year. We have asked for responses. happened in the past, but we are pretty confident When we send you the document I can give you the now, because we are close enough and we can see the deadline date, if that is helpful. numbers. If the Committee will forebear with me for a moment, we track this on what is called a targeted Q178 Dr Naysmith: Finally on this area, do you list basis: so not only do we track the number we know how well the NHSis currently performing on know are waiting now we track the people we know a rough 18-week target? we have to treat by the end of December in order to Mr Bacon: No, is the straightforward answer, and I hit the target, and so we are tracking that, as we have can tell you why that is. every other one, and we are confident that we are going to make that target. Q179 Dr Naysmith: It is a bit worrying? Mr Bacon: There are three components to the 18- Q173 Dr Naysmith: I do not have any problems with week target, the first of which is the out-patient targets as some people do, as long as they are appointment, and we have not to date collected sensible, they make sense, and they are relatively anything other than statistics of people waiting over easy to measure. As Mr Bacon said earlier with 13 weeks, but we do know what the cohort of people sexual heath, they have chosen the target that was in total is below 13 weeks. We know precisely what easiest to measure in working out what was the in-patient waiting dimension is, but the bit in the happening to all the money. Which brings us to the middle which we are introducing as part of this question of why, when you were accounting the 18- target, which is the diagnostic phase, we have never week target from GP referral to start of treatment, collected statistics on; so the bulk of the work here in did not the oYcials and ministers realise that no looking at definitions and what statistics we should definition of that target existed. At the time that you collect has been concentrating on that phase. I can set the target there was a lot of confusion about what give you numbers for the first element and the third this target actually meant? element, but what I do not have, because we have not Mr Bacon: That is true. Since we set that target we collected them in the past, is that middle element. have done substantial work. We knew broadly what the target would be, so it is not true to say we had no Q180 Dr Naysmith: Would you agree that this is a bit idea. We knew the basic elements of it and we worrying, because all you are doing is opening up the worked through very carefully in the planning opportunity for my colleagues on the right and left process both the deliverability of it and the financial over there who may not want to support the consequences of it; so that is built into our planning Government in these targets to start attacking you assumptions. What we have been doing over the last about having fiddled the targets. It makes it very year or so is to work through the minute detail in the suspicious. I am sorry Paul, you would not do that! definition sense, when the clock starts for certain Sir Nigel Crisp: May I make two points? We actually things. do have some experience of this. What Mr Bacon is saying is we do not have the total picture, but we do Q174 Dr Naysmith: When the treatment actually have some experience because last year, as you may starts, so it is not just an estimate of something and recall, we had two cancer targets which were from then six months after that? initial engagement to treatment for children and for Mr Bacon: Yes. I do not know whether the members testicular cancer, and that period had to be four of the Committee will remember, but in the early weeks, and that has been achieved. At the moment, days of the in-patient and out-patient waiting list as again you probably know, we have got targets for targets we had similar definition problems. As we cancer again over a 30-day period and a 62-day move into this 18-week from GP referral to period, so there is some learning going in the system treatment target some of these definition issues are around this as well, but it is important that we go out much more complex. We have had a very extensive to consultation on this definition precisely for the process over the last year of engaging with the NHS reason you say, so that the definition is clear, upfront on the best definition of some of these things. We and there will not be any discussion about the have just gone out with a document which sets out definition once it is settled. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 25
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q181 Dr Naysmith: If you can, will you let us have population, how many MRIs, or whatever, you that information, please? would expect to see in a population of that size, and Sir Nigel Crisp: Yes. in asking the service to plan for this target we asked them to say what their rate would be, and, if it was Q182Dr Taylor: Do you have any feel for the not close to the normative level, we went back and number of trusts that might be keeping clandestine asked them to plan for more. As far as you were able waiting lists to go onto the waiting lists so these to predict how many of various types of diagnostic people do not appear on the failed target list? procedures the population is likely to need, we did Sir Nigel Crisp: Let me come back again to the point careful research, we produced that normative on the Audit Commission. We have Audit number and that is what the service has planned for. Commission spot-checks to actually go and What we have started to do is to look now at investigate. They see about 50 trusts a year, and we particular diagnostic procedures, and, as you know, have not found any like that at all if we are talking there are many types of diagnostic procedures some about our current waiting definitions for out-patient of which result in an in-patient episode some of and for in-patients. which are the episode themselves, so it is quite a complicated area. That is why we need the rules Q183 Dr Taylor: Surely those hidden waiting lists straight, we need the definitions clear and why we could be hidden even from the Audit Commission? need to build this database, but it is building from, Sir Nigel Crisp: If you know of one, let us know. we would confess, a low base because this is not an area where we have collected data in the past. Q184 Dr Taylor: I know of several. Sir Nigel Crisp: Let us check that you have got your Q188 Mr Burstow: Certainly when this has been the definition right. Can I make a point here, which I subject of some exchanges on the floor of the House, think is an important one? Many trusts, when they the previous Secretary of State seemed to be able to put you onto the waiting list, say, “We will contact draw on some data which suggested that there was you again in due course to agree a date with you”. within the Department some information about Some people mistake that for them not going on the diagnostic waiting times. It will be useful if that waiting list until they are contacted, when they go on information could be shared with the Committee. the waiting list at that first point. That may answer Mr Bacon: We have done some work to look at this your point. in a research sense, but this is by no means comprehensive, this is looking at individual Q185 Dr Taylor: So they go onto the waiting list geographies for individual diagnostics, but to the when they get that letter that says, “We cannot give extent we have got it, I am sure we will be happy to you an appointment yet”? share it with you. Sir Nigel Crisp: “We cannot give you an appointment date yet”, is what the letter actually says, and they go onto the waiting list at that point. Q189 Mr Burstow: Have you looked at utilisation rates of the equipment? Mr Bacon: We are beginning to look at that, Q186 Dr Taylor: Would not it not be reassuring for particularly in planning for what diagnostic facilities them to know that they were put onto the waiting individual organisations would need to deliver the list: because the ones who are coming to me do not target. One of the things they will be looking at, and know that they are? we asked them to look at, was the utilisation rate of Sir Nigel Crisp: I think there is a very good point particularly the major pieces of equipment; and we there which I am sure many people get right, but do know that our utilisation rates can be maybe just as a result of this conversation we will ask substantially improved, because if you look at the people to say, “We have now put you on the waiting performance of the best against the worst, if I can use list and we will confirm the date afterwards”, that word, there are significant diVerences. One of because this is where, when other people have raised the things that Sir Nigel referred to earlier, which is this with me and I have looked at it, that is actually his work around high impact changes, is to look at what is happening. They go on the waiting list and how you organise say an imaging service to ensure there is a very precise definition about when they get that facility can be used more intensively and, on the waiting list. therefore, we can achieve these targets through not just growth in the service but more intensive use of Q187 Mr Burstow: Very briefly, in terms of this issue the service we have got. of diagnostics, whilst accepting you have yet to start a formal collection of data, presumably in terms of modelling this and getting some grip of the nature of Q190 Charlotte Atkins: Turning now to NHS the problem you have got to grapple with to achieve reorganisation, can you tell us, on the basis of the the 18-week wait, you have done some individual polls on PCT reorganisation submitted by the SHAs data collections to start to try and gather some but also based on deliberations of the External information. Can you confirm that you have Review Panel, what will be the costs of this collected data on that basis? reorganisation? Mr Bacon: We did two things in thinking about this. Sir Nigel Crisp: I do not think we can yet do that, One was to look at what one might call the because part of what you are asking about there normative utilisation. So, you have got a given presumably is redundancy, for example. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 26 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q191 Charlotte Atkins: Indeed. for the reasons that Mr Bacon has said, that we do Sir Nigel Crisp: We do not yet have a complete not know exactly what the configuration will be, but picture on what that is going to be; so we do not have that is something that we will get. a cost on that. Q198 Charlotte Atkins: I am sure you must have Q192Charlotte Atkins: You mean because the some sort of estimate of what it might be. You must external panel is still considering the proposals from have two or three scenarios. We are being told that the SHAs or what? PCTs may be reduced by two-thirds from 300 odd to Mr Bacon: No, what we have done yesterday, and I about 100, so you must have some sort of ideas, after had understood we had written to MPs individually, all, this a financially driven exercise, is it not? or our ministerial team had. Sir Nigel Crisp: No, it is not a financially driven exercise. I understand you have had a hearing on this anyway in which I am sure it was made very clear Q193 Charlotte Atkins: I am sorry; I cannot quite that we are trying both to improve commissioning hear you? and, secondly, actually deal with the issue, as, again, Mr Bacon: I had understood that we had written to I think maybe in your own area, we already had a MPs about this—whether you have yet received the number of PCTs with joint management, and with letters or not, I think they were sent out yesterday— 47 around the place it was quite clear that we needed announcing the deliberations of the external panel, to, and we have been holding back mergers for a long and I have now written to SHAs telling them that we time, so those are the reasons. People can make all have agreed that they can go on to consult, and in the kinds of rough estimates if they work out how many letters that I have sent I have said on what proposals staV 250 million might represent, but then it is they can consult. terribly diYcult to get an accurate picture because Charlotte Atkins: I have not seen my letter yet. you do not know how many staV maybe leaving anyway or what the turnover is or what the Q194 Dr Naysmith: They only arrived yesterday. redundancy costs will be. The redundancy costs will Mr Bacon: They were signed and sent yesterday, clearly be the big one, and until we get a clearer fix whichever method you get your mail. on where these are we will not know these numbers and I do not think I should speculate. Q195 Charlotte Atkins: Every MP has a diVerent Q199 Charlotte Atkins: You are saying that it is not method and I have not seen it yet, but that is not a financially driven exercise, but when I met my local really the issue. What I am looking for is what you SHA leaders and they put forward a proposal which estimate to be the overall costs given that was unacceptable to my constituents, when I redundancies will be aVected? suggested an alternative I was told, having been told Mr Bacon: We would not pretend that there will not originally that was not financially driven, that be redundancies, there will in this process. One of the actually that was not any good because that would reasons we cannot be specific is because, as you will leave the SHA a million pounds adrift. Mr see when you get individual letters and as you see the Nicholson was very clear that therefore what I was growing position, health authorities will be suggesting was not acceptable because it was a consulting on a variety of options, and in some parts million pounds too little in terms of savings. of the country the number of PCTs that will emerge Sir Nigel Crisp: We are maybe using language after public consultation and after ministerial diVerently here. I do not mean to be pedantic about decision could be significantly diVerent depending this. Clearly, we have got to deliver the savings as on what the outcome of that process is, and that will, well, but that is not the purpose of the exercise. The of course, aVect the amount of redundancy costs. purpose of the exercise is to develop good and eVective commissioning around the country and to Q196 Charlotte Atkins: I certainly hope they will be deal with these questions of mergers that have been significantly diVerent, if I can talk personally, but coming up. There is a financial constraint and people having said that, the exercise is expected to ensure do, indeed, have specific financial envelopes they £250 million in savings, as I understand it? have got to work within. Mr Foster: Yes. Q200 Charlotte Atkins: We cannot clarify the Q197 Charlotte Atkins: So, in addition to the costs, financial costs, but what about the costs in terms of which will have to be recouped, there is also the issue staV morale and people taking overtime and people of the savings which are already on the drawing deciding that really this is another reorganisation board, if you want? too far? Sir Nigel Crisp: That is absolutely right, there will be Sir Nigel Crisp: Yes, you are absolutely right, this is an upfront cost, and that will need to be repaid from deeply disruptive and disruptive for individuals. the first bit of the savings, but, as I say, there will be an upfront cost and there will be savings year on year Q201 Charlotte Atkins: And demoralising? on year of at least £250 million. What we have asked Sir Nigel Crisp: Demoralising for individuals and health authorities to do is to tell us how they will also for organisations, but you need to look at the recover that £250 million. What we cannot do yet is decision which we needed to take, which is actually to get an accurate picture on the upfront cost simply that we needed to get the commissioning 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 27
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster organisations up and running eVectively so that we Sir Nigel Crisp: Literally I have not been interviewed were able to manage what was happening in the by either of those two organisations on this topic. I NHSmore e Vectively, and I am sure you have had have been interviewed by both of them on previous that argument and discussion played out here. occasions. Let me tell you the process we are going Regrettably, we came to the conclusion that this was through, because where that came from was a leak of the only way we could do that. On the particular a document in the middle of an exchange of diVerent point which we were asked earlier about service documents and, therefore, inevitably they both got a provision, we have accepted that we were too little bit of a story and they also got it completely the constrictive on that and that, indeed, was damaging, wrong way round. I think the Health Service Journal but on the basic point about reconfiguration this, is quoted that following some comments I made at a something we need to do in order to deliver the conference about that. What we are going to do on changes in the NHSwhich we believe will be this reorganisation is make sure that we do not just necessary. The key for us now is how well can we re-organise, get people into new jobs and then just manage it, and we have agreed with the trade unions leave it. What we are going to do is the same sort of the way in which we will handle the HR type issues, process as we are doing with NHShospitals as they we are putting in place interim appointments, we are become foundation trusts. Firstly, we expect them at putting in place all the sorts of things you would their starting point to set out very clearly what it is expect us to do in order to try and manage this as they are going to do and how they are going to smoothly as we possibly can, and it is helpful we now deliver all their functions, use a process of diagnosis have some decisions to go out to consultation. to see if that is going to be eVective and then have a development programme thereafter. The nature of Q202 Charlotte Atkins: In the future, Sir Nigel, will the development programme will be tailored to the you try to avoid issuing ground-breaking letters, as nature of the individual organisation. In some cases, you did, at beginning of the recess? I was a bit if we feel that they do not have adequate clinical worried earlier on because you were talking about governance in their plans, for example, we will no things coming out at the turn of the year, and it doubt agree with them—and by “we” I mean seems to me that, as we go into the recess just before ourselves and the SHAs—that they will have clinical Christmas, more letters or more documents may be guidance, some kind of process for development. If slipped out during the recess. Hopefully that is going we do not think they have adequate financial plans, to be avoided, is it? we will also be sitting very closely to them to start oV Sir Nigel Crisp: I am very confident that the White with to make sure that they convince us in end that Paper we are talking about will not come out during they have actually got adequate financial plans and the recess. This was not intended in any sense to be management skills for the next process. That is what slipped out, it was later that we wanted to do it, but we will be doing. It is a development process. It is not we believed it was better to get it out in July so that about saying whether or not people are, well, it is at we got on with it. That was the pure reason. We one level about whether or not people are capable of would like to have got it out earlier, but in terms of doing their full job, but that means— actually getting things ready it was important that we got on with it. That was the reason. Q206 Mr Burstow: They will be no less financially autonomous after the reorganisation than they Q203 Charlotte Atkins: It will be avoided in the were before? future. Sir Nigel Crisp: They will be in the same position as Sir Nigel Crisp: We will do everything we can to foundation trusts are if they are not yet convincing avoid that in the future, yes. We have learned some us absolutely that they are in control of everything, lessons from it, if that is part of your question, as that they will have much closer monitoring. This is well. about monitoring. I will not rule out the point that conceivably I might use my accounting oYcer status, Q204 Mr Burstow: To pick up on some reporting but I think I have only ever had to threaten to use from the Health Service Journal and the Financial that once in my entire time. It is not something that Times of interviews with you, Sir Nigel, regarding I will be waving around. We want those V the issue of your role as the accounting oYcer for the organisations to do the job as e ectively and be V NHSand the extent to which, with the introduction equipped e ectively to do a really important job— of new primary care trusts as part of this that is what it is—and that is why leaks often get it reorganisation, you will be withholding your completely the wrong way round. accounting function from PCTs. It is the issue of Chairman: I am very conscious of the time, so I think whether or not some PCTs will be told they are not we should be able to have time to ask all the grown up enough to manage their own budgets and questions and hopefully we will get them answered whether that is actually going to happen. as well without having to exchange even more paper Sir Nigel Crisp: Thank you for asking that question. than what we have agreed already this morning! I am Firstly, I have not been interviewed by either the going to move on to Anne. Health Service Journal or the Financial Times. Q207 Anne Milton: We have mentioned foundation Q205 Mr Burstow: So you have a double trusts. Can you tell me what the cost of setting the somewhere? foundation trusts up was? 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 28 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Sir Nigel Crisp: In individual foundation trusts? one year. Would I have expected to see 12 out of 25 in the first year? I would have probably hoped there Q208 Anne Milton: No, setting them up to date, all would be more in surplus than there actually were. of them. Mr Douglas: I have not got the information at hand Q215 Anne Milton: They are doing worse than non on what the total cost will have been. I do not know foundation trusts, are they not? whether any of my colleagues could help on that. I Mr Douglas: Overall it is broadly the same. am sorry; I have not got that figure at hand. Q216 Anne Milton: I have got something here that Q209 Anne Milton: Can you let us have that? says 28% of trusts overall are in deficit, so it is not Mr Douglas: We can. What we will do is provide the broadly the same, it is slightly worse? costs for individual organisations and the costs of Mr Douglas: In financial terms it is not dissimilar. the regulators oYce as well, which are the principal elements. Q217 Anne Milton: But it is worse? Mr Douglas: In financial terms it is about the same. Q210 Anne Milton: Have any additional resources been given to foundation trusts that are in deficit? Mr Douglas: No, nothing has been given to Q218 Anne Milton: Is it worse or better? foundation trusts that are in deficit. They have not Mr Douglas: In numbers terms proportionally I been treated any diVerently from any of the rest of think there are slightly more. the NHS, so those that are in deficit have to manage them. Q219 Anne Milton: More foundation trusts in deficit? Q211 Anne Milton: Twelve out of 25 operating in 04/ Mr Douglas: In terms of numbers of organisations 05 reported a deficit. Do you think the piloting of who have a value. Payment by Results contributed to their diYculties? Sir Nigel Crisp: But in terms of the overall deficit, the Mr Douglas: I do not think it has contributed to the amount of deficit they have scored between them is deficit, no. I think the reasons they have got deficits in proportion to the number of other organisations. are probably very similar to ones in the rest of the Chairman: We are going to move on to private sector NHS. For most foundation trusts piloting Payment involvement in the NHS. by Results is generally beneficial to them, because they tend to be low cost organisations and their income tends to rise under Payment by Results and Q220 Mr Campbell: Private sector involvement: this so they will not have lost out as a result of Payment is a hot potato obviously. From information by Results, they will actually have gained income. provided in previous years by PEQ, the response revealed that prices paid to (non-ISTC) private hospitals greatly exceeded the cost. Is this still Q212 Anne Milton: No, Payment by Results might happening? in time be good for them, but it is the piloting of it Mr Douglas: I think overall where we have been that might have cost them and caused them before was a spot-purchase price. Hospitals going diYculties now? out and buying things on the spot market for the Mr Douglas: Even in the short-term most of them private sector was a higher cost than us buying will have benefited, so even ones that became quite through the independent sector. We believe that is well-known with deficits, like Bradford, Bradford still the case, although we do not think the was getting significant income growth under diVerential is probably as great as it was, partly Payment by Results that it would not have been because the independent sector programme has getting under the previous system, even in the first started to drive down, to some extent, the spot prices year. in the market—so there will be a diVerence, but not as significant as before—and we are tending to focus Q213 Anne Milton: Are you happy that 12 out of 25 a lot more now on looking at what is the diVerence are in deficit? Do you think that is reasonable? between the independent sector price and the NHS Mr Douglas: In some ways it is not initially for me to price rather than doing the comparison with the be happy. It is for more for the regulator to be spot-market, which was more appropriate for a time happy. when we had very serious capacity constraints. There is a diVerence but it is a reducing diVerence. Q214 Anne Milton: I am just interested. I feel quite happy asking you about your happiness with this. Q221 Mr Campbell: Can I ask you to provide Happiness is important! information on the cost of the independent Mr Douglas: What we have always said with providers other than the ISTC? foundation trusts is that they will not be in a position Mr Douglas: We can provide some information. It is of being tested on break-even each year statutorily not very good information, which is one of the by government interested organisations, and they reasons we have not provided it, because it is based will have to demonstrate their financial viability. on not a very good data collection, but we can That can then be looked at over a longer period than provide the best information we have got. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 29
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q222 Mr Campbell: It is very important, because it capacity building because at the time there were is a big debate and it is a debate on the floor of the clearly capacity constraints to achieving some of our House of Commons on many occasions, and this objectives. One dimension of it was capacity. We information should be available. Can I follow on to also felt that we would get innovation from diVerent say, when will the trusts and foundation trusts be ways of doing things which would improve permitted to compete with the independent sector? productivity, would improve access to services and Mr Bacon: Forgive me, I missed your question. would improve the patient experience. As we have progressed the initiative and as the NHShas Q223 Mr Campbell: When will the National Health developed its capacity, we now see the advantage Trust and Foundation Trust be permitted to much more in the innovation and productivity than compete on price with the independent sector? Will we do on a pure capacity basis. There is evidence that that ever happen? the arrival of the private sector in a very limited Mr Bacon: Where we are moving towards is a way—let us be clear here, when we have achieved position where essentially the price . . . This relates our second wave of ISs we will still be less than 10% to individual patients choosing where they wish to of the total volume of electives, so this is at the have their service provided, and we will manage that margin, so at the moment we are talking about a very transaction through a tariV: so to the purchaser of small volume being delivered through the healthcare the location of the treatment is neutral, in independent sector—the stimulus of the other words, you pay the same rate as a purchaser of independent sector coming in, not because they are healthcare, the PCT, to the independent sector as more dedicated or whatever, they simply do have you would do to an NHSTrust. To the extent that some diVerent ideas which it is worth capturing, there is any price diVerence we would be carrying stimulate change both in the NHSand even more that in a central pool. We have evidence already dramatically in the indigenous private sector in through the programmes we have run that whilst I England, in BUPA and BMI. We have seen would agree that in the first wave of independent tremendous changes in the way that they operate on sector treatment centres the price we are paying is the back of our initiatives. I think this is broadly above the NHSrate, for some aspects of it, speaking delivering the objectives. particularly the diagnostic phases, we are actually paying a lower rate to the private sector than the Q226 Chairman: I am interested in this concept. NHSrate. So,we expect a mixture here, but what we Looking in my particular area of the UK, the second are very keen to do is to ensure that for a patient and phase particularly seems to have united the health for that patient’s primary care trust or practice the community throughout South Yorkshire where the decision as to where to be treated is neutral in price first phase did not; it has united them against it at terms. That is very important. this particular stage. It does not look very evidence based in terms of what the needs are as opposed to Q224 Mr Campbell: What I am trying to get at is to the choice issue. There is not much private sector see if we can get a level playing field: because trusts choice in South Yorkshire, probably because of its cannot go below the national tariV, whereas the socioeconomic background and it is not a very rich private sector can, and so we have not got a level part of the country so there is not a lot of money playing field here. I think we have indeed stated our around that has brought on a very active private intention that progressively we will move to a sector. Do you think you are playing a role in that position where there is no premium for the private respect of ISTCs? sector. In other words, they either compete at the Sir Nigel Crisp: I think we are playing a role in terms going rate or they do not. of choice, which I think is part of the point of Mr Douglas: If I could be clear about the issue of opening up a wider range of choices as well as pricing on this. A private sector provider will not innovation and capacity. provide services to a PCT at a cost less than the tariV price. The PCT will face the same price whether they purchase from the private sector or whether their Q227 Chairman: Do you take into account the patients go to the private sector Foundation Trusts. independent sector that is there now and look at the If a private sector organisation comes in at a price levels they are working to and their individual lower than tariV, so if they bid in at a price that is capacity now as a part of putting out the second 10% lower than tariV, clearly we will not say to them phase, as it were, of the ISTCs? Is it a wide picture we are going to pay the full tariV price regardless, that you look at? what we will do is we will take that 10% centrally and Sir Nigel Crisp: I think the point about the existing recycle it in the system. independent sector in any area is that may not be Sir Nigel Crisp: And oVset it against elsewhere. We available to the NHSbecause the NHSwill be will not force money on people. seeking to purchase at NHSquality levels and also at NHSprice. It needs to be much more of a local judgment as to the range of what you would take Q225 Chairman: Can I just ask you a question that into account. is ISTC specific. What is the idea behind the ISTCs? Is it an issue of capacity or of choice? Mr Bacon: I think when we started the IS Q228 Chairman: Who will take the local judgment? programme, which was some while ago now, 2002, Sir Nigel Crisp: The discussions are with the we had a number of objectives, the first of which was strategic health authorities. 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 30 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q229 Chairman: They will take the final decision in Q233 Mr Burstow: It does beg the question how we relation to these things, will they? can make any meaningful comparisons with the way Sir Nigel Crisp: They will be part of the final in which PFI schemes are going forward. It is quite decision. interesting looking at the paperwork that has been supplied that PFI costs compared to outline business Q230 Mr Burstow: Can I just ask about something case costings for PFI projects are overrunning by as that puzzled me in something Mr Bacon was saying much as 60% in terms of 30 of the biggest projects, earlier on around this whole issue of getting into the that is £25 million-plus schemes. How can we diagnostics issues and understanding what is going meaningfully compare the costs of providing finance on and what the capacity is within the NHS. Clearly from the public sector against PFI schemes when the Department at this stage is still in the dark about you do not supply and do not appear to be collecting all of that and it does rather beg the question how the that information? Department could justify on value for money terms Mr Douglas: If I could return to that and see if we letting contracts for scanning. How could you have can re-establish the collection of that data. It is done that without knowing what is going on within clearly one of the ones we have stopped as part of the the NHS? process of change we have had in the Department. It Mr Bacon: You are referring, no doubt, to the Allied is probably one that we should look at re- Medical issue that we talked about before. What we introducing. did perceive in MRI terms on the basis of the Mr Bacon: I am sure we can do that. There have been information we did have which, as I have already very few significant publicly funded schemes in the said, was limited was we had clear evidence that NHS. people were waiting too long for MRI scans. Given the nature of the illnesses that one tends to have an Q234 Mr Burstow: Looking, for example, at earlier MRI scan for, we thought we would do what we figures that were supplied previously, we were told could very quickly to address the worst of that. What that 10 of the schemes that were running at we did was to procure at national level some mobile something like £10 million as capital costs, their cost scanners which we have targeted very specifically at overruns on the previous figures were something like places where we had information that there were 2.6% compared, probably on a like-for-like basis, long waits. What we did was to say to the SHA at with a 7.5% cost overrun on PFIs, or a 60% overrun SHA level, “Your share of this national if you just compare it with outline business case contract . . .”— figures. There is an issue here of publicly funded schemes actually coming in at lower costs and lower Q231 Mr Burstow: With respect, I understand all of overruns than PFI and yet this figure now is not that and I am fairly familiar with the roll-out. What available to us because you have stopped collecting I wanted to get at and be very clear about was how it so we are unable to see whether that trend is could the Department justify on value for money continuing or not. terms when it did not have suYcient information, on Mr Douglas: I think we will have to look at the like- your admission really, to make an objective for-like comparison on that. I do not think the decision? comparison at the OBC stage would be a like-for- Mr Bacon: We could perceive from the information like one. we did have that we had people waiting too long, Mr Burstow: The 7.5% is like-for-like whereas I point number one. Point number two, the way to accept the 60% may not be. begin to address that was an immediate injection of new capacity to tackle the long wait, which I doubt Q235 Dr Taylor: Can I ask for clarification on table people around the room would dissent from. We did 5.3.3(c), which is the expenditure profile of capital manage to procure at a price below—I do not think spend. This tells us that there are six major PFI that is giving away anything commercially schemes that are operational but what I do not confidential because we have said it before—the understand—if I can use my own one in NHSrate. In value for money terms, we were Worcestershire as an example—is it lists the amount purchasing at— of expenditure in 1998–99, 1999–2000, 2000–01 and 2001–02 and that adds up to the total price of £86.6 Q232 Mr Burstow: That is helpful. I am conscious of million. Does that mean that was paid and, if so, everyone’s time and I just want to move on. Mr who paid it? Amess was raising questions about gaps in the Mr Douglas: No. response to the questionnaire we sent. Another such gap is in relation to long-term capital projects, and in Q236 Dr Taylor: Why do you put it in as expenditure particular in respect of 5.3.1 which is about publicly under those years when it has not actually been paid? funded capital projects where you told us that the Mr Douglas: What it tries to show is the spend information requested is no longer available in terms profile of the total capital costs. What it is trying to of cost and time overruns. Can you tell us why that do is show how much capital investment there was information is no longer available? in each of those schemes in each of those years. We Mr Douglas: I will probably have to come back to do not pay until the scheme becomes operational. you on that, I am afraid. It may have been one that What it is showing is how much money would have has gone with the change in data collection but I been spent on developing the scheme by the private would need to check on that. sector over that period. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Health Committee: Evidence Ev 31
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Q237 Dr Taylor: So the private sector bore those Q247 Dr Naysmith: Perhaps you could just check costs in those years? that, if it is possible, and let me know if it is IT Mr Douglas: They would be the capital costs borne spending or if it is projected future building costs. eVectively by the private sector. Mr Douglas: The PFI capital spend continues to increase, it is just the extent to which it is a Q238 Dr Taylor: And we started paying the proportion of the total capital spend. I will look mortgage from the moment we moved in? back at the figures. Mr Douglas: We start paying the unitary charge Dr Naysmith: Thank you. from the moment it becomes operational, yes. Q248 Chairman: Just a few questions more, not long Q239 Dr Taylor: Going on to the unitary charge, I now. How much of the NHScapital programme will understand why it has increased but could you tell us be financed by the Credit Guarantee Finance in how many of the six that are functional have got future? written into their contract a surcharge for bed Mr Douglas: We have got two schemes at the occupancy levels? moment where we are piloting Credit Guarantee Mr Douglas: I could not tell you that oV the top of Finance, which is Leeds Oncology and Portsmouth. my head, but I could— The Credit Guarantee is part of a cross-government Treasury led initiative. Until the results of those two Q240 Dr Taylor: I know that the local one has a 12% have been evaluated across government I could not surcharge when the bed occupancy rate goes above say whether that will extend further than that or not. 90%, which seems an extraordinarily short-sighted It has been done as a pilot, we are looking at how it contract to have agreed to when you knew there were works with the Treasury and a decision will be made fewer beds. If that is so across all six, the expense after that. from a badly agreed contract is absolutely amazing. I would like to make sure that other ones in the Q249 Chairman: Given that we are led to believe it is future do not have that sort of contract. much cheaper than private finance, presumably if Mr Douglas: I am sorry to have to provide you with the pilots do not show anything untoward it is likely a note again, but I will have to. that this could be a way of increasing investment in Dr Taylor: Above 90% occupancy and there is a capital in the NHS? surcharge which I am told is at the rate of 12%. Mr Douglas: That will be a decision for the Treasury. It is a Treasury led scheme that we are operating two Q241 Dr Naysmith: There is another interesting little pilots on. figure in the response about PFI and that is it shows Chairman: I cannot tempt you down this road at all, the share of NHScapital spending to be financed via Mr Douglas. There are many other questions that PFI as 29.4% in 2006–07 and it is going to decline to flow from this in terms of public finance. 23.5% the following year. Does that mean that there is going to be a downturn in the importance of PFI Q250 Anne Milton: Can you explain what it is, I am funding? afraid I do not fully understand it? Mr Douglas: No, it has nothing to do with a Mr Douglas: EVectively, what happens is the public downturn in the importance of PFI funding. sector, or the Department, lend money to the private sector. So we lend part of the money for the scheme Q242 Dr Naysmith: What does it mean then? to the private sector. We lend it to them at rates they Mr Douglas: It may well be something to do with the would face in the market, so they do not get a benefit build up of spend on the capital side of the national from it, but we can borrow the money at lower rates programme for IT. These numbers can change quite through the Treasury. In eVect, the private sector significantly from year to year as proportions. There does not get the benefit from it, we get the benefit is no planned decline in there. from it. Actually, the Treasury gets the benefit from it. Q243 Dr Naysmith: It will reflect some decisions that have already been made for future expenditure? Q251 Chairman: The Treasury may get the benefit Mr Douglas: Yes. from one or two Parliamentary Questions on and around this subject. I realise it is not for you. I Q244 Dr Naysmith: Possibly on IT, you are saying? understand you are about to make some form of Mr Douglas: It may be on IT, I would have to check. statement later today about the issue of deficits, is there anything you would like to tell the Q245 Dr Naysmith: Some of that is PFI as well, is Committee now? it not? Sir Nigel Crisp: Yes, thank you for that. I thought it Mr Douglas: Sorry? might have come up earlier. In answer to a Freedom of Information request we will be publishing a list at Q246 Dr Naysmith: Is none of the IT PFI? the half year position this year, the six month Mr Douglas: The national programme for IT is not. position, of the forecast for end of year by every Mr Bacon: One or two of the earlier PFI schemes organisation in the country. The position is showing included IT as part of the PFI but we have moved something of the order of a £600 million projected away from that now. The national programme is all deficit at the six months’ position, that is about the pure public capital. same as where it was last year, and you will see the 3178272001 Page Type [E] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
Ev 32 Health Committee: Evidence
1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster distribution with all of that being in 30% of the that. We have a conversation with the strategic organisations. I will also be saying something I did health authorities and at that point you get behind say earlier today, that in those organisations that the numbers a lot more and understand better what have the biggest diYculties we will be putting in action could be taken to bring them back. There is a more support and help in terms of getting them degree of pessimism always at certain times of the sorted out. I just did not want that to go by without year, particularly people will tend not to declare actually mentioning that to the Committee. surpluses early on because the history they were used Mr Burstow: Are we allowed to ask some questions to years ago was that someone would take the about this little statement we are now having? I surplus back oV them if they did. Although it may be appreciate the figure has been mentioned, and that is a harder figure than last year’s figures, we still expect very helpful, but not to be able to ask anything about to get this £600 million down to something no worse it is rather puzzling. than the position we ended last year in. Chairman: I am not saying that at all. If Nigel is comfortable with that, he can answer. Q257 Mr Burstow: So you think you will end up with a deficit of no more than £250 million still? Is that Q252 Mr Burstow: Maybe we need the nudge and what you are telling us at this stage six months in? the wink. Certainly two or three weeks ago we asked Sir Nigel Crisp: What we agreed earlier in the year, for the reports that you receive from SHAs so that again on the same basis that we talked about before we could get ourselves that information, so it is about the pace of change, was we would agree with useful that it is coming out of Freedom of organisations control totals for what they would Information. You said that 28% of organisations at have to achieve at year end, which was either zero or, the end of the financial year were in deficit. What in some cases, a higher figure. Our current proportion of organisations on the basis— expectation on plan is to be £200 million in deficit Sir Nigel Crisp: About the same. which would be covered by savings elsewhere.
Q253 Mr Burstow: It is still 28%. It has ballooned to Q258 Dr Taylor: Does this statement you are going £600 million, has it? to make give us any idea of the number of trusts that Sir Nigel Crisp: It is almost exactly the same position have to make plans so that they are in balance in as it was this time last year. In our experience, 2006–07? I am sure this must be higher than the 28% forecasts are always pessimistic. It is looking at because there is a huge threat to community about that level. It is paying back the £250 million hospitals, for example, around the whole country. from last year and it is also dealing with the Sir Nigel Crisp: All trusts have to be in balance in overspend from last year. 2006–07. Q254 Mr Burstow: Part of it is this accumulative deficit, but on top of that there is another £300 or Q259 Dr Taylor: How many are having to make £400 million. plans to save £20 million or £30 million, like the two Sir Nigel Crisp: That was the rate that it was that I know of? spending at before. It is about the same position as Sir Nigel Crisp: Everyone has to make plans and in last year. some cases those plans may seem tougher than in other cases because you have got to achieve balance by the end of the year. Q255 Mr Burstow: The other thing you say in response to the PEQ is that you have improved the monitoring arrangements and you are very Q260 Dr Taylor: Is it possible to know how many cognisant of the fact that NHSorganisations tend to trusts are having to make plans to save greater than be very pessimistic in-year about what is happening. £20 million? Given that you have been fine tuning and trying to Sir Nigel Crisp: I am not sure we can do that because improve the monitoring to avoid that, are you all trusts will be having income rises of a very therefore able to say that this is a harder figure? significant amount and individually people will then Presumably you will have been working harder to be planning how to spend that money and how they get a better fix and surely this is a harder figure than need to adjust their services. I do not think that we last year’s figures? have anywhere—unless Mr Douglas is going to Sir Nigel Crisp: I think it probably is, yes. correct me—a statement about what people are thinking about in detail for 2006–07 yet. Q256 Mr Burstow: So this is a more realistic assessment compared with last year. Q261 Dr Taylor: It must be known. The two trusts Sir Nigel Crisp: Mr Douglas might comment on in my area, one has to save £20 million and the other that. £30 million, so it must be known. Mr Douglas: What we try to do in terms of the Dr Naysmith: To bring succour to anyone who has monitoring is focus down very much on bringing in had anything to do with local authority finance, the individual strategic health authorities and really which is not the same thing as NHSfinance, about going through the figures with them in some fine this time of the year every year, for the last 20 years, detail. The £600 million forecast reflects what I have been involved in similar kinds of discussions individual NHSTrusts and PCTs will be putting into with treasurers and defi cits projected. Good luck, our system. It is individual organisations saying gentlemen. 3178272001 Page Type [O] 27-04-06 16:17:42 Pag Table: COENEW PPSysB Unit: 1PAG
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1 December 2005 Sir Nigel Crisp, Mr John Bacon, Mr Richard Douglas and Mr Andrew Foster
Chairman: Gentlemen, could I thank you very much answer a question we are likely to ask it in here. I do indeed for coming. I know it has been a bit of a take note that when we do want something specific marathon session. Could I say I hear what you were that we have not got from the PEQ we will try, if it saying in relation to one of the questions you had is at all possible, to let you know before you arrive. earlier today about an absence from the Once again, thank you very much for coming along questionnaire that was sent out to yourselves, but I and sharing your experience with us this morning. would say a rule of thumb should be if you do not Thank you. 3178272PAG Page Type [SE] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
Ev 34 Health Committee: Evidence
Tuesday 6 December 2005
Members present:
Rt Hon Kevin Barron, in the Chair
Mr David Amess Anne Milton Charlotte Atkins Dr Doug Naysmith Mr Paul Burstow Mike Penning Mr Ronnie Campbell Dr Howard Stoate Jim Dowd Dr Richard Taylor
Witnesses: Rt Hon Patricia Hewitt, a Member of the House, Secretary of State for Health, Sir Nigel Crisp, Chief Executive of the NHSand Permanent Secretaryand Mr Richard Douglas, Director of Finance, Department of Health, gave evidence.
Q262 Chairman: Good afternoon, Secretary of Ms Hewitt: With GPs what we did, unlike Agenda State; could I just ask you, for the record, to for Change, was to tie a very significant part of the introduce yourself and your two colleagues? pay negotiations to outcomes, measured within the Ms Hewitt: Yes, thank you, I am Patricia Hewitt, quality and outcomes framework, and it certainly Health Secretary; Sir Nigel Crisp our Permanent appears to be the case that the profits that GPs are Secretary and Chief Executive; Richard Douglas, making as a result of the new contract are higher our Director of Finance. than we and I think they anticipated, but that is a result of their having achieved more on the quality and outcomes framework than we were anticipating, Q263 Chairman: Thank you very much for coming so although certainly there is higher pay there—or along to help us with this inquiry into expenditure. higher profits—it is earned through that outcomes- Secretary of State, last week Sir Nigel said that 50% related pay. Obviously, we are taking that into of the additional NHSspending had gone on new account as we negotiate next year’s round. activity, new staV and new drugs; 20% had been spent on training and capital and 30% on more pay Q265 Chairman: Obviously, an increase in for existing staV. I just wondered, how do we know productivity you expect, but is that going to be that there was a need for increasing pay, other than measured? Have you got a way of measuring the the obvious? Was it to do with the business, the benefit that patients will have due to these increases? activity of the National Health Service? Ms Hewitt: In terms of the GP framework, Ms Hewitt: We knew, when we were first elected, obviously the quality and outcome framework is that there was a real issue about pay in the public directly tied to issues like dealing with diabetic sector generally and specifically within the NHS, patients, for instance, or advising patients to give up and we could see the diYculties that we were having smoking, dealing with a whole range of issues that in recruiting to training, recruiting to fill our we identified as a priority. In the case more broadly vacancies and we could see the levels of pay that our of the NHSand the results we are getting for the staV were getting compared, for instance, with those increased investment, there has been, I think, a long in the private sector, so when we embarked on pay and vexed debate, not least amongst the statisticians, reform and particularly Agenda for Change, it was about how you measure productivity within the in the very clear recognition that we needed to be NHSor more broadly public services, and we have rewarding NHSsta V properly for the commissioned some additional work on that and extraordinarily important job they do and the indeed we will be publishing some of that tomorrow dedication with which they do it. We have not only alongside Sir Nigel’s annual report. achieved that, particularly through the most recent three-year pay increase that we have had, but Q266 Chairman: Will we have a measurement for through Agenda for Change we have also patients’ benefit or will that be as a consequence of established a modern pay system that we believe productivity measurement and increase? meets, for instance, the needs of equal pay for work Ms Hewitt: The quarrel, in a sense, the criticism that of equal value and, perhaps most importantly of all, we had of traditional measures of productivity allows our staV to be recognised for the skills and the within the NHSwas that they really took no account competencies that they have, and then to progress at all of improvements in the quality of patient care and acquire new skills, take on board responsibilities and patient experience, and they also absurdly and, of course, in many cases be even better undervalued, for instance, the increased number of rewarded for doing so. people’s lives saved as a result of statins. What they were doing was looking at the cost of the statins, and of course they are a rather cheap drug, rather than Q264 Chairman: Was that the same for GPs? Was the fact that we are saving more people’s lives, which this movement into the primary sector the reason is the real outcome that of course you want to that we have now ended up with the highest-paid achieve and you want to measure. Our own general practitioners in Europe? departmental statistical team, with the help of some 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas academics and, indeed, the OYce of National in inner cities, in diYcult estates? What do you Statistics, have been looking at how you really try intend to do to improve equality there, because those and account for improvements in the quality of care directly impact on your department? that patients get, the outcome that patients get and Ms Hewitt: Your point is absolutely right and, given the quality of patients’ experience, and then reflect that one of the founding values of the NHSwas that in the measures of output and productivity. equal access based on need, not on ability to pay, it is quite shocking after nearly 60 years that we have still got, as a general rule, the worst services, the Q267 Dr Stoate: I am particularly interested in poorest services, in the poorest areas; it is not health inequalities in this country. As you know, life acceptable. What are we doing about it? First of all, expectancy can vary by as much as nine years across I am delighted to say that John Reid made really social class and across regions in this country, there landmark decisions about the pace with which we are huge inequalities in cancer, in heart disease, in would move the allocations to primary care trusts strokes, in diabetes, in obesity and enormous towards their target level. You will be aware that diVerences. One of the targets the Government set back in about 2000 when we recalculated the targets, was to reduce health inequalities by 10%, but we based on need, we had some primary care trusts that heard last week that that was going to be missed and were over 20% below their target formula. Over the in fact inequalities are more likely to widen before next two years we will get to the point, by the end of they get any better. What are you going to do to try 2008, when no primary care trust on the current and bring these inequalities under control? boundaries is more than 3.5% away from their Ms Hewitt: The more I look at this issue of health target. That is an enormous improvement and it inequalities, which are deep and very disturbing, the means that there will be some very, very large more convinced I am that we have to act on a whole increases in funding, largely to the poorest and most range of issues, some of which are within the control under-provided for areas over the next two years. of the NHSand the Department of Health, some of Everybody will continue to get significant increases which of course go far, far broader than that. The but obviously those who have been above their single biggest cause of health inequalities is simply target allocation level will get lower increases than poverty, so the commitment we have made as a those where we need to put the most money in to government is to reduce and then to eradicate child bring them up to or as close as we can get them to poverty and to cut poverty among people of working their allocation. That will make, I think, a very big age and of course amongst the retired population. diVerence. The other point I wanted to make is that That will have a very direct bearing on the health in the White Paper that we are going to be publishing outcomes, on all the dimensions that you mention, shortly on primary and community care we are of the population in future, but I know from some looking specifically at what we need to do in areas of the communities that I represent myself just how where you have not got enough doctors, where you deep-seated these health problems can be when you have got more closed lists, where patients are saying have, for instance, a baby born with a low birth- loud and clear through the surveys that they are not weight, to a young single mother who may have satisfied with the services, and we are looking both at what the trigger for action should be and then what smoked throughout the pregnancy and perhaps not action the primary care trust should be required to had very good nutrition either, whose own parents take. have perhaps been unemployed or not working, may even have had a disability, so that you have a real inter-generational problem of very poor health Q269 Dr Stoate: I hope that is going to work because outcomes that are directly linked to social and we have had a resource allocation working party— economic deprivation, not just in one generation but which was the predecessor of the current going back three, sometimes four or even five redistribution system—since 1978 and, although a generations. We have got to tackle all of those as well lot of work went in, very little came out in terms of as making sure that through the NHS, for instance real redistribution of health resources, because when through the stop smoking programme, or through this Government took over inequalities were the kind of targeted work that was done in SheYeld absolutely rampant through the system. Are you on heart disease, we most directly give support to confident that this new system will be any more those who need it most. eVective than the previous one which spent a long time really achieving very little? Ms Hewitt: I am confident, but the point you make Q268 Dr Stoate: I appreciate that many things to do is absolutely right. The problem is that you had the with inequalities you have no control over as a single RAWP working away, trying to get to as good a department, and it has to be across government, but measure of need as you could, and therefore coming nevertheless there are significant discrepancies in up with the targets, but even if you moved the access to healthcare, diVerences in quality and allocation towards the target there was no guarantee availability of GPs, out-of-hours services, hospitals that the spending was going to follow the allocation. vary quite markedly across the country, so there are I am sure we will come on to talk about deficits, but very specific health inequalities due to diVerences in one of the very striking features of the deficits is that access to healthcare facilities which are under the by and large the worst deficits are arising in the parts control of your department. What do you intend to of the country that are both healthier and wealthier do, for example, to improve access to primary care and, up until very recently within the NHSfinancial 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
Ev 36 Health Committee: Evidence
6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas system, deficits in one part of the country were Herceptin and discussed it very carefully with simply covered by surpluses elsewhere, and if you colleagues and with oYcials because we are in a look at the average figures—and these are only diYcult position. As you rightly say, it is not licensed averages, obviously there are exceptions—what was for early use treatment and, by definition therefore, happening was a redistribution from the North and has not been evaluated. It has always been the the Midlands, the areas generally with greater position as I understand it that clinicians can, if they poverty and worse health needs, to the South and the want to, prescribe an unlicensed drug, but the South East with better-oV populations and healthier particular position we had with Herceptin was that populations. That was allowed to happen, that was here was a drug, not yet licensed for early stage use the way the finances worked. What we have now which nonetheless, on the early reporting of the done—indeed we were discussing it at an earlier clinical trials, appeared to show results in terms of session at this Committee—is to say, no, if a trust or lives saved that were as good as the breast cancer a whole health community is getting into deficit, screening programme—as good clinically in terms of then they are responsible for that deficit and if they about 1,000 lives saved a year, as good in terms of want to borrow money from a diVerent part of the value for money. That is not my judgment— NHSto cover the deficit, then they will be charged obviously, it would be wholly inappropriate for me interest on it, and the part of the NHSthat is in to try and make that judgment —that is the judgment surplus and is lending the money will gain interest on not least of our national cancer director. In that it, so we have an incentive in the system, coupled of situation, it seemed to me right, following course with the rest of the reform programme, to discussions in particular with NICE, both to urge ensure that money is spent where it should be spent, the company to get their application in for licensing that there is a constant incentive in there to improve as quickly as possible—that application as far as I the services and improve value for money, and you know has not yet gone in—secondly, to speed up the do not have the perverse incentive to overspend, pile NICE evaluation process, not only for Herceptin up the deficits and rely on somebody else to bale but for other drugs as well because I think there was you out. a general feeling it was taking too long; thirdly, to put in place, as we did in September, the testing that Q270 Dr Stoate: Just a final and very brief question, was required so that every woman newly diagnosed in 2006/07 what will be the percentage increase in with breast cancer would also get a test for HER2 to allocation to the most below target PCT compared see whether or not at the end of her other treatment to the average allocation increase? she would be suitable for treatment potentially with Ms Hewitt: The average is going to be 9.2% next Herceptin and then, fourthly, to make it plain that year, 9.4% the following year. The primary care PCTs should not be refusing a request where the trusts which are furthest away from target will clinician believed that this was the right treatment receive an increase of over 30%; those who are most for an individual patient solely on grounds of above their target allocation obviously will not have funding. money taken away from them, the least they will get is 8%. Is that right, Richard? Q272 Charlotte Atkins: You say that PCTs should Mr Douglas: Yes, 8.1% is the lowest. not refuse solely on the ground of funding; certainly Ms Hewitt: There you are, 8.1% is the lowest so with the North Stoke PCT there was clearly a lot of everyone gets at least that, the average is 9.2%, rising pressure from yourself and the Department for the to 9.4% but much higher—that is 30% over two North Stoke PCT to fund the lady who needed years, forgive me—for the ones who are furthest Herceptin. This of course brings into very strong away. What that will mean is that by 2007–08, if you relief the position of PCTs, because you will be look at the 5% of PCTs in the most deprived areas aware that nearly all the North StaVordshire PCTs in health as well as economic terms, they will receive are in deficit and they are certainly not in the about £1,700 per person capitation, compared to wealthier and healthier parts of the country, as I am just under £1,200 per person in the 5% of PCTs that sure you would recognise, so on what grounds could are healthiest and wealthiest, so it is a significant a PCT refuse Herceptin for a particular patient if it redistribution. is not on cost? Dr Stoate: Thank you. Ms Hewitt: These judgments on these exceptional requests for particular therapies are made largely by Q271 Charlotte Atkins: Secretary of State, you have clinicians, and they would have to look at the case recently made a number of announcements about because, of course, what has to be balanced in the Herceptin and in doing so you appear to have short- case of Herceptin is on the one hand the apparent circuited the role of the drug regulation authorities very real benefits for a minority of women with simply because, obviously, Herceptin is not licensed breast cancer, but on the other hand some very real for the early onset of breast cancer and nor has it concerns about side eVects, particularly in relation been through NICE. Is it an appropriate role for a to heart disease, which were not really an issue for politician to be making these decisions on late stage breast cancer but of course become much Herceptin? more of an issue for early stage treatment. These are Ms Hewitt: It is a hugely important question; I very clinical judgments, they are certainly not for me to much hope I have not in any way undermined or make as the Health Secretary, but they are the kind sidestepped either the licensing or the evaluation of judgments that primary care trusts and their body. I have thought very, very carefully about clinicians are used to making. If we all reflect on the 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
Health Committee: Evidence Ev 37
6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas last 10 years or so, we are all aware of very diYcult spending around 10% of total national income on cases sometimes involving a child whom the clinician the health service, we will not have enough money to thought would benefit from a very particular, pay for the next generation of Herceptins and possibly untested and expensive therapy, and that beyond. We have to have that really rigorous focus would go before the primary care trust and the on value for money and organising services in the clinical committee would evaluate it and so on. So way that delivers the best possible health and best although Herceptin is unusual because of the nature possible healthcare along with the best possible of the clinical trials and the reports that have come value for money. The final point I wanted to make from those clinical trials, it is not a unique situation is that the Department also plays its part in this, not for primary care trusts to find themselves in. Of merely by giving PCTs more money than ever before course it is diYcult, not only in Stoke—but I am but, for instance, in a very tough and successful certainly aware of the financial diYculties there— negotiation on the PPRS, getting a 7% reduction in when a primary care trust is already under financial the price of medicines that we estimate will save the pressure, but that is one of the reasons why they NHSaround £2 billion over the next five years. That exist: to hold the NHSbudget, to get the best will help deal with some of the c ost pressures for the possible care and the best possible value for money new drugs. for their local population and to make decisions that Y will sometimes be di cult on priorities. Q274 Charlotte Atkins: Finally, who will take responsibility if the use of Herceptin for women Q273 Charlotte Atkins: What worries me in diagnosed with early onset cancer goes dreadfully particular is that Herceptin is not going to be the first wrong and we find a lot of these women dying from or the last drug of this nature that supposedly is a heart failure? wonder drug, even if it is based on clinical trials Ms Hewitt: That is a responsibility that the clinician sponsored by the manufacturer and clinical trials takes, but in full discussion with the woman and, in which in fact lasted no longer than 12 months, so for many cases, directly or indirectly with her family. I early onset it is obviously an issue. The other issue is have to say the women I have spoken to, and you that if a PCT has to pay £44,000 for two years have probably had the same experience, are saying treatment and, at the same time, you will be aware “I will sign any disclaimer, just let me have this that the North StaVordshire PCTs are having to ask chance”. the hospital to delay treatment on 500 patients, is this a fair position to put PCTs in, given that no Q275 Dr Taylor: Secretary of State, I have battles extra money is going to be made available from with my own PCT about getting them to fund government to pay for this exceptionally expensive licensed drugs that have got NICE guidelines—not drug? NICE appraisals, NICE guidelines—so it Ms Hewitt: I believe it is. Stoke, along with every completely puzzled me why you leapt on Herceptin. other primary care trust, is getting more funding It struck me really as a knee-jerk reaction to the than it has ever had before and although there are tremendous emotional pull for people with breast very real cost pressures in the system, of which cancer and the press campaign. I have a tremendous Herceptin is one, there are also savings in the system battle with ventricular pacemakers in my patch at and you refer quite rightly to the fact that Herceptin the moment, which are lifesaving for people in severe is not going to be the only expensive new drug heart failure, but every person with that in my area coming through, and we can see from the is having to go through a special, complicated case pharmaceutical companies and indeed the scientific panel. It was hard to know why you selected research that there are going to be more and more Herceptin to jump on like this. new drug treatments, new therapies, often very Ms Hewitt: It certainly was not a knee-jerk reaction expensive and often, I think we can anticipate, quite and it was based on a very careful consideration of remarkable in their eVects as we develop drugs based all the diVerent factors, not least the need to on the human genome project, for instance. Those reinforce the licensing and the evaluation process. cost pressures, which are faced by every health The licensing process obviously is there for health service across the world, underline the importance of and safety reasons and we must not in any way the reforms that we are making and the immediate undermine it, but we also need to recognise that it steps we are taking to ensure that trusts that have has always been possible for clinicians to prescribe deficits get back and get help to get back into unlicensed drugs when they think that is appropriate balance. Fundamentally we have got to make sure for the individual patient. In the case of NICE I that we get much better value for money, much thought the criticisms of the length of time that the greater productivity gains, we do far more evaluation took were justified; I discussed them with prevention, we do far more in the community than Mike Rawlings at NICE, my colleague Jane we are currently doing—compared with, for Kennedy worked on this over quite a long period— instance, the out-patient work that is done in acute we had been looking at it before Herceptin became hospitals—we do more day case surgery, we reduce a major media issue—and we were able to work with the length of stay, we spread best practice far faster NICE to come up with a much faster process; for across the NHSthan has traditionally been the case, instance, in a case like this starting the evaluation as because unless we do all those things, even at the end soon as the licensing application went in, rather than of 2008 when we will be around the European waiting until the licence had been granted and thus average for investment in health services, we will be having several months delay in the process. All of 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas that is important and welcome and it strengthens the Ms Hewitt: I certainly will. I will have a look at what evaluation process, but of course where NICE is you are saying on that because, of course, in a sense recommending the use of particular therapies for that reinforces the point that one wants the NICE particular clinical indications, then we have made it evaluation to follow as rapidly as possible after very clear to primary care trusts that within three licensing, because obviously if there is a long period months they should be implementing that. post-licensing and pre-evaluation then that is not very satisfactory. In some cases, though, it may take Q276 Dr Taylor: I absolutely welcome the fact that some time for side eVects to emerge and enough data NICE is now going to assess these crucial drugs to build up, so I am not sure that there is a perfect much more quickly, but I am still rather confused answer to this problem. between guidelines which are recommendations and technology appraisals which are must-dos. Last Q280 Dr Naysmith: Can I follow up on that, please, week I asked for further detail and clarification of Secretary of State; it is interesting that drug Table 3.5.2, and I think all we got is a change of the companies and NICE would like to get to the stage word at the bottom from “recommended” to where both evaluations take place together and “routine”. It still does not separate which are licensing and recommendations from NICE are technology appraisals and which are guidelines, and issued at the same time, everyone would like to work there is so much confusion about this that it would towards that. I am a great fan of NICE, I think it has be hugely welcome to have that absolutely clarified. done enormously good work for the National On this table there are now a number of things that Health Service and in other ways as well since it was are called routine; does that mean those are the introduced, and I am glad to hear you have been appraisals that have to be funded and, if so, would it discussing these things with NICE. Do you think it not be much easier to say that? The amount of extra has had any eVect on the morale of NICE that you money that you have to find has gone down between are now interfering at this level on things that should the two tables from £836 million to £758 million. be their province really? Ms Hewitt: Yes, someone has found a saving. Ms Hewitt: I do not believe I am interfering, I am certainly not aware of any impact on morale. As I Q277 Dr Taylor: But we do not know which of those say, I have made a point of discussing this with the appraisals are must-dos and which are guidelines chairman of NICE and making sure he was and which are just recommendations. comfortable with what I was doing on the Herceptin Ms Hewitt: You raise an enormously important issue because at every point, I think, in virtually point, Dr Taylor. I do not know the answer to it so every statement I made, I was trying to reinforce the why do I not take that one away, have a closer look importance, both of NICE and obviously of the at it myself and then perhaps I could write, licensing process. Like you, I am a huge fan of NICE Chairman, to you with a fuller response on that, and I am very struck by the way in which people all because it sounds like a very valid point to me. around the world are coming to Britain to look at Chairman: Thank you. how it is working and to see how they can copy it, and indeed what I would now like to do is invite Q278 Dr Taylor: Finally, you mentioned licensing. NICE to start looking at some very long-established On the pharmaceutical industry inquiry that we did treatments and therapies that may no longer— we were very worried that when a new drug is indeed they may never have been—thoroughly licensed there is an absolute explosion of justified. prescription of that drug. Obviously, the firms have to try and make their money; that will not apply quite the same to Herceptin because it is such a Q281 Dr Naysmith: At one of the previous Health closed market, but have you any comments on that Select Committee inquiries into NICE that was one as a general point, the explosion of prescriptions of the things that we recommended, that there were immediately after licensing? treatments being undertaken that could well be Ms Hewitt: I must admit it is a point I have not looked at again, but their argument is that they are looked at before so I have not seen the evidence for under constant pressure from drug firms and other it, but assuming there is that explosion of prescribing people and so on to put things that are newly I guess, particularly if clinicians have been waiting in discovered through the process. a sense for a better treatment for a particular Ms Hewitt: Of course they are under pressure and in condition, it is not surprising that at the point where a sense that pressure will go on building up as all the drug becomes available under licence and they these new drugs and therapies come through. We no longer have to make quite that same case by case will certainly be talking to them about trying to find judgment on their own responsibility, there might some space to review some of those very long- well be an incentive to prescribe it at that point. established treatments because I think the Health Select Committee was absolutely right to say in some cases it may well be that money is simply being Q279 Dr Taylor: The huge problem is that the claims wasted on treatments that really have very little that this or that drug are better are not fully value. substantiated by that time, and with the explosion one then gets into the horrific side eVects, but we will be bringing that up in the debate on Thursday and I Q282 Chairman: We are now going to move on to hope you will be able to answer. your favourite subject, deficits, Minister. Paul. 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Ms Hewitt: Thank you for that introduction, have set them, and living within their means. That is Chairman. what we expect everybody to be able to do. If I look at the position both last year and this year, the bulk Q283 Mr Burstow: We are, Chairman, but there was of the deficit is in a very, very small proportion of just one thing on NICE that I wanted to very quickly trusts—over half of the currently projected deficit is pick up on, which is this welcome process of in only 5% of the organisation—so we have got to reviewing NICE’s processes and shortening the focus on those organisations that have allowed the length of time there, but there is also the question of problems to build up, for a variety of reasons behind the topic selection issue within the Department. I them, and that is why last week I announced that we understand that currently topic selection takes, on were sending in turn-around teams to the average, nine to twelve months. That would suggest organisations which have got the worst problems so there is quite a variation and range within that in that they can get it under control now, get to where terms of how long certain drugs will take before they they need to be this year, and for the worst emerge from that process. Could you give us a bit organisations obviously they are unlikely to get to more information on what the breakdown might balance this year but we will want them to get to well be—and I do not necessarily mean today but balance next year. maybe in a note—of how long it does in fact take the Department to do its selections for the various Q285 Mr Burstow: One of my colleagues wants to procedures and drugs it has had to look at so far? explore a bit further the whole issue of recovery Ms Hewitt: We will happily send you a note on this. planning and some of the other statistical I have not got the details in front of me; my information that has not been supplied so far around recollection is, when Jane Kennedy looked at that, it financial support, but can I come back really to this was clearly taking too long and we seemed to have a point? You say the Department is not planning for rather cumbersome process for that kind of pre- failure; surely the problem with not planning for selection, and I am pretty sure we have shortened failure is that when failure then comes along the that. Nigel, do you want to add to that? problem is far greater. Therefore I assume the Sir Nigel Crisp: Can we come back to you with the Department actually has planed for failure and does details? have some contingencies in place for NHS organisations that do not, within the three or four Q284 Mr Burstow: That was a very quick question, year periods for recovery planning, pull it back and, so if I can go on to deficits now because, as you certainly in the timescales you have just described, anticipated, we want to ask about these. Can I start Secretary of State, do not pull it back to balance. with just a question about the deficits as you Just what is the contingency arrangement to deal reported them in the response to our questionnaire with those organisations that fail to deliver on your and the £30 million deficits: how are the trusts that requirements and bring the organisations back into are £30 million in deficit—and there are a number of balance? these—realistically going to recover their financial Ms Hewitt: We are not sitting here with a plan B that positions and what are you going to do with the might well send a message to the leadership of those trusts that fail to recover? organisations that they can carry on in deficit and Ms Hewitt: We are not planning for failure here. then something else will come along to sort it out. What we found of course, particularly with the When I say we are not planning for failure, the audited accounts for 2004–05, was that we had a approach we are taking on the deficits is exactly minority of trusts with deficits, some of them quite the approach that we have taken, for instance, significant levels of deficit. We have been putting in on the four hour A&E target. You will remember place a recovery programme for each of those either when we first set the four hour A&E target we had a individual organisations or broader health lot of people saying this was completely impossible; communities, and the strategic health authority in I have had so many A&E consultants say to me in each case has been agreeing a recovery path and a the last six months “I was one of the ones who said control total for the current year. We have been it was impossible; the truth is we have done it, that monitoring that month by month, since those target was a very good target, even though we did control totals were agreed, and of course last week— not say so at the time, because it has forced us to I think for the first time ever—we published the mid- rethink the way we deliver the services”. What we year forecasts for the end of year figures. What those did with the hospitals who were really struggling suggest is that exactly like last year a minority of with their A&E departments and were not getting organisations are predicting a quite unacceptably anywhere near their four hour target, we sent in our high level of end year deficit—the forecast deficit at excellent recovery support teams. What we are now the moment is around the same as it was at this time doing, alongside the recovery and support teams last year. We believe that by managing this very that focus on the services—the waiting lists, the four closely we will get the net overall deficit back to hour target and so on—we have now put in recovery around £250 million at the end of this year and we teams that focus on the finances. The reason why we will, at the very least, get back to balance by the end are managing this, if you like, as a single programme of next year. What I would want to stress here is that with a single team is we do not want trusts saying the majority of NHSorganisations are “We can hit the financial targets but then of course simultaneously improving services to patients and we will have to give up on the waiting time target”, meeting all the waiting time and other targets that we or vice versa. 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Q286 Mr Burstow: On that point, if I may, because Q287 Mr Burstow: So slowing down is something that is clearly one of the concerns that is emerging that would be an acceptable part of the way of and has emerged from some of the reporting of your managing the financial position. statement last week in terms of how NHS Ms Hewitt: In specific circumstances, as a short- organisations are in fact trying to balance the books, term way of managing the recovery, it would make achieve the financial objectives that are being set for sense to slow down, but recognising that that still them and at the same time manage the pressures means a maximum of six months wait for the in- around targets. We had the example of Harrow, for patient treatment, a maximum of three for the first instance, where they had issued some very blunt out-patient appointment, it does not mean going advice to frontline NHSorganisations to do the back to the nine, 12, 15, 18 months waits that used minimum necessary to achieve your targets. You to be commonplace. have also said that there is a new incentive system to be introduced that means that NHSorganisations in Q288 Mr Burstow: I understand that. Can I move on deficit will have to pay an interest charge to others slightly, if I may, to another issue about the use of to finance the funding that they will get to keep their the resources and the eVects that deficits have? You books in balance temporarily. Surely some of the will know that newly qualified physiotherapists, consequences of these changes will be direct impact junior doctors and graduate nurses have all been on frontline services; patients will in fact notice that reported at the moment as being unemployed in they are having to wait longer to get access to higher numbers than for a number of years, the treatment, or are the Harrow PCT and others who numbers of trainees not getting job oVers is quite are issuing similar advice completely missing the significant. Do you regard this potentially point that you are trying to get across, Secretary of permanent loss of resources to the NHSin terms of State? trainees, that the NHSorganisations themselves Ms Hewitt: I understand very well the real anxiety have actually paid for, really as being something that that patients are going to feel if they live in an area is a necessary sacrifice in terms of the quest that you where their hospital or primary care trust is in deficit set for zero tolerance of NHStrusts financial and where they may well have the media, in deficits? It does seem to us that we are training staV particular, telling them that their care is going to V and then there are no jobs for them to go to: 805 su er as a result. So the first point that I would want physiotherapists, for example, that do not have jobs to stress is that the great majority of NHS to go to this year. It seems a huge investment of organisations are doing both: they are improving public money in training people who then cannot go services, they are hitting the waiting times and and do the jobs that we would like to see them doing waiting list targets—in fact just last Friday we in the NHS. published the latest waiting list figures which showed Ms Hewitt: The first point that I want to make is just the waiting list at the lowest level since records to put this in context, which is nearly 10,000 more began, so we can see the improvements coming consultants than we had eight years ago, over 4,000 through, right across the country. The vast majority more GPs, over 1,000 more GP registrars, nearly of organisations who are delivering those 79,000 more nurses, nearly 14,000 more health improvements are also living within their means. In professionals. some parts of the country where deficits have arisen we have an almost paradoxical position where the hospital would be able to go even faster than we have Q289 Mr Burstow: The Committee understands asked them to do. We have said we do not want any that. It is useful to have it, but we could do with an patients waiting more than six months for their answer to that question. operation by the end of the year, and we will achieve Ms Hewitt: Absolutely, and I am coming to that that target. There are hospitals who could hit a much point. More professionals in every category are lower maximum than that, if the money was there to employed than ever before. What we are seeing is a finance them to do it, but in a deficit trust the money small number of physiotherapist graduates and a is not there and, of course, the truth is, if you look at small number of junior doctors and so on having where we are this year, getting down to a six month diYculties getting their first job. I have not got maximum wait and where we want to be at the end precise figures on the physiotherapists, though I of 2008, with the maximum of 18 weeks from GP certainly had not heard that figure before, and in referral to hospital treatment, we phased that so that terms of doctors I believe the BMA figures, which we build up the hospital capacity and we build up the were very widely reported, were a wild over-estimate funding over the next couple of years. Some of the true position, but there is now much greater hospitals, possibly because they have increased their competition for the vacancies precisely because we staV, increased the capacity or whatever, would have built the workforce up and we are seeing so dearly love to get rid of all those waiting times this many graduates coming through the training year or in the next six months or so, but the funding programme because we have funded so many more is not yet there to do it. That is why, in some people to do medical and clinical training. That is a situations—and I do not know Harrow in detail, I good thing, of course we would like every single one am not commenting specifically on that—it will of them to get a job and I am pretty confident that make sense for the primary care trust to say to the the vast majority will get a job, but they may not get hospital as well as the maximum which you their first job in exactly the place or the specialism absolutely have to hit, it makes sense in this very that they would like and, as we know, the popular short term to have a minimum as well. jobs are becoming increasingly hotly contested. 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Q290 Mr Burstow: Of course there is a whole new Mr Douglas: We did a preliminary costing as part of group of graduates coming through next year and the last spending review and we will continue to adding to that competition. refine that, but there is costing for delivering the 18 Ms Hewitt: Modernising medical careers, week target. particularly on the doctor’s front, will help enormously there because they will not have to go Q293 Mr Burstow: Can we have it in that case? through an annual round. Mr Douglas: I see no reason why not. Ms Hewitt: Chairman, just on this point, because I Q291 Mr Burstow: I am conscious that I need to think this issue of productivity and getting better move on to one final question if I may which is about care and better value for money simultaneously is the whole range of additional commitments that the absolutely central, I would like to give the NHSis dealing with, not least GPs’ contracts which Committee an example. I recently heard the chief we heard about last week in Agenda for Change, and executive of one of the London strategic health indeed the commitments around moving to an 18 authorities talk about the seven hospitals in his area, week target. We are coming to an end in 2007–08 of and he had been comparing length of stay for the current comprehensive spending review and, as diVerent procedures. He took the example of hip you yourself have intimated, we are likely to be in a fracture, very common. In two of his hospitals the period after it where the level of increased growth in length of stay was below the NHSaverage which is the NHSwill be lower. Are you confident at the 25 days, they were doing it in 20/22 days; the other moment that with all of the commitments that have five were above the NHSaverage and the worst one been entered into, many of which will run well had an average length of stay of 38 days, and the beyond the current round of comprehensive hospitals with the longest stay had the worst clinical spending review, all of these things can be aVorded outcomes. He estimated that if every one of the within the likely levels of resources that will be given hospitals managed to get the same length of stay as by government in 2008–09 and beyond? the top quarter of NHShospitals—which is not Ms Hewitt: I am confident that they can be aVorded, world class—they would find themselves in this one providing we make very significant eYciency and part of London with over 600 more acute beds than productivity gains right across the NHS. I am also they need. That is just one illustration for one SHA confident that the reforms we are putting in place— area of what I call the productivity pot of gold that a much stronger voice and more choice for patients, the NHSis sitting on. That is what we have to release more diverse providers with more freedom to to deal with all of these cost pressures in the system, innovate, connected by payment by results, money all of these rising expectations and improved following the patient and a better IT system—are the treatments that are coming through, and that is what right framework to get the continuing the reform programme will help us to deliver. improvements, both in the quality of the care and in the value for money that we need, but at the moment Q294 Mike Penning: I am very interested, Secretary and historically we have not had incentives within of State, that you are, quite rightly, cherry-picking the system to get the best value for money or to the good points, but very often you are not talking adopt best practice everywhere. Indeed, in many about the real problems that are occurring. You cases we have had perverse incentives. If I can give have referred to a trust there in London, and you are you one very small example of that, under the star probably aware that Beds and Herts Strategic rating system for trusts you were allowed to get a Health Authority have closed beds and they are two-star rating, even with the deficit up to a cutting in one hospital trust over £10 million out of million—with 600 organisations that could frontline services. That is what is making people represent a hell of a lot of deficit—and you could get frightened, it is not the figures that you are jumping a one-star rating with a deficit with no ceiling. around with now. What you have done to help that Clearly, that is not acceptable and I am very pleased situation is send in your hit squads. You announced that the Healthcare Commission is in future going to last week that hit squads will be sent into hospitals take an even tougher approach on financial with the worst deficits to help with their financial management so that that is taken fully into account situation; so it is about finances and not that clinical in assessing the performance of the hospital as a need then. whole. That is just one example, we were talking Ms Hewitt: They go together, and the point I have earlier about the problem of better-oV areas shifting been making all the way through to the Committee their overspending into worse-oV areas, that is and I will continue to make, and so will my another example of having the wrong incentives in colleagues to the service, is that these things go the system. together. If you are not managing your finances wisely, the chances are that you are not delivering the best service. Q292 Mr Burstow: You say you are confident, does that mean you have a costing for the 18 week target already, that that has been costed and you know Q295 Mike Penning: Can you tell me what clinical how much it will cost you? qualifications a large group of accountants have got Ms Hewitt: Richard, do you want to just elaborate when they go into a hospital and tell staV this is the on that? way you are going to run your hospital? 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Ms Hewitt: That is not how the turn-around judgment, is the best way of ensuring that they get teams—which is what they are, not hit squads—are themselves back under financial control without going to work. I was saying earlier, and it is an compromising patient care. I think it would be important point, the turn-around teams, the helpful if Nigel elaborated on this point. financial experts, are going to be working alongside and with the clinical recovery and support teams, Q300 Mike Penning: I want to take you up on that who are experienced NHSmanagers, and what they point, Secretary of State, because that particular will do is deal with the fact that, unfortunately, some point you are making is fundamentally wrong in the NHSorganisations have not got their financial constituencies you and I represent, not the oYcials, management under control. You and I obviously you and I as elected people. You cannot say that you have a close interest in Bedfordshire and are getting a better outcome in a hospital if you are Hertfordshire— closing wards and cutting £10 million from front line services. I am sorry, that just does not add up. At the Q296 Mike Penning: Not as close as I would like. end of the day, you are either in charge of this Ms Hewitt: I have been looking at the most recent department or not; it is either their fault or your board papers and at the beginning of the financial fault. Is it your fault that they cannot manage year the strategic health authority agreed, as part of themselves so we can treat our patients and our the recovery plan to get the deficit under control, a constituents today with the treatment they need or set of measures to ensure that the staV numbers were not? You cannot pass the buck around the Civil brought into line with what the organisations in that Service. Is it your responsibility or not? area could aVord. They set a path, if you like, to Ms Hewitt: There is a responsibility upon all of us to reduce the staV numbers by a modest amount—they ensure not only that we give the NHSadequate would still have significantly more staV than were in funding, and I would say we are more than post a couple of years ago—but instead of that discharging that responsibility, but also upon each happening over the last six months the staV numbers part of the service to use that money as eYciently across Bedfordshire and Hertfordshire have gone up and eVectively as possible. What I would say to and up and up. I would hope that you and everyone you— else on the Committee would agree that if a trust or if a whole health community has got a financial problem—and the deficits are quite severe in some of Q301 Mike Penning: The Committee if you do not the Bedfordshire and Hertfordshire hospitals—then mind. continuing to add staV numbers when you cannot Ms Hewitt: Absolutely. What I would say to you, aVord those staV, is grossly unfair to the staV you are collectively, is that any trust and any health taking on, and to everybody else. community that is over spending, even on the enormously increased allocations we are giving them, is relying on another part of the country, quite Q297 Mike Penning: The accountants that your possibly with greater health needs, to bail them out. department has put in—because you are in charge of I do not regard that as either fair or acceptable, the health service in this country—have your because my responsibility is for patients in every part authority to make staV redundant and close wards? of England, including but not confined to those in Ms Hewitt: No. Bedfordshire and Hertfordshire. There are fundamental problems, which you and I have Q298 Mike Penning: It is a simple question. Yes or discussed on an earlier occasion, within no? Bedfordshire and Hertfordshire which have to do Ms Hewitt: No. with the configuration of services across multiple hospital sites. There is an agreed way forward on Q299 Mike Penning: That is what they have done, that which will include a very large PFI rebuilding because in West Herts Hospital Trust your hit programme long-term, or medium to long-term squads went in there months ago. You announced it because obviously it involves a reorganisation of the last week. They have been in there since before, I services in the mean time. That is a very important think, you came into post. So they are there closing part of the answer, but that is not an excuse. wards. Your authority has been put in there to designate what they do. On the basis of financial Q302Mike Penning: Can I bring you back to the outcomes you are closing wards, and the chief question, because you are not answering the executive said to me, “I will not be able to pay my question. staV in the fourth quarter unless I close these units Ms Hewitt: That is not an excuse for employing and cut back”. That is on your authority, is it, more staV than the service in Bedfordshire and Secretary of State? Hertfordshire can aVord. Ms Hewitt: I am afraid that the trusts in Bedfordshire and Hertfordshire, like the trusts everywhere else, have to live within their means, and Q303 Mike Penning: That is right; it is an excuse not their means are significantly bigger than they were to treat patients. That is what you are saying. One last year and massively bigger than they were eight last question. The cost of these accountants, is that years ago. The clinicians, the clinical directors, the going to be borne by the trust or your department? finance directors, the managers and the recovery Mr Douglas: The central recovery team costs will be teams work together to decide what, in their borne by the Department. 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Q304 Mike Penning: The Department itself? and we would like to remove that, but we need to get Mr Douglas: The recovery teams that went out organisation back into recurrent balance first before setting up, they will be borne by the Department. we can do it.
Q305 Mike Penning: The ones that are already in Q311 Dr Taylor: Secretary of State, we welcome the place? statement, we do not welcome it but we welcome the Mr Douglas: The teams that are already in place that openness, that £620 million is the forecast deficit for have been employed by the trusts are paid for by the end of this year. I am slightly worried that this the trusts. may underestimate what is going on, because if you look through the list of the deficits admitted to for Q306 Mike Penning: So that is yet more money that this year, if I just pick up a couple that I know about, is coming out of the front line to meet your targets? in Worcestershire the deficit is forecast to be £3.8 Ms Hewitt: I think it comes back to a judgment, and million, and yet the plan for the year after that is the you and I may disagree on this, about whether good necessity for a £20 million saving, in Shropshire £10 financial discipline and management is an important million is admitted to and the plan for the year after part of a good health service. I think it is. You may that is a saving of, I think, more than £30 million. disagree, obviously, but I think it is and therefore I Somehow that £620 million is not nearly the size of think, if you have a trust with weak financial— the saving that has got to be made the next year, because it is not taking into account brokerage and shifts, as you have said. Is there any way that we Q307 Mike Penning: I do, but what I think, could get a grip on the total feared deficit in 2006–07 Secretary of State, does not matter. It is what the which these people are working so hard to save, Committee decides, and, at the end of the day, it is amounts of £20, 30 million? about treating patients. That is what the NHSis Ms Hewitt: I suspect, I hope, the answer is, “Yes.” there for. I will hand back to the Chairman. Richard, elaborate, if you would. Ms Hewitt: That is why I am proud of the fact that Mr Douglas: I think I did promise the Committee at we are putting more money in than before, but I am last weeks meeting to give you a summary of what is absolutely determined that we get value for money. called the “planned support” in the system. The only thing I would say about the numbers, and I do not Q308 Chairman: Sir Nigel, did you want to add know the numbers you particularly refer to for next anything to that? year, but when people talk about a savings Sir Nigel Crisp: I think it has probably been covered. programme for next year that may well include— I could say more about performance management, and I do not know without those figures—their but I do not think so. assumptions about what eYciency targets they will have to meet. Every organisation will have an Q309 Jim Dowd: Briefly on defences, do you think eYciency target to meet each year, so to present a that the resources, accounting and budgeting savings figure as equivalent to a likely deficit, they regime, otherwise known as RAB, I believe, assists are diVerent things. I think we can disentangle or obstructs trusts in deficit from achieving balance? those two. Ms Hewitt: It is many years since I was a treasury minister and had the pleasure of a training session on Q312Dr Taylor: If you are an accountant, yes! Have RAB. I am not sure. I am going to turn to Richard you, Secretary of State, made any analysis of the on this, because I think we are getting into technical major trusts and PCTs with the really big deficits? areas which I do not really feel qualified to judge. I You have mentioned that they are worst in healthier think the issue you are referring to is that eVectively and wealthier regions. If you look at the 12 worst if someone overspends in one year we take that PCTs and the 10 worst acute trusts, certainly the money oV the allocation the following year. PCTs do appear to be in wealthy areas, but some of the acute trusts are not; and one of our advisors has Q310 Jim Dowd: And they still have to recover the analysed them by SHAs and County Durham and deficit. Tees Valley come very high in the area, north-west Ms Hewitt: They will still have to recover the deficit London comes high, so it is not as simple as that? over the five-year period, but once someone gets to Ms Hewitt: No. the point of recovering the deficit we could look at making some changes around the RAB adjustment. Q313 Dr Taylor: It would be worth analysis. Is it The diYcult thing is we introduced the RAB because of under funding or bad management or adjustment, what people call the RAB problem, what? because every time someone overspends it takes Ms Hewitt: This is a very important point. I stressed money out from somewhere else in the system and earlier that I was giving you an average picture, and we have to pay that money back, not in five years obviously there were exceptions to it. If I look at the time but the following year, and that is what we did. largest forecast deficits from the trusts—you are I think the issue about recovery over the five year looking at Surrey and Sussex, St George’s, period is an important one. One of the things we are Hammersmith Hospital, Hillingdon, West looking at in the new financial regime and that we Hertfordshire, North West London, Kensington are trying to develop is not having that thing that the and Chelsea, Bedfordshire Heartlands, NHSe Vectively call a “double whammy” on this, Southampton—South Tees Hospital stands out 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas geographically in that list. If I look, as I did some this year when, in fact, the Department of Health months ago, at the overall position for net surpluses press release on 1 December says £200 million. I and deficits and how they have been moved around wanted to clarify which one it was. the system in previous years, it is very noticeable. Mr Douglas: Our control totals we have agreed You see a shift, if you like, between north-east would take us to 200. London, which is poorer, to north-west London, which is wealthier, from London and the South East, Q318 Anne Milton: Sorry? or, rather, from the North and the Midlands down Mr Douglas: The number that we have fixed on that to London and the South East, but the overall we will aim towards this year is £200 million. figures conceal, obviously, the particular problems. Ms Hewitt: I am sorry, I was wrong then with 250. The particular problems are themselves caused by a number of diVerent factors. You may have in some Q319 Anne Milton: Picking up on some points that cases hospitals with very high costs; in other cases, you made earlier, you said that you did not feel that sometimes associated with excessive length of stay, PCTs should deny treatment on the grounds of you may have low levels of day surgery, excessive costs. Do you mean any treatment? referrals into the acute sector, not enough done in Ms Hewitt: No, and indeed this is the point of NICE, the primary sector, you may just have poor because you have to make an assessment of both management. clinical eVectiveness and cost eVectiveness.
Q314 Dr Taylor: So your hit squads will pick up Q320 Anne Milton: Could we have yes or no these things? answers? Ms Hewitt: Our recovery and turn-around teams Ms Hewitt: No, I cannot give you a yes or no answer will undoubtedly pick up these problems, and Surrey because what I said about denying treatment on and Sussex—I mean not simply the hospital but grounds of cost related specifically to Herceptin Surrey and Sussex SHA—which is one of our very where the initial estimate, based on the clinical trials problematical health communities, we have just put so far, is around a thousand lives saved a year. That in an interim chief executive, in fact both to Surrey is the same number of lives at round the same cost and Sussex hospital and to Surrey and Sussex SHA. as the breast-cancer screening programme, which, of They have both got new chief executives in there to course, is generally regarded as a rather successful help sort things out. and in a sense low-cost programme. That is the balance, if you like, that I was drawing the PCT’s Q315 Dr Taylor: Our advisers have given us a very attention to, but I certainly would not make that as useful table comparing the increase in revenue a blanket statement in relation to all or any therapies spending of £6.6 billion, and, taking oV the impact that people might come along with. of cost increases, it leaves £3.73 billion available for new programmes, and they have balanced that with Q321 Anne Milton: So you do not think that PCTs commitments that add up to £3.6 million. If we sent should deny treatment on the grounds of cost in the you a copy of this table would you be able to analyse case of Herceptin? it and see if you agree with it: because if it is right it Ms Hewitt: That is right. means that there is only £100 million left over, apart from eYciency savings which you are banking on for Q322 Anne Milton: But you would not take it any doing everything else the NHShas got to do? further than that? Ms Hewitt: I would certainly like to have a look at Ms Hewitt: Where there has been a NICE evaluation the table, so I would welcome the chance to have our and NICE say that for these clinical indications this people analyse it, and my first question would be treatment should be given, the PCT should be whether they have taken account of the savings that organised to make that available within three are also in the system as well as the cost pressures; months of the NICE recommendation. I am afraid it and I do not simply mean the eYciency savings, is horses for courses here. although, while I am on the point about eYciency savings, perhaps I could say we are ahead of where Q323 Anne Milton: What about delaying treatment? we committed to be in terms of our Gershon savings There are stories about some operations being and we have achieved savings of £1.7 billion since delayed until the next financial year. What do you March 2004, which puts us £200 million ahead of feel about delay of treatment due to cost? our target. The overall target, of course, is £6.5 Ms Hewitt: What I said earlier was by the end of the billion by March 2008, but we are achieving those year we expect a maximum wait of six months for an savings and that is more money available for front in-patient treatment and we are certainly not line services. prepared to see trusts go beyond that even if they have financial problems, but if their hospital is Q316 Dr Taylor: Thank you. It would be most saying, “We would really like to get rid of all these helpful if we could send them? waiting lists and we can do it all in the next six Ms Hewitt: We will do that months. We want to spend all the money that is going to be in the system next year and the year after, Q317 Anne Milton: Secretary of State, I wonder if I we would like to spend it right now and get to a zero could clarify a few points. You said that you were waiting time now”, then it is perfectly reasonable for planning for a deficit of £250 million at the end of the PCT to say, “Not quite so fast”. Six months now, 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas and then you start moving that down to 21 weeks, 18 of primary care procedures that used to be done in weeks, and so on, and we have set out the phasing hospitals and the increase in the number of that will happen for that final part of the system as procedures that are done in out-patients. I have got you wait for the operation as we move towards the all the rest of the information. I have not got an goal of 18 weeks from GP referral to operation, and adequate fix on that piece of information, which is we will get there by the end of 2008, not the end of why I have not given it to you, because I would 2005/6. rather give you accurate information. I do apologise for the fact that you do not have a note to the eVect Q324 Anne Milton: It is the fact that operations are of what I have just said. being delayed to save money, but we hear talk in the broad papers about over-performance, which I Q326 Mr Amess: Sir Nigel, you earn your money, think is a rather sweet term, is it not? you have been positively charming. The Chairman Ms Hewitt: I understand the frustration. Clearly, if would not want me to delay proceedings by going on you have got a hospital that believes it has enough about that issue. I am sure it is perfectly acceptable spare capacity to do operations even faster and they if, when you do have the final piece of the jigsaw, you would like to do that, if the primary care trust can would kindly send it to us. Secretary of State, your aVord that and wants that to happen when it looks predecessor, John Reid, said that earnest statistics at all its other priorities, that is fine, that is a on productivity being 4 to 5% lower in 1997 judgment for the primary care trust, but if the compared to 2003 were absurd. Do you agree with primary care trust cannot aVord to get, not to six that statement made by your predecessor? months (everyone has to do six months) but cannot Ms Hewitt: Of course. I always agree with my aVord this year to get to five months or four months, predecessor, almost. “Almost”, I did say at the end that is okay, because next year and the year after of that sentence. However, on this particular issue, they will get, by the end of 2008, down to 18 weeks. yes, I do agree. This issue of productivity in Of course it is frustrating for people who are being healthcare has been argued over by statisticians for told, “You are going to have to wait six months”, many, many years and not only in our country. We when maybe the hospital is saying they could do it in have been looking at it and working on it, our own four months, but, compared with where we were not staV, some academics and ONSitself, because I so many years ago, it is still an enormous thought John Reid made a very pertinent criticism improvement and it will not breach the six month that the productivity figures did not take account of maximum. the improvements in the quality of care and patient experience (the point that we were referring to right at the beginning), and we will be publishing, as I Q325 Mr Amess: Chairman, I cannot help thinking think I said, more detail on this tomorrow, but I that our proceedings this afternoon are somewhat think it is absolutely essential to take a proper overshadowed by the election of the new Pope, or, account of the real changes in activity and outcomes should I say, new leader of the Conservative Party, that are taking place in the NHS. but we will just have to cope with the event! Sir Nigel, you and I had a robust exchange last week and, unlike the chief medical oYcer, you were Q327 Mr Amess: So that the Committee gets it clear, absolutely not for resigning, indeed it had never what are the figures to which you wish the crossed your mind. You will recall how upset the Committee to refer to prove that overall National Committee were that, for whatever reason, a Health Service productivity activity is increasing? number of our questions were not answered in full, Ms Hewitt: What I would like to do, if I may, and I shared with you that question 3811, where we Chairman, is send the Committee tomorrow the asked for a set of figures on patient admissions rather lengthy report, in fact two, I think, lengthy broken down by in-patient and day care plus a reports and articles that we are publishing as a sort commentary, was not done. You did not provide a of accompaniment to the chief executive’s report, table of figures and the commentary amounts to one and then we would be very happy, and it might make very short paragraph and does not refer to the data more sense for our statisticians to come along, but I at all and a second paragraph refers briefly to one would be very happy to come back with them and go series only. You, Sir Nigel, told the Committee that through that in much more detail, because you accepted fully our disappointment and that you essentially what we are looking at is a whole series of would provide us with that information this week. I adjustments to productivity figures. I gave the am advised by our clerks that, in spite of chasing up examples of statins taking account of the lives saved this information, we still have not got it? rather than the cost of the treatment. There is a Sir Nigel Crisp: Mr Amess, I did on Thursday say whole series of adjustments like that. that I intended to get you the information. I can take you through it verbally if you wanted me to, but the Q328 Mr Amess: If you could send us that reason that I have not got it for you in detail is there information it would be very useful. Could I is one figure which may— May I just remind you, recommend some bedtime reading called Heathcare there was a particular point here, I think. You were UK 1991 and a splendid article written by the saying that the number of decisions to admit seemed notable academic Sea´n Boyle called, Minor surgery to be going down, so what was happening? That was in general practice: The eVect of the 1990 General one of the questions you wanted to know. I said that Practitioner Contract. I think, Sir Nigel, this goes I thought it was to do with the increase in the number back to our exchange last week: because we have in 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas the course of the week had an opportunity to reflect and the waiting times. They and we believed it was on this matter and I think I did describe this whole simply unacceptable to have, for instance, an elderly presentation as a fiddle. Relying on this data, the person waiting in agony for a hip replacement for Committee is a little bit confused about your relying months and months on end, those months often on the increased activity of general practitioners stretching out beyond a year, sometimes close to two because it seems in 1991 there were about a million years or even worse. We did not think that was of these procedures that general practitioners were acceptable, and we therefore made the promise that doing in any case. Again, I think the Committee we would get the waiting lists and the waiting times comes back to the original point: why are the waiting down. I think clearly there is a disagreement between lists falling? We really do feel very, very strongly that us about the figures. We believe, not just on the basis the waiting lists are falling because in a very real of the statistics, though we think those are robust, sense there are less and less people put on these but also on the basis of what our own constituents waiting lists, and I think the Committee feels it is tell us, that the waiting times have come down very unfair that you are relying on the increased activity sharply indeed. The recovery and support team of general practitioners? within the department who go round supporting Sir Nigel Crisp: Not just that. The other very big hospitals that are struggling are very, very clear, thing that is happening in hospitals is that there are because they can practically tell you the names and many more procedures being done in out-patients addresses of people who, for instance, at the time rather than in-patients. So people will bring people when we were trying to get the maximum wait down back to have some minor surgery or, indeed, in some to nine months, were in danger of breaching that cases, some quite significant surgery, coming back as point. They went through every one of those patients out-patients, and so they are part of a diVerent with the hospitals concerned to make sure those system. They are not admitted to the hospital, they patients got their treatment. If the patient no longer come in for the day and they have the procedure. In needed the treatment, obviously that was a diVerent addition to that, there are a significant number of situation, but the patient who needed the treatment increases in primary care. We started to try and got the treatment. That is what is now happening on collect these systematically. I do not know that the six-month wait, it is what is happening on the particular study. There are lots of studies, as you are much more complex challenge we have set ourselves probably aware. We began to attempt to collect this of the 32–61 day target, which is an end to end target, information systematically three years ago when we for cancer patients which we have set as the target systematically went round the country and asked for the end of this year and which will give us very people to identify the specific changes that were good experience to bring to bear on the general 18- planned changes: for example, people taking week target before the end of 2008. We believe it was vasectomies out of their hospital service and putting the right thing to prioritise, because it is what the them in primary care and so on. We have now got a public wanted, we believe we are making enormous better set of figures which are measuring the improvements and will continue to make the changes. There is a base-line level of activity, but improvements that are still needed, because specifically aimed at identifying measuring the although six months is a lot better than it used to be, changes not what the overall activity is. That is why it is still not good enough. So a lot done, a lot still to this is both anecdotally and evidentially happening. do on this; and, of course, in order to achieve the 18 Our figures are not yet as good as they might be, weeks we have got to get into that black box of the which is why I have not been able to give you the diagnostics and the additional out-patient figure earlier. appointments beyond the first out-patient appointment where we know people have long waits Q329 Mr Amess: I shall not labour the point, and, at the moment and those waits, of course, have not without wishing to be seasonal, I think the even been countered. That is what we are now Committee still feels that you are skating a little bit tackling in relation to cancer and we will tackle on thin ice with these figures? everything as we move towards the 18-week target. Sir Nigel Crisp: May I bring back examples, if you Mr Amess: I understand everything you say about would wish? the pressures from the general public, and I will finish my questioning there, Chairman, but I would simply say that, while I understand about the Q330 Mr Amess: We are finishing at five o’clock, and pressures from the general public, the Committee I do not think we are quite halfway through yet. My does increasingly hear from clinicians that they feel final point, Secretary of State, and this again has there is a distortion in priorities because of the been a divide between the Government and the pressures on the managers, but in the interests of opposition about waiting lists, the argument is that time, Chairman, I leave the questioning there. we feel very strongly that the waiting lists and the Government’s reliance on the figures tends to distort clinical priorities. Why do you feel so strongly, Q331 Dr Stoate: You talked a lot this afternoon Secretary of State, that these waiting lists should be about targets, and certainly targets can concentrate a priority for National Health Service managers? the mind wonderfully when it comes to assessing Ms Hewitt: Because they were the top priority for performance, but, equally, targets can at times have the public, and the public made it very, very plain to adverse and perverse eVects. For example, the 48- us before 1997 that the thing they were most hour target for GP appointments has led many distressed about was the length of the waiting lists practices to prevent patients booking routine 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas appointments in advance and, in fact, have forced priorities. What do you do to avoid this culture some people to have to phone on the day through where targets drive you in one direction to the busy phone lines simply to get an appointment at all exclusion of others? and hide behind the Government’s policy by telling Ms Hewitt: There are a couple of things you can do. patients, “Oh, no, the Government insists we do As you say, a target is not a target if everything has this”, and we all know of an example where this has a target, and so you do have the problem that people happened. What can you do to avoid these perverse will focus on the identified priorities, possibly at the eVects happening to distort the way targets are being expense of other things that are very important. We interpreted? can obviously make adjustments to the quality and Ms Hewitt: The first point I would make is that I outcomes framework each year so we embed best think you and I would agree that targets are very practice and then move on to the next priority, and useful, although they can also have some that will help in some situations, but I think practice- unfortunate perverse eVects, and I want to stress the based commissioning and an indicative budget for very useful point, having been a critic of the every primary care practice showing them what they Government for having had too many targets in the are currently spending in the acute sector is going to past, and I think we have largely dealt with that, but concentrate attention on all those long-term I have been genuinely surprised by the number of conditions, obesity being one, alcoholism, alcohol clinicians who have said to me in the last six months, abuse being another, that have appalling eVects on “Such and such a target was really brilliant because people’s lives and appalling results in terms of it forced us to redesign and rethink the way we did emergency admissions to hospitals, and so it comes things”, and so I think that important. The 48/24 back to embedding the incentives in the system. hour example you give is a very good one, a very There will be an incentive in there for the GPs, nurse good one on perverse results, because we do now practitioners and others working with the primary have a very significant number of patients who are care trust to say, “Hang on, what is driving our acute very unhappy about the way their GP’s appointment bed occupancy?” We have got a real problem of system is working. Again, I would observe, the obesity, alcohol abuse, diabetes, a whole series of majority of GP practices meet their 48/24 hour target other things, so let us focus on those, look at what and they do it with a perfectly sensible appointment we need to do in terms of prevention and public system: people can get through on the phone and if health, but also look at what we need to do to enable they want to book an appointment in advance they people to manage their condition better—diet, can do so because that was never ruled out, certainly exercise, and so on—where we know that something never intended to be ruled out by our 24/48 hour like half of people with long-term conditions do not target. But I think there is a bigger point here. We have a proper care management plan agreed with can always try and design targets to be smarter and their primary care practice. avoid these odd eVects, if you like, that some of them have had. I think the much bigger gain to be made is by moving towards this thing we call a patient-led Q333 Dr Stoate: The logical conclusion of what you NHS: because if the patient and the user of the are saying then is simply to have even more targets service has got more choice and a greater say in how and let best practice drive clinical practice? that service is designed, then you will not need to rely Ms Hewitt: Best practice by itself does not do it. on top-down targets nearly so much, and that is the Almost anywhere you go in the NHSyou will find fundamental point of the reform programme, that one or two examples of best practice, and for we put in place a whole set of incentives that will anything you care to name you will find best practice enable the NHSto become genuinely self- somewhere in the NHS, but you very rarely find an improving, because there will be this constant organisation that is systematically applying best motivation of incentive to respond to what patients practice across everything and across the entire want, to improve the quality of care and the quality health community. That is where we need the system of the patients’ experience and to keep getting better reforms, Payment by Results to make the costs value for money, because without that you cannot transparent, practice-based commissioning to give do all the other things as well. GPs a real incentive to pull care out of the acute sector and focus on prevention and better management of long-term conditions. You can do Q332Dr Stoate: I accept all that, but there is still that, and that will give you the results that you and going to be a problem with the target culture, and I both want—it will not be no reliance—but with less that is that some areas of NHSactivity will reliance on targets because you will not have to inevitably be target driven. Will that not mean there single out obesity, or diabetes, or alcoholism because will be clinical distortions, because areas that are not they will be so visible as you look at the patterns of target driven could easily find themselves missing care and expenditure across the entire practice. out? I will give you one example, I passionately believe that GPs should take much more care of obesity. I would like to see much more notice taken Q334 Dr Stoate: If that still remains, if you are going of patient size and appropriate advice being given. to have diabetes rolled up with heart disease and That is not part of the quality and outcome everything else, you do not need targets for it framework and therefore there is no incentive for because you are simply going to have the best local GPs to concentrate on that because they have other outcomes driving activity, and it is illogical, 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas therefore, to have a diabetes target but not to have Ms Hewitt: I am surprised by that figure actually. I an obesity target because one will inevitably was just asking Richard to check it for me. There is a undermine work in the other. significant diVerence in the foundation trust regime, Ms Hewitt: But it might make more sense for the which is that obviously Monitor checks very primary care practices and the primary care trusts to thoroughly the financial health of the organisation identify one of the biggest problems of long-term before clearing it for foundation trust status, but it conditions in their area, which may well be obesity then, going forward, allows the foundation trust to and diabetes, to look at the patients who are, if you balance its books over three years, so you could well like, at the top of the pyramid, who have the worst have a situation where a foundation trust is quite conditions and are probably being admitted, deliberately, if you like, building up a deficit in the possibly more than once a year, to emergency care. first year while it invests in new services and What do we do better to manage those people and reorganises itself, and Monitor would be concerned keep them out of an acute admission at all, and then, about that if they did not think they were going to in the middle of the pyramid, what do we do for get back into balance over the three year period. people in the danger zone who need real help in Mr Douglas: I am sorry, I have not got the number managing that condition better? You do not of trusts to check, we only have the value of the necessarily have to have a target for this, that and the deficits there. other. What you can do is put the incentive in the system, make the best practice information Q337 Anne Milton: available, encourage people and in some cases The figure I have is 50%, whereas possibly require people to benchmark themselves, the deficit overall is 28%. In terms of deficit, they are and then make sure they are driving the doing far worse than the normal NHStrusts? improvements. Ms Hewitt: First of all, I think there is an issue about the size of those deficits and, secondly, it is a diVerent performance management regime, and perhaps we Q335 Jim Dowd: Can I look at another target before could get a note from Monitor for you on that. our way to A&E. Imagine, if you will, one of the busiest A&E units in London which is currently regularly hitting 98%, 95% occasionally 96%, but the Q338 Anne Milton: You have got something about investment required to hit 98% is completely the size? disproportionate to the eVect it will have on other Mr Douglas: The value of the deficits is roughly hospital services, requiring something between 8 and similar to the proportion for NHSorganisations. It 10% additional expenditure on the current A&E was around £34 million last year. My understanding budget. Is that 2, 2°% improvement worth that eVort is that the foundation trust system as a whole is and that expenditure? planning for a break-even position for this year. Ms Hewitt: I obviously do not know the details of the particular example you are giving, and I would Q339 Anne Milton: So the interim figures suggest really want to talk to our recovery and support that, do they? people about what is going on in that individual Mr Douglas: I have not got the interim figures for hospital because I have heard that general point foundation trusts because they are monitored and made before. When I have gone back and checked regulated by our foundation trust regulator. with our delivery people, who are superb, fundamentally what they say is if you redesign the service in the right way, you can achieve the 98% Q340 Anne Milton: Maybe you could let us have target even in a really busy, stretched inner city some information. hospital, which I guess is the kind of hospital you are Ms Hewitt: It is a matter for Monitor. I am not sure talking about, but if you are just box-ticking or what they collect, but we will ask them and come drawing lines on the floor and calling one side A&E back to you on that point. and the other side a medical admission unit, you probably will not hit the targets or, if you do, you Q341 Chairman: Can we move on to the issue of will not hit them through a real improvement in the private sector involvement in the National Health experience and the care of the patients going in. I am Service. Evidence to date suggests that the perfectly happy to look at the detailed example if contribution of ISTCs to NHS output is marginal. Is you want me to, but that is the general view of our the idea behind ISTCs to either increase choice, recovery and delivery support people. It may be you capacity or innovation, or all three? are referring to one of the small number of hospitals Ms Hewitt: All three, and I would not dismiss that is continuing to struggle with the A&E target, changes at the margin. I think when you are dealing but we would need to look at it in detail to be sure with waiting lists or trying to change the of that. performance of organisations, changes at the Chairman: One question on NHSreorganisation. margins can be hugely important. The cataract example, which I have used often and sometimes Q336 Anne Milton: Foundation trusts. 50% are in been challenged on, suggests that although the deficit, which I think is a surprise to many of us, and private and not for profit sector is, as you would it is the case that the foundation trusts are more expect, doing only (and I have not got the exact likely to be in deficit than normal NHStrusts. I figures) a relatively small p roportion of the total would like your comments on that? number of cataract operations, it was responsible for 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas between a third and a half of the reduction in the independent sector in that we saw the really big falls waiting list; so a relatively small input can have quite in waiting times and the very significant changes on a significant eVect. the part of some consultants for whom, of course, long waiting lists had often been a source lucre in the Q342Chairman: I think we accept that. About 4% of private sector. overall cataract operations are being done in that way, and presumably geographical targeting has Q344 Dr Naysmith: I do not disagree with that, meant it has been a success in those areas, but that is because it is true in many cases, but I am talking not necessarily improving the innovation of the really about the North Bristol Trust situation where National Health Service cataract overall. Could you we are reducing capacity slightly in the acute sector tell us precisely what is the reason for the second and moving a lot of activity to primary care centres wave? Is there any evidence base from need, as it and other really top quality stuV. Can you were, in terms of waiting lists, or is it more to do with understand why it seems just a trifle perverse to some setting up choice? of the clinicians and to some of the people who live Ms Hewitt: As we have said, Chairman, for several in the area that we are promoting an ISTC? years now, we believe the private and not for profit Ms Hewitt: Yes, I understand the point that people sector can help us by increasing capacity, thus in the existing the hospitals are making, but I think getting the waiting lists and times down, by the important thing here is always to look at it from supporting patient choice, which in turn helps to the point of view of the patients and making sure drive further quality improvements in the service, that we get what we are really driving towards, and by bringing more innovation and more which is a system that has got enough diversity and challenge to the NHSitself. Again, cataracts are challenge on the provider side and enough choice— quite an interesting example because, of course, it was the independent sector that brought in the Q345 Dr Naysmith: There is a lot of challenge going mobile cataract surgery units that are now being on in North Bristol at the moment. used for some other procedures as well and which Ms Hewitt: Indeed there is, but challenge from other have been enormously helpful because they are providers as well, and enough choice on the patient faster, you can mobilise them quickly, you can get side to give us that incentive for continuous them to parts of the country where you have got the improvement both in clinical care and in value for worst problems, they are particularly useful in rural money. The wave two proposal, which has not yet areas, and so on. It is for all of these reasons that we gone out to tender—I am sure that is right—was the want to have a small, but nonetheless thriving and result of discussions between the Department and competitive, independent sector share of the total the Strategic Health Authority, as it was in other NHSdelivery for patients. parts of the country, but has not yet gone out to tender, so at this point we do not know who might be Q343 Dr Naysmith: Secretary of State, you will be interested in providing it or whether it will represent familiar with the situation in the North Bristol value for money. Trust, which has been discussed endlessly, and Mr Douglas also is familiar with it in the past. It is Q346 Dr Naysmith: Is this part of the ideological bit undergoing major reorganisation in the South moving towards 10 or 15% of independent sector Gloucestershire, North Bristol area, and not treatment? Is that why it is happening? uncontroversial reorganisation, and somehow it has Ms Hewitt: I do not think that an absolute popped up that there is an ISTC plan for this health commitment to continuously improving care and community. I wonder, can you tell me what this is continuously improving value for money is really supposed to contribute to what is already a rather ideological, but maybe we can use diVerent words diYcult and tricky situation? for it. That is what the commitment is. As part of Ms Hewitt: There is, indeed, a proposal for an that we want to have a modest involvement but, elective treatment centre, an independent sector nonetheless, significant from the private and not for treatment centre as part of wave two for exactly the profit sector, for all the reasons I have said, because same reasons as I was outlining to the Chairman. We we do need more capacity in the system. We do not want to give patients more choice, both because we want to continue running all of our hospitals at the believe patients value that in itself but also because 90%, or thereabouts, occupancy rates that we had to it gives you more chance of having the good local have in order to get the waiting lists down, so we hospital on your doorstep that of course people want capacity, we want choice, we want more want, we want to bring in more capacity so that as innovation, we want more contestability, and for all we get to the 18 weeks, which is the maximum, of of those reasons we have got the commitment that I course, the average will be lower, and then we want have announced to wave two both on the diagnostic to be able to sustain that at a level of funding with side and on the electives, which I think is where your lower rates of growth subsequently than we have particular scheme comes in. I am sorry, the 10% and enjoined in current years; we want to keep getting the 15% figure—let me just pick up on that. more innovation in the system, we want to keep that degree of competition and challenge that we think Q347 Dr Naysmith: What is the ideological bit? will continue to drive further service improvement; Ms Hewitt: I do not think this is ideological. John and the evidence for this, I think, is very striking, but Reid made the point that, looking at what he it was after we made the decision to bring the thought was needed, he did not believe, I think the 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
Ev 50 Health Committee: Evidence
6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas phrase was, in his political lifetime that it would be NHShospital trusts t o focus on what they need to do more than 15%. I have obviously looked at those to improve the quality, improve speed and improve figures, and if I take wave one and wave two, that value for money as well. would represent in total about 10% of all elective treatments and about 1% of the total budget of the Q350 Mr Campbell: Value for money. We have got NHS, and that is what I mean by modest but in front of us some figures that were given to us on significant. In the great scheme of things 1% is really ISTCs in comparison with the health costs, but after not very large. In terms of the impact that it will have repeated requests from PEQ no information has on the quality, the speed, the levels of innovation for been provided on the cost of in-patients and day- elective care and diagnostics, it will be significant, care treatment purchased by the private sector. If we and that is why we want it. are looking at the whole gamut of the private sector we must have all the figures in hand. I would like to Q348 Chairman: Could we say that the choice then request those figures for the Committee, if you can is that you need to have an independent sector there get them, for the private sector involvement in the within a geographical area? The choice is in part the health service. As I say, we have got ISTCs, but we independent sector? have not got the private sector providers. Ms Hewitt: The choice is in part the independent Ms Hewitt: I will get Richard, perhaps, to sector. If I look at my own city of Leicester and the supplement this in a moment. broader county of Leicestershire, Leicester East PCT has been trialling information to patients on Q351 Mr Campbell: It is very important because we choice, and the choice that is oVered there is the three obviously want to make some comparisons and look hospitals from the University Hospitals of Leicester at the value for money. Trust, a NuYeld and a Bupa hospital within Ms Hewitt: Absolutely, and this is why I want to give Leicester, but also Northampton and Kettering you a thoughtful answer. Before we started on this trusts just down the road; so there is choice, which procurement of the independent sector we have had includes NHShospitals, but also in this case two for a very long time NHShospitals buying private sector providers. operations (spot purchasing of operations) from the private sector when their waiting lists were simply intolerable, their waiting times were intolerable. Q349 Chairman: In South Yorkshire we have got Those prices were very, very high indeed, reflecting four what you would call “disciplined hospitals”. the fact that until recently the private health sector The one at SheYeld is a big teaching hospital, but in Britain was one of the most expensive in the quite a lot of my constituents go to Bassetlaw world, and so, when the NHSwas using it, it was Hospital, because I border on to Nottinghamshire, using it at an enormous premium. The first wave of and in a sense in a short period of time they have five ISTC procurement brought that premium down NHShospitals which, being in urban areas, are quite very significantly. There is still a premium in the easy to get to if you have got your own transport, but system which we needed to pay in order to get it needs to have more than the independent sector providers into the NHS, in order to get the that we have in SheYeld now for the department to investments that they had to make, because they be happy presumably? were not previously working for the NHS, but that Ms Hewitt: What we have said in relation to choice is not true for everything. I was visiting the NuYeld by the end of this year is that there should be a choice Hospital in Leicester last Friday, as it happens. They of at least four providers, and, if there is an are part of a diVerent contract where they are doing independent sector treatment centre or some other orthopaedic operations, helping to get those waiting private provider, then that should be included on the times down, at the NHStari V price. Obviously, with choice menu. Once we get to the end of 2008 patients wave two we do not yet not know what prices we are will have a completely free choice. Most people will going to be paying because we are in the early stage not want to travel, but they will have a completely of those procurements. In the case of the diagnostics free choice of any hospital within England that is so far, we have been buying quite significant oVering that particular treatment at the NHSquality numbers of scans and other diagnostic tests at and the NHSprice, and if they want to travel, which significantly less than the average NHSprice; so it is some people will want to do for family reasons, of a mixed picture. That is why I wanted to give you a course they can do so. They can choose any hospital thoughtful answer. I think there are some figures that meets those particular criteria. But the reason that we simply are not able to make available to you, for having this modest expansion through wave two because of the commercial confidentiality, and I of the ISTCs is not only to support choice and just know that is something we discussed previously and give patients more choice and control over their I sent you a note. treatment, which I think is a good thing in itself, it is also to help drive innovation and quality Q352Mr Campbell: I say that in all respect, of improvements and value for money improvements course. I just want to have a comparison, if we can across the whole system, and I think, looking at the get that, if that is a possibility. I think that is very reference costs of certainly some of the hospitals in important, because I have always got this funny South Yorkshire, they are higher than one would feeling that we are getting ripped oV by the private want, and having some contestability as well as sector and sometimes I get a feeling that the private Payment by Results is a way of really getting our sector is doing something that the health service 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas itself can do cheaper without being pushed in are generally led by local hospitals who are through the back door. I have got that feeling. I hope desperate to rebuild their premises and improve you are going to relay that feeling? their services, sometimes re-organise services Ms Hewitt: It is the diagnostics. As I say, we have maybe across several sites. They are the ones been buying rather more cheaply than from within champing at the bit, if you like, for PFI. We have the NHS. to make sure, as we do in every case, that there is Mr Douglas: We have a limited cost collection real value for money and that the health about the comparisons of other forms of private community as a whole locally can aVord what the sector, other than through the ISTC programme, hospital itself wants to build. which we collect as part of the annual reference cost collection. I can provide the Committee with that. It is quite limited. What I am looking at Q354 Mr Campbell: I appreciate that is the only doing in addition to that is some separate survey thing on hand, because the hospitals are never work amongst a number of hospitals that I know going to get government grants because we have have used the spot market to get spot places not got the expenditure to do it, and the Tories are directly from them; so I want to supplement the always telling us we are spending too much money information that comes on a standard collection anyway, but in saying that what do you say to the with something that is targeted around those accusation from the National Audit OYce when it places where we know they have used spot describes PFI projects as scientific mumbo jumbo? purchasing, and when I have got that we can then Ms Hewitt: I do not agree with that at all. put that together. Ms Hewitt: We will certainly let the Committee Q355 Mr Campbell: It is the National Audit have that. The other point I would make is one Y that John Reid made, I thought very eVectively, as O ce? Ms Hewitt: I know, but I am entitled to disagree it emerged about a year ago. The private health Y care sector in Britain, as I was saying, has always with the National Audit O ce, I think, and I do been incredibly expensive by world standards and disagree with that particular conclusion. I must the fees paid to consultants in the private sector, confess, I do not recognise the quote, but anyway. including NHSconsultants working overtime, I do not agree with that comment. Both the have been amongst the highest in the world. Those Treasury and ourselves do rigorous, painstakingly prices and costs are now dropping very rapidly, rigorous, value for money assessments of any PFI both because we are getting the waiting times programme or, indeed, any LIFT programme, down in the NHSitself (so that is having an impact which of course is a primary care report. on demand), but also because the companies want to work for the NHS, and in order to do that they Q356 Mr Campbell: They also say they are all have got to get their costs down because we are not over priced? going to pay the kinds of charges that they were Ms Hewitt: I think it is fair to say that lessons have charging us when we were simply buying from spot been learnt from the early PFI projects—no doubt purchasing. all—and I think we are now much smarter at procuring these. I think we have learnt, not least Q353 Mr Campbell: Just a couple of questions on from Bradford, about making sure that you have PFI. You said that the greater levels of local got flexibility so that you can refinance if that is initiatives and autonomy should be brought into desirable, and where the private sector refinances the health service. How does that square with the we get some of the benefit of that refinancing if it large increase in PFI programmes when you have makes it cheaper. Richard, doyouwanttosay got the hospitals being built by these private something about this? You have been doing this companies who are nearly running everything, of longer than I have. course? Mr Douglas: Unfortunately, I recognise the Ms Hewitt: The PFI programme, of course, was phrase “pseudo-scientific mumbo jumbo” because our response to the fact that there had not been a another committee of this House raised it with me new hospital built in England for longer than any on a PFI scheme. The actual comment from one of of us, I think, can remember—there simply had the NAO Assistant Auditor Generals was that the not been any—and large parts of the NHSwere public sector comparator was pseudo-scientific working in pre NHShospitals, rather too many of mumbo jumbo rather that the whole PFI process, them nineteenth century never mind twentieth unless he has said something else since then, and century, and PFI has enabled us to make an that was really an issue about how the value for enormous diVerence in terms both of refurbishing money test worked. and modernising or commissioning entirely new hospitals, and we are seeing those new hospitals opening around the country—University College Q357 Anne Milton: This is probably for you to Hospital in London being the nearest one—but deny rather than anything else because I cannot that, I think, is really helping to improve the remember the source, I had in my head that the quality of care that the NHScan give patients. Of Government had a target of 30% of all elected course, those PFI projects are not imposed by the surgery in the private sector? Department on local health communities. They Ms Hewitt: No. 3178272002 Page Type [E] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Q358 Anne Milton: Is that wrong? Ms Hewitt: Let me see if I can remember this Ms Hewitt: We do not have a target. correctly. When we allowed for the cost of implementing Agenda for Change in the PCT Q359 Anne Milton: Is that not passed down by the allocations, we allowed for a bit more than we Department? believed Agenda for Change would cost us. That Ms Hewitt: No. was why at the point when we made that announcement on the two tier workforce we were Y Q360 Anne Milton: Sir Nigel? confident that there would be su cient within the Sir Nigel Crisp: There was one point about 18 allocations. months ago when we asked PCTs to plan on the basis of a certain percentage of expenditure but we Q366 Mr Burstow: A bit more, at least £75 million. changed our minds, we did not see that through. I Ms Hewitt: Precisely. I have to say, since then the cannot remember the percentage, I do not think it cost of implementing Agenda for Change looks to was 30%, I think it was 8%. I will check. be rather more than we originally estimated. Q361 Anne Milton: Theotherissueisaboutusing the private sector to train staV. One of the Q367 Mr Burstow: My other quick question was arguments, which has been around for a long time, the King’s Fund are saying that the NHSis is that the private sector does not carry the costs currently ill-placed to prevent hospital failure. of training staV, particularly doctors and nurses. I They are advocating quite strongly for a financial would appreciate your comments on that? distress regime to address the causes of deficits. Ms Hewitt: I think that is an absolutely fair point. They are particularly identifying two types of It was a criticism that was made quite frequently deficit which are in need of attention. One is the with the wave one ISTCs. What we have done since legacy costs that come out of decisions which were then is discuss it with the BMA. We have come to made in the past, investment decisions; the other is an agreement that there can and should be training the consequences of capital costs which cannot be in the ISTCs. Junior doctors would get experience fully recovered which is particularly the case when of hip replacements if those are being done in large you come to payment by results where the tariV numbers in an ISTC, and we will mandate that in may not fully reflect that. Are you looking at the wave two contracts. constructing systems given we are moving into an era of payment by results that does allow for more Q362Anne Milton: And nurses? flexibility in that way? Ms Hewitt: We have spoken to the BMA which is Ms Hewitt: Certainly we are looking at not only about doctors. Have we had parallel discussions the immediate management of deficits which we on nurse training? have talked about but what the long-term regime should be for trusts that are struggling financially Q363 Anne Milton: Have you not talked to the or even at risk of failure. Yes, we are looking at RCN? that, we will have more to say on it. Ms Hewitt: No,wetalktotheRCNagreatdeal. Let me double check this. Sir Nigel Crisp: I am not sure. Q368 Mr Burstow: That will include looking at the Ms Hewitt: The criticism was being made tariV issue and the interface with PFI? particularly in relation to the junior doctors’ Mr Douglas: Whereweareatthemomentwith training. We have dealt with that one and we will tariV is for five years after the opening of any new mandate that in wave two contracts. I want to capital scheme, PFI or otherwise, we have tapering check the specific position on nursing. supports to the tariVs. The revenue cost of the capital scheme is added to the tariV for five years Q364 Anne Milton: Can I correct you on the on a tapering basis. The intention of that is it number of hospitals that have been built. There allows people to transition over that period. have been some built under the previous Rather than them taking additional costs out they government. Chelsea & Westminster, Princess have a chance to change the cost structure to Royal, there are about 50; it was not none. manage with the additional costs of the capital Ms Hewitt: Right. Thank you. scheme. The other side of that is that the tariV increases naturally each year. For every piece of Q365 Mr Burstow: To pick up on something which new capital investment in the system there is a you were talking about earlier on. In a press capital element added for tariV.Wethinkatthe statement from the Department announcing an moment that transition phase should be suYcient extension of Agenda for Change to the private but we have said we will continue to evaluate that sector, it states that the annual cost to the full and see whether it really does work as well. regime from 1 October 2006 is estimated to be £75 Ms Hewitt: It does come back to a value for money million and that has been provided for within PCT judgment on new capital projects so that we do not allocations. How can that be, given that the allow NHSorganisations to commit to capital announcement of the policy came well after the expenditure where really they cannot aVord the announcement of the allocations? revenue consequences long-term. 3178272002 Page Type [O] 24-04-06 18:31:59 Pag Table: COENEW PPSysB Unit: 2PAG
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6 December 2005 Rt HonPatricia Hewitt MP, Sir Nigel Crisp andMr Richard Dou glas
Q369 Chairman: Secretary of State, thank you and Ms Hewitt: Absolutely. your colleagues very much indeed for giving evidence. There are one or two questions that we skipped through because we realise you need to be Q370 Chairman: A comprehensive one would be away. We may write to you to clarify one or two very good for us. Thank you. points. We would appreciate the answers to our Ms Hewitt: Thank you very much indeed, original questionnaire which have been promised Chairman. We will get those replies to you as fully again today. and rapidly as we can. 3178271044 Page Type [SE] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 54 Health Committee: Evidence Written evidence
Takenbefore the Health Committee
Public Expenditure Questionnaire 2005 Where questions are identical to those included in the 2004 PEQ, last year’s question number is given in square brackets at the end of the question. Questions are in italics. New questions are given in bold text.
1. Current Issues 1.1 NHS staYng 1.1.1 Could the Department please provide time-series data on the number of nurses completing training since 1990, and estimates of the numbers leaving the profession in each year since 1990? Could these figures be provided for both headcount and Whole Time Equivalent (WTE)? [1.1.1] Answer 1. Information on the number of nurses completing training since 1990 or on the number of nurses leaving the profession each year is not collected by the Department. Table 1.1.1(a) shows the number of nurses employed in the NHSsince 1990. Table 1.1.1(b) shows information on the number of training places for nurses and midwives since 1992–93, the first year for which information is available.
Table 1.1.1(a) NHS HOSPITAL BASED AND COMMUNITY QUALIFIED NURSING, MIDWIFERY & HEALTH VISITING STAFF IN ENGLAND AS AT 30 SEPTEMBER EACH YEAR (excluding practice nurses)
Year Full-time equivalent Headcount 2004 301,877 375,371 2003 291,925 364,692 2002 279,287 346,537 2001 266,171 330,535 2000 256,276 316,752 1999 250,651 310,142 1998 247,238 304,563 1997 246,011 300,467 1996 248,070 301,253 1995 246,822 298,650 1994 238,784 289,284 1993 241,851 293,379 1992 246,570 297,351 1991 243,254 293,774 1990 242,342 285,359
Source: Department of Health non-medical workforce census.
Table 1.1.1(b) NHS PRE-REGISTRATION NURSING AND MIDWIFERY TRAINING COMMISSIONS
Period Total (1) 2004–05 25,016 2003–04 24,284 2002–03 22,956 2001–02 21,770 2000–01 20,021 1999–2000 18,707 1998–99 17,689 1997–98 16,539 1996–97 14,984 1995–96 13,381 1994–95 12,480 1993–94 14,197 1992–93 16,338
Notes: (1) Adjusted to take account of Dearing transfer of 1,017 nursing degree places to NHS1992–93 to 1997–98 3178271001 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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1.1.2 Could the Department supply figures for the number of practice nurses, both in headcount and in Whole Time Equivalent, for the past four years? [1.1.2] Answer 1. Information on the number of headcount and full time equivalent practice nurses for the past four years is shown in Table 1.1.2.
Table 1.1.2 PRACTICE NURSES EMPLOYED BY GP PRACTICES
England, as at 30 September 2001 2002 2003 2004
Whole-Time Equivalents 11,163 11,998 12,967 13,563 Headcount 19,846 20,983 21,667 22,144
Source: Department of Health General and Personal Medical Statistics. 2. Between 2001 and 2004 the number of practice nurses employed by GP practices increased by 2,298 (11.6%) headcount and 2,400 (21.5%) whole-time equivalent.
1.1.3 Could the Department provide information on the expenditure on agency nurses for each NHS trust, and totals for the NHS in England? Answer 1. Information is collected from all NHStrusts on expenditure on non-NHSs taV salaries and wages, including those of nursing staV. The latest year for which this data is available is 2003–04. For England as a whole the total expenditure under the heading of nursing, midwifery and health visiting was about £525 million. Of this £443 million was spent by NHStrusts, £82 million by primar y care trusts and £4,000 by strategic health authorities. The year-on-year trend in rising expenditure of non-NHSnursing sta V salaries has started to decline, for example the 2003–04 spend showed an 11% decrease over the previous year. This reduction reflects the increase in NHSnurses and the impact of targeted act ion by the NHSPurchasing and Supply Agency, Agency Framework Agreements (AFA’s) and the NHS Professionals (SpHA). 2. Detailed information is given in Table 1.1.3(a) to 1.1.3(c).
Table 1.1.3(a) SALARIES AND WAGES NON-NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2003–04 ENGLAND
Nursing, midwifery and health visiting Code NHS Trust (£)
RA2 Royal Surrey County Hospital NHS Trust 1,199,238 RA3 Weston Area Health NHSTrust 1,488,872 RA4 East Somerset NHS Trust 412,372 RA7 United Bristol Healthcare NHSTrust 2,091,432 RA9 South Devon Health Care NHS Trust 357,005 RAE Bradford Teaching Hospitals NHSTrust 758,000 RAJ Southend Hospital NHS Trust 802,394 RAL Royal Free Hampstead NHSTrust 4,771,833 RAN Royal National Orthopaedic Hospital NHSTrust 1,153,209 RAP North Middlesex University Hospital NHSTrust 2,056,863 RASThe Hillingdon Hospital NHSTrust 1,133,579 RAT North East London Mental Health NHSTrust 7,662,560 RAX Kingston Hospital NHSTrust 3,919,036 RB1 Avon Ambulance Service NHS Trust 0 RB4 Essex Ambulance Service NHS Trust 0 RB5 Gloucestershire Ambulance Services NHS Trust 0 RB6 Mersey Regional Ambulance Service NHS Trust 0 RB7 StaVordshire Ambulance Service Trust 0 RB8 South Yorkshire Ambulance Service NHS Trust 0 RBA Taunton and Somerset NHS Trust 809,477 RBB Royal National Hospital Rheumatic Diseases NHSTrust 53,653 RBD West Dorset General Hospitals NHSTrust 1,863,030 RBF NuYeld Orthopaedic Centre NHSTrust 155,596 RBK Walsall Hospitals NHSTrust 821,065 RBL Wirral Hospital NHSTrust 1,240,237 3178271002 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 56 Health Committee: Evidence
Nursing, midwifery and health visiting Code NHS Trust (£)
RBN St Helens and Knowsley Hospitals NHS Trust 338,579 RBQ The Cardiothoracic Centre—Liverpool NHSTrust 325,750 RBSRoyal Liverpool Children’s NHSTrust 741,775 RBT The Mid Cheshire Hospitals NHSTrust 682,746 RBV Christie Hospital NHSTrust 210,574 RBX Lincolnshire Ambulance NHSTrust 0 RBZ Northern Devon Healthcare NHSTrust 145,214 RC1 Bedford Hospital NHSTrust 1,427,560 RC3 Ealing Hospital NHSTrust 1,479,149 RC9 Luton and Dunstable Hospital NHSTrust 865,337 RCB York Hospitals NHSTrust 871,372 RCC Scarborough and North East Yorks NHS Trust 289,382 RCD Harrogate Health Care NHSTrust 480,433 RCF Airedale NHSTrust 138,933 RCSNottingham City Hospital NHSTrust 1,376,575 RCU SheYeld Children’s NHSTrust 479,938 RCX Kings Lynn and Wisbech Hospitals NHSTrust 91,659 RD1 Royal United Hospital Bath NHSTrust 2,291,714 RD3 Poole Hospital NHSTrust 724,903 RD7 Heatherwood and Wexham Park Hosps Trust 0 RD8 Milton Keynes General Hospital NHSTrust 562,470 RDD Basildon and Thurrock Univertsity Hospital NHSTrust 2,302,365 RDE Essex Rivers Healthcare NHSTrust 2,160,184 RDR South Downs Health NHS Trust 1,045,977 RDU Frimley Park Hospital NHSTrust 2,564,870 RDY Dorset Health Care NHSTrust 236,411 RDZ Royal Bournemouth and Christchurch Trust 675,287 RE6 Cumbria Ambulance Service NHS Trust 0 RE9 South Tyneside Health Care NHS Trust 4,070 REF Royal Cornwall Hospitals NHSTrust 1,779,945 REM Aintree Hospitals NHSTrust 1,076,798 REN Clatterbridge Centre for Oncology Trust 211,087 REP Liverpool Women’s Hospital NHSTrust 41,496 RET Walton Neurology Centre NHSTrust 115,890 RF4 Barking, Havering and Redbridge Hosp NH 2,831,585 RFF Barnsley District Gen Hospital NHSTrust 308,961 RFK Queen’s Medical Notts Uni Hosp NHSTrust 2,545,044 RFR Rotherham General Hospitals NHSTrust 1,583,576 RFSChesterfield and N Derbyshire Hosp Trust 318,346 RFU Beds and Herts Ambulance and Paramedic T 0 RFW West Middlesex University Hosp NHSTrust 1,651,320 RG2 Queen Elizabeth Hospital NHSTrust 1,096,737 RG3 Bromley Hospitals NHSTrust 7,228,968 RGC Whipps Cross University Hosp NHSTrust 7,664,581 RGD Leeds Mental Health Teaching NHSTrust 2,844,891 RGH West Yorkshire Ambulance Service Trust 0 RGM Papworth Hospital NHSTrust 544,978 RGN Peterborough Hospitals NHSTrust 1,626,075 RGP James Paget Healthcare NHSTrust 726,423 RGQ Ipswich Hospital NHSTrust 1,418,647 RGR West SuVolk Hospitals NHSTrust 304,408 RGT Addenbrookes NHSTrust 1,025,135 RGZ Queen Mary’s Sidcup NHS Trust 301,479 RH1 Royal Berkshire Ambulance Service Trust 0 RH5 Somerset Partnership NHS and Soc Care Trust 33,657 RH8 Royal Devon and Exeter Healthcare NHSTrust 632,970 RHA Nottinghamshire Healthcare NHSTrust 903,076 RHM Southampton University Hosps NHS Trust 5,546,575 RHP Dorset Ambulance NHSTrust 0 RHQ SheYeld Teaching Hospitals NHSTrust 1,094,819 RHR Wiltshire Ambulance Service NHS Trust 0 RHU Portsmouth Hospitals NHSTrust 8,295,505 RHW Royal Berkshire and Battle Hosps NHSTrust 1,358,925 3178271002 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 57
Nursing, midwifery and health visiting Code NHS Trust (£)
RHX Oxford Learning Disability NHSTrust 968,092 RHY Two Shires Ambulance NHS Trust 0 RJ1 Guy’s and St Thomas’ NHS Trust 9,947,540 RJ2 The Lewisham Hospital NHSTrust 2,130,325 RJ5 St Mary’s NHS Trust 6,379,239 RJ6 Mayday Healthcare NHSTrust 3,373,059 RJ7 St George’s Healthcare NHS Trust 3,889,266 RJ8 Cornwall Partnership NHSTrust 293,882 RJ9 Westcountry Ambulance ServiceS NHS Trust 0 RJC South Warwickshire Gen Hosps NHS Trust 305,040 RJD Mid StaVordshire Gen HospitalSTrust 351,811 RJE Univ Hosp North StaVordshire NHSTrust 2,751,301 RJF Burton Hospitals NHSTrust 1,099,569 RJH Good Hope Hospital NHSTrust 1,733,201 RJL North Lincolnshire and Goole Hosps NHSTrust 820,088 RJN East Cheshire NHSTrust 392,343 RJR Countess of Chester Hospital NHSTrust 607,831 RJX Calderstones NHSTrust 0 RJZ King’s College Hospital NHSTrust 2,637,958 RK5 Sherwood Forest Hospitals NHS Trust 447,627 RK9 Plymouth Hospitals NHSTrust 4,366,267 RKA West Midlands Ambulance Service NHS Trust 0 RKB Univ Hosps Coventry and Warwickshire NHSTrust 1,714,847 RKD Hampshire Ambulance Service NHS Trust 3,584,664 RKE The Whittington Hospital NHSTrust 2,929,157 RKL West London Mental Health NHSTrust 3,605,473 RL1 Rob Jones and A Hunt Orthopaedic NHSTrust 29,420 RL4 Royal Wolverhampton Hospital NHSTrust 3,192,476 RL5 Hereford and Worcester Ambulance NHSTrust 0 RL6 Coventry and Warwickshire Ambulance NHSTrust 0 RLN City Hospitals Sunderland NHS Trust 256,504 RLQ Hereford Hospitals NHSTrust 781,052 RLT George Eliot Hospital NHSTrust 665,346 RLU Birmingham Women’s Health Care NHSTrust 926,152 RLY North StaVs Combined HC NHSTrust 170,966 RM1 Norfolk and Norwich Uni Hosp NHSTrust 531,068 RM2 South Manchester Univ Hosp NHS Trust 1,115,000 RM3 Salford Royal Hospitals NHS Trust 2,124,085 RM4 TraVord Healthcare NHSTrust 546,436 RM6 Northgate and Prudhoe NHSTrust 0 RMA Greater Manchester Ambulance NHSTrust 0 RMC Bolton Hospitals NHSTrust 1,501,050 RMD Lancashire Ambulance Service NHS Trust 5,872 RMP Tameside and Glossop Acute Servs NHS Trust 830,071 RMY Norfolk and Waveney MH Partnership NHSTrust 893,153 RMZ East Anglian Ambulance NHSTrust 0 RN1 Winchester and EastleigH Hlthcre NHSTrust 1,129,489 RN3 Swindon and Marlborough NHS Trust 4,244,648 RN5 North Hampshire Hospitals NHSTrust 2,646,931 RN7 Dartford and Gravesham NHSTrust 615,262 RNA Dudley Group of Hospitals NHSTrust 1,603,701 RNH Newham University Hospital NHSTrust 4,058,108 RNJ Barts and the London NHSTrust 6,217,948 RNK Tavistock and Portman NHSTrust 0 RNL North Cumbria Acute Hospitals NHSTrust 0 RNN North Cumbria MH and Learning Disab NHSTrust 181,709 RNP Newcastle on Tyneside and Northumberland MH NHS267,141 RNQ Kettering General Hospital NHSTrust 731,304 RNSNorthampton General Hospital NHSTrust 1,525,648 RNU Oxfordshire Mental Healthcare NHSTrust 152,748 RNY Oxfordshire Ambulance NHSTrust 0 RNZ Salisbury Health Care NHS Trust 902,001 RP1 Northamptonshire Healthcare NHSTrust 2,392,891 3178271002 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 58 Health Committee: Evidence
Nursing, midwifery and health visiting Code NHS Trust (£)
RP4 Great Ormond St Hosp for Children NHS Trust 1,859,760 RP5 Doncaster and Bassetlaw Hospitals NHSTrust 272,698 RP6 Moorfields Eye Hospital NHSTrust 1,417,324 RP7 Lincolnshire Partnership NHSTrust 485,150 RPA Medway NHSTrust 1,213,933 RPC The Queen Victoria Hospital NHSTrust 453,496 RPG Oxleas NHSTrust 1,523,671 RPH Kent Ambulance NHSTrust 0 RPL Worthing and Southlands Hospitals Trust 1,355,966 RPQ Surrey Ambulance Service NHS Trust 0 RPR Royal West Sussex NHS Trust 1,182,960 RPY The Royal Marsden NHSTrust 1,237,222 RQ2 Sussex Ambulance Service NHS Trust 0 RQ3 Birmingham Children’s Hospital NHSTrust 2,833,250 RQ6 Royal Liverpool Broadgreen Univ Hosp Trust 1,121,291 RQ8 Mid Essex Hospital Services NHS Trust 3,607,612 RQM Chelsea and Westminster Healthcare Trust 3,256,497 RQN Hammersmith Hospitals NHSTrust 8,806,444 RQQ Hinchingbrooke Health Care NHSTrust 212,986 RQW Princess Alexandra Hospital NHSTrust 3,914,860 RQX Homerton University Hospital NHSTrust 7,268,979 RQY SW London and St George’s Mental Hlth Trust 7,547,169 RR1 Birmingham Heartlands and Solihull Trust 2,043,451 RR2 Isle of Wight Healthcare NHSTrust 1,286 RR7 Gateshead Health NHSTrust 969,105 RR8 Leeds Teaching Hospitals NHSTrust 2,420,146 RRD N Essex Mental Health Partnership NHSTrust 3,032,696 RRE South StaVordshire Healthcare NHSTrust 986,027 RRF Wrightington, Wigan and Leigh NHSTrust 783,075 RRJ Royal Orthopaedic Hospital NHSTrust 568,157 RRK University Hospital Birmingham NHSTrust 2,069,290 RRP Barnet, Enfield and Haringey MH NHSTrust 1,517,441 RRU London Ambulance Service NHS Trust 0 RRV University College London Hospital NHSTrust 7,343,332 RT1 Cambs and Peterborough MH Partnership Trust 1,874,492 RT2 Pennine Care NHSTrust 1,687,826 RT3 Royal Brompton and Harefield NHSTrust 1,881,954 RT5 Leicestershire Partnership NHSTrust 1,131,054 RT6 SuVolk Mental Health Partnership NHSTrust 860,991 RTC County Durham and Darlington Prior Srv T 124,362 RTD Newcastle Upon Tyne Hospitals NHSTrust 1,764,434 RTE Gloucestershire Hospitals NHSTrust 2,892,512 RTF Northumbria Health Care NHSTrust 448,649 RTG Southern Derbyshire Acute Hospitals NHS Trust 805,371 RTH Oxford RadcliVe Hospitals NHSTrust 3,774,963 RTJ Surrey Hampshire Borders NHS Trust 761,306 RTK Ashford and St Peter’s HospitalS NHS Trust 1,836,469 RTM East Kent NHSand SCPartnership Trust 382,956 RTN Surrey Oaklands NHS Trust 4,253,251 RTP Surrey and Sussex Healthcare NHS Trust 4,401,109 RTQ Gloucestershire Partnership NHSTrust 2,259,210 RTrust South Tees Hospitals NHS Trust 1,498,081 RTV 5 Boroughs Partnership NHSTrust 873,844 RTX Morecambe Bay Hospitals NHSTrust 184,377 RV1 Tees East and Nth Yorkshre Amb Serv NHS 3,784 RV3 Central and North West London MH NHSTrust 2,534,801 RV5 South London and Maudsley NHS Trust 3,825,109 RV6 East Midlands Ambulance Servce NHS Trust 0 RV7 Bedfordshire and Luton Community NHSTrust 1,420,488 RV8 North West London Hospitals NHSTrust 3,836,245 RV9 Hull and East Riding Comm Health NHSTrust 1,468,029 RVJ North Bristol NHSTrust 6,565,877 RVK North East Ambulance Service NHS Trust 0 3178271002 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 59
Nursing, midwifery and health visiting Code NHS Trust (£)
RVL Barnet and Chase Farm HospitalSNHSTrust 3,975,737 RVN Avon and Wiltshire Mhp NHSTrust 3,088,761 RVR Epsom and St Helier Uni Hosps NHS Trust 677,015 RVV East Kent Hospitals NHSTrust 1,620,270 RVW North Tees and Hartlepool NHSTrust 446,172 RVX Tees and North East Yorkshire NHSTrust 343,815 RVY Southport and Ormskirk Hospital NHS Trust 412,937 RW1 Hampshire Partnership NHSTrust 2,452,031 RW3 Cent Manchester/Manchester Child NHSTrust 5,415,659 RW4 Mersey Care NHSTrust 3,306,859 RW5 Lancashire Care NHSTrust 644,203 RW6 Pennine Acute Hospitals NHSTrust 5,329,503 RW7 North West Surrey MH NHS Partnership Trust 618,911 RW8 West Sussex Health and Social Care NHS Trust 1,813,051 RW9 South of Tyne and Wearside MH NHS Trust 8,191 RWA Hull and East Yorkshire Hospitals NHSTrust 566,582 RWC Doncaster and South Humber Hlthcare NHS 420,801 RWD United Lincolnshire Hospitals NHSTrust 1,855,620 RWE University Hospitals of Leicester NHSTrust 8,524,976 RWF Maidstone and Tunbridge Wells NHSTrust 4,102,212 RWG West Hertfordshire Hospitals NHSTrust 5,682,388 RWH East and North Hertfordshire NHSTrust 1,097,568 RWJ Stockport NHS Trust 1,516,723 RWK East London and The City MH NHSTrust 2,037,788 RWN South Essex Partnership NHS Trust 1,826,873 RWP Worcestershire Acute Hospitals NHSTrust 5,484,466 RWQ Worcestershire MH Partnership NHSTrust 462,200 RWR Hertfordshire Partnership NHSTrust 2,262,595 RWT Buckinghamshire Mental Health NHSTrust 1,362,242 RWV Devon Partnership NHSTrust 1,428,355 RWW North Cheshire Hospitals NHSTrust 3,105,131 RWX Berkshire Healthcare NHSTrust 3,259,238 RWY Calderdale and Huddersfield NHSTrust 255,774 RXA Cheshire and Wirral Partnership NHSTrust 0 RXC East Sussex Hospitals NHS Trust 4,297,948 RXD East Sussex County Healthcare NHS Trust 1,071,402 RXF Mid Yorkshire Hospitals NHSTrust 2,017,750 RXG South West Yorkshire Mental Health NHS Trust 431,944 RXH Brighton and Sussex Univ Hosps NHS Trust 6,236,799 RXJ West Kent NHSand SocialCare Trust 1,964,298 RXK Sandwell and West Birmingham Hosps NHS Trust 1,068,143 RXL Blackpool, Fylde and Wyre Hosps NHSTrust 64,300 RXM Derbyshire Mental Health Services NHS Trust 1,026,261 RXN Lancashire Teaching Hospitals NHSTrust 1,530,891 RXP Co Durham and Darlington Acute Hosp NHSTrust 1,681,660 RXQ Buckinghamshire Hospitals NHSTrust 2,386,748 RXR East Lancashire Hospitals NHSTrust 2,437,135 RXT Birmingham and Solihull MH NHS Trust 1,443,029 RXV Bolton Salford and TraVord MH NHSTrust 922,806 RXW Shrewsbury and Telford Hospitals NHS Trust 244,419 TAD Bradford District Care Trust 449,697 TAE Manchester Mental Health and Social Care Trust 1,018,785 TAF Camden and Islington MH and Social Care Trust 4,875,214 TAH SheYeld Care Trust 1,817,115 TAJ Sandwell Mental Health NHS and Social CT 683,541 England Total 442,672,685
Source: Annual financial returns of NHStrusts 3178271003 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 60 Health Committee: Evidence
Table 1.1.3(b)
SALARIES AND WAGES NON-NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2003–04 ENGLAND
Nursing, midwifery and health visiting Code Primary Care Trust (£)
5A1 New Forest PCT 642,865 5A2 Norwich PCT 1,470,546 5A3 South Gloucestershire PCT 43,146 5A4 Havering PCT 1,416,294 5A5 Kingston PCT 760,068 5A7 Bromley PCT 560,957 5A8 Greenwich Teaching PCT 347,463 5A9 Barnet PCT 774,602 5AA South Manchester PCT 375,003 5AC Daventry and South Northamptonshire PCT 322,000 5AF North Peterborough PCT 1,251 5AG South Peterborough PCT 0 5AH Tendring PCT 592,323 5AJ Epping Forest PCT 562,806 5AK Southend on Sea PCT 67,573 5AL Central Derby PCT 529,325 5AM Mansfield District PCT 14,008 5AN North East Lincolnshire PCT 0 5AP Newark and Sherwood PCT 0 5AT Hillingdon PCT 432,330 5AW Airedale PCT 4,091 5C1 Enfield PCT 321,866 5C2 Barking and Dagenham PCT 524,310 5C3 City and Hackney Teaching PCT 1,347,593 5C4 Tower Hamlets PCT 1,291,851 5C5 Newham PCT 1,545,562 5C9 Haringey Teaching PCT 702,140 5CC Blackburn with Darwen PCT 13,320 5CD North Dorset PCT 503,749 5CE Bournemouth Teaching PCT 0 5CF Bradford City Teaching PCT 526 5CG Bradford South and West PCT 62,414 5CH North Bradford PCT 209,413 5CK Doncaster Central PCT 0 5CL Central Manchester PCT 100,633 5CM Dartford, Gravesham and Swanley PCT 116,370 5CN Herefordshire PCT 541,135 5CP Hertsmere PCT 150,890 5CQ Milton Keynes PCT 558,997 5CR North Manchester PCT 21,953 5CV South Hams and West Devon PCT 39,622 5CW Torbay PCT 70,887 5CX TraVord South PCT 21,266 5CY West Norfolk PCT 195,629 5D1 Solihull PCT 191,121 5D2 West Lincolnshire PCT 615 5D3 Lincolnshire South West Teaching PCT 28,019 5D4 Carlisle and District PCT 18,466 5D5 Eden Valley PCT 0 5D6 West Cumbria PCT 0 5D7 Newcastle PCT 15,926 5D8 North Tyneside PCT 1,211 5D9 Hartlepool PCT 0 5DC Harlow PCT 1,200 5DD Morecambe Bay PCT 212,217 5DF North Hampshire PCT 455,076 5DG Isle of Wight PCT 0 5DH West Wiltshire PCT 66,268 3178271003 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 61
Nursing, midwifery and health visiting Code Primary Care Trust (£)
5DJ South Wiltshire PCT 978 5DK Newbury and Community PCT 173,417 5DL Reading PCT 387,580 5DM Slough PCT 102,097 5DN Wokingham PCT 78,798 5DP Vale of Aylesbury PCT 92,125 5DQ Burntwood, Lichfield and Tamworth PCT 63,151 5DR Wyre Forest PCT 28,085 5DT North East Oxfordshire PCT 182,413 5DV Cherwell Vale PCT 201,778 5DW Oxford City PCT 355,166 5DX South East Oxfordshire PCT 274,670 5DY South West Oxfordshire PCT 333,223 5E1 North Tees PCT 8,414 5E2 Selby and York PCT 45,043 5E3 East Yorkshire PCT 280 5E4 Yorkshire Wolds and Coast PCT 268,306 5E5 Eastern Hull PCT 66,312 5E6 West Hull PCT 0 5E7 Eastern Wakefield PCT 0 5E8 Wakefield West PCT 0 5E9 Mid-Hampshire PCT 4,121 5EA Chesterfield PCT 13,394 5EC Gedling PCT 34,823 5ED Amber Valley PCT 179,115 5EE North SheYeld PCT 3,321 5EF North Lincolnshire PCT 288 5EG North Eastern Derbyshire PCT 12,465 5EH Melton, Rutland and Harborough PCT 154,914 5EJ Leicester City West PCT 1,322 5EK Doncaster East PCT 0 5EL Doncaster West PCT 0 5EM Nottingham City PCT 1,022,761 5EN SheYeld West PCT 4,891 5EP SheYeld South West PCT 4,035 5EQ South East SheYeld PCT 984 5ER Erewash PCT 73,996 5ET Bassetlaw PCT 59,083 5EV Broxtowe and Hucknall PCT 81,227 5EX Greater Derby PCT 6,164 5EY Eastern Leicester PCT 2,042 5F1 Plymouth Teaching PCT 456,802 5F2 Chorley and South Ribble PCT 54,186 5F3 West Lancashire PCT 2,668 5F4 Heywood and Middleton PCT 20,793 5F5 Salford PCT 183,587 5F6 TraVord North PCT 3,226 5F7 Stockport PCT 137,461 5F8 Bebington and West Wirral PCT 0 5F9 Southport and Formby PCT 5,925 5FA Ashfield PCT 205 5FC RushcliVe PCT 336,399 5FD East Hampshire PCT 1,321,529 5FE Portsmouth City Teaching PCT 1,284,475 5FF South West Kent PCT 67,877 5FH Bexhill and Rother PCT 54,980 5FJ Hastings and St Leonards PCT 0 5FK Mid-Sussex PCT 0 5FL Bath and North East Somerset PCT 1,573,536 5FM West of Cornwall PCT 65,480 5FN South and East Dorset PCT 58,658 5FP South West Dorset PCT 267,170 5FQ North Devon PCT 24,614 3178271003 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 62 Health Committee: Evidence
Nursing, midwifery and health visiting Code Primary Care Trust (£)
5FR Exeter PCT 96,930 5FT East Devon PCT 130,015 5FV Mid Devon PCT 56,533 5FW Somerset Coast PCT 141,597 5FX Mendip PCT 176,879 5FY Teignbridge PCT 59,085 5G1 Southern Norfolk PCT 40,502 5G2 Bracknell Forest PCT 289,649 5G3 Windsor, Ascot and Maidenhead PCT 145,658 5G4 Chiltern and South Bucks PCT 58,606 5G5 Wycombe PCT 82,435 5G6 Blackwater Valley and Hart PCT 119,961 5G7 Hyndburn and Ribble Valley PCT 50,951 5G8 Burnley, Pendle and Rossendale PCT 93,216 5G9 North Liverpool PCT 56,012 5GC Luton PCT 211,629 5GD Bedford PCT 59,963 5GE Bedfordshire Heartlands PCT 555,362 5GF Huntingdonshire PCT 0 5GG Welwyn Hatfield PCT 88,268 5GH North Hertfordshire and Stevenage PCT 83,285 5GJ South East Hertfordshire PCT 97,485 5GK Royston Buntingford and Bishops Stortford PCT 341,582 5GL Maldon and South Chelmsford PCT 343,720 5GM Colchester PCT 1,153,925 5GN Uttlesford PCT 433,785 5GP Billericay, Brentwood and Wickford PCT 759,185 5GQ Thurrock PCT 0 5GR Basildon PCT 15,000 5GT Great Yarmouth PCT 12,181 5GV Watford and Three Rivers PCT 74,604 5GW Dacorum PCT 936 5GX St Albans and Harpenden PCT 0 5H1 Hammersmith and Fulham PCT 1,284,978 5H2 Birkenhead and Wallasey PCT 89,267 5H3 Cheshire West PCT 0 5H4 Central Cheshire PCT 18,342 5H5 Eastern Cheshire PCT 19,970 5H6 Ellesmere Port and Neston PCT 76,772 5H7 Derbyshire Dales and South Derbyshire PCT 137,564 5H8 Rotherham PCT 0 5H9 East Lincolnshire PCT 223,600 5HA Central Liverpool PCT 371,047 5HC South Liverpool PCT 51,581 5HD Preston PCT 36,362 5HE Fylde PCT 0 5HF Wyre PCT 0 5HG Ashton, Leigh and Wigan PCT 50,472 5HH Leeds West PCT 0 5HJ Leeds North East PCT 2,089 5HK East Leeds PCT 190,028 5HL South Leeds PCT 68,762 5HM Leeds North West PCT 26,843 5HN High Peak and Dales PCT 59,394 5HP Blackpool PCT 3,373 5HQ Bolton PCT 252 5HR StaVordshire MoorlandSPCT 68,563 5HT Dudley South PCT 8,676 5HV Dudley Beacon and Castle PCT 438,881 5HW Newcastle-under-Lyme PCT 4,112 5HX Ealing PCT 1,063,000 5HY Hounslow PCT 362,789 5J1 Halton PCT 34,981 3178271003 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 63
Nursing, midwifery and health visiting Code Primary Care Trust (£)
5J2 Warrington PCT 38,165 5J3 St Helens PCT 12,755 5J4 Knowsley PCT 0 5J5 Oldham PCT 0 5J6 Calderdale PCT 0 5J7 North Kirklees PCT 282 5J8 Durham Dales PCT 28,144 5J9 Darlington PCT 18,855 5JA Hinckley and Bosworth PCT 0 5JC Charnwood and NW Leicestershire PCT 93,268 5JD South Leicestershire PCT 35,832 5JE Barnsley PCT 203,722 5JF Bristol North PCT 3,281 5JG Bristol South and West PCT 22,340 5JH Cambridge City PCT 344,590 5JJ South Cambridgeshire PCT 13,920 5JK East Cambridgeshire and Fenland PCT 127,483 5JL Broadland PCT 50,579 5JM North Norfolk PCT 781,075 5JN Chelmsford PCT 0 5JP Castle Point and Rochford PCT 206,157 5JQ Ipswich PCT 22,258 5JR SuVolk Coastal PCT 130,352 5JT Central SuVolk PCT 99,682 5JV Waveney PCT 148,947 5JW SuVolk West PCT 56,305 5JX Bury PCT 137,313 5JY Rochdale PCT 31,611 5K1 South Somerset PCT 0 5K2 Taunton Deane PCT 87,269 5K3 Swindon PCT 476,407 5K4 Kennet and North Wiltshire PCT 263,386 5K5 Brent Teaching PCT 2,267,470 5K6 Harrow PCT 81,579 5K7 Camden PCT 3,829,638 5K8 Islington PCT 1,408,562 5K9 Croydon PCT 1,459,741 5KA Derwentside PCT 2,350 5KC Durham and Chester-le-Street PCT 0 5KD Easington PCT 1,370 5KE Sedgefield PCT 26,396 5KF Gateshead PCT 117,152 5KG South Tyneside PCT 20,399 5KH Hambleton and Richmondshire PCT 78,614 5KJ Craven, Harrogate and Rural District PCT 172,522 5KK Scarborough, Whitby and Ryedale PCT 100,265 5KL Sunderland Teaching PCT 14,511 5KM Middlesbrough PCT 52,662 5KN Langbaurgh PCT 243,113 5KP East Elmbridge and Mid Surrey PCT 867,685 5KQ East Surrey pct 218,161 5KR North and East Cornwall PCT 19,501 5KT Central Cornwall PCT 9,280 5KV Poole PCT 92,847 5KW Cheltenham and Tewkesbury PCT 0 5KX West Gloucestershire PCT 0 5KY Cotswold and Vale PCT 152,366 5L1 Southampton City PCT 449,908 5L2 Maidstone Weald PCT 98,646 5L3 Medway PCT 246,440 5L4 Swale PCT 499,455 5L5 Guildford and Waverley PCT 690,212 5L6 North Surrey PCT 759,993 3178271003 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 64 Health Committee: Evidence
Nursing, midwifery and health visiting Code Primary Care Trust (£)
5L7 Surrey Heath and Woking PCT 324,860 5L8 Adur, Arun and Worthing PCT 487,182 5L9 Western Sussex PCT 313,994 5LA Kensington and Chelsea PCT 2,985,520 5LC Westminster PCT 1,554,305 5LD Lambeth PCT 1,367,772 5LE Southwark PCT 844,599 5LF Lewisham PCT 337,416 5LG Wandsworth PCT 926,755 5LH Tameside and Glossop PCT 183,249 5LJ Huddersfield Central PCT 0 5LK South Huddersfield PCT 0 5LL Ashford PCT 0 5LM Canterbury and Coastal PCT 730,824 5LN East Kent Coastal PCT 59,865 5LP Shepway PCT 79,218 5LQ Brighton and Hove City PCT 0 5LR Eastbourne Downs PCT 164 5LT Sussex Downs and Weald PCT 131,705 5LV Northamptonshire Heartlands PCT 2,178 5LW Northampton PCT 75,074 5LX Fareham and Gosport PCT 791,064 5LY Eastleigh and Test Valley South PCT 10,691 5M1 South Birmingham PCT 4,167,543 5M2 Shropshire County PCT 481,880 5M3 Walsall Teaching PCT 260,995 5M5 South Sefton PCT 0 5M6 Richmond and Twickenham PCT 433,990 5M7 Sutton and Merton PCT 72,152 5M8 North Somerset PCT 0 5M9 Rugby PCT 20,614 5MA Crawley PCT 173,203 5MC Horsham and Chanctonbury PCT 62,348 5MD Coventry Teaching PCT 0 5ME North Stoke PCT 42,193 5MF South Stoke PCT 34,048 5MG Oldbury and Smethwick PCT 0 5MH Rowley Regis and Tipton PCT 9,086 5MJ Wednesbury and West Bromwich PCT 0 5MK Telford and Wrekin PCT 176,563 5ML East StaVordshire PCT 0 5MM Cannock Chase PCT 22,097 5MN South Western StaVordshire PCT 3,933 5MP North Warwickshire PCT 1,625,055 5MQ South Warwickshire PCT 903,337 5MR Redditch and Bromsgrove PCT 158,336 5MT South Worcestershire PCT 161,188 5MV Wolverhampton City PCT 329,656 5MW North Birmingham PCT 104,272 5MX Heart of Birmingham Teaching PCT 136,153 5MY Eastern Birmingham PCT 2,358,540 5NA Redbridge PCT 1,078,542 5NC Waltham Forest PCT 1,274,708 TAC Northumberland Care Trust 5,186 TAG Witham, Braintree and Halstead Care Trust 48,082 TAK Bexley Care Trust 225,583 England Total 81,998,420
Source: Annual financial returns of primary care trusts 3178271004 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 65
Table 1.1.3(c) SALARIES AND WAGES NON-NHS STAFF (AGENCY, ETC) (BY NHS CLASSIFICATION) 2003–04 ENGLAND
Nursing, Midwifery and Health Visiting Code Strategic Health Authority (£)
Q01 Norfolk, SuVolk and Cambridgeshire SHA 0 Q02 Bedfordshire and Hertfordshire SHA 0 Q03 Essex Strategic HA 0 Q04 North West London Strategic HA 0 Q05 North Central London Strategic HA 4,024 Q06 North East London Strategic HA 0 Q07 South East London Strategic HA 0 Q08 South West London Strategic HA 0 Q09 Northumberland, Tyne and Wear Strategic HA 0 Q10 County Durham and Tees Valley SHA 0 Q11 North and East Yorkshire and N Lincs SHA 0 Q12 West Yorkshire Strategic HA 0 Q13 Cumbria and Lancashire Strategic HA 0 Q14 Greater Manchester Strategic HA 0 Q15 Cheshire and Merseyside Strategic HA 0 Q16 Thames Valley Strategic HA 0 Q17 Hampshire and Isle of Wight Strategic HA 0 Q18 Kent and Medway Strategic HA 0 Q19 Surrey and Sussex Strategic HA 0 Q20 Avon, Gloucestershire and Wiltshire SHA 0 Q21 South West Peninsula Strategic HA 0 Q22 Dorset and Somerset Strategic HA 0 Q23 South Yorkshire Strategic HA 0 Q24 Trent Strategic HA 0 Q25 Leics, Northants and Rutland SHA 0 Q26 Shropshire and StaVordshire SHA 0 Q27 Birmingham and the Black Country SHA 0 Q28 West Midlands South Strategic HA 0 England Total 4,024
Source: Annual financial returns of strategic health authorities 1.1.4 How many GPs and consultants respectively have been employed by the NHS, and how many have left the NHS in each year since 1997? Could these figures be provided for both headcount and Whole Time Equivalent? [1.1.4] Answer 1. The number of GPs employed by the NHS, and the number who left the NHS in each year since 1997 is shown in Table 1.1.4(a). The Department does not collect comparable data about consultants. The number of medical and dental consultants employed by the NHSin each year si nce 1997 is shown in Table 1.1.4(b). 2. Figures have been provided for both headcount and full time equivalent.
Table 1.1.4(b) HOSPITAL, PUBLIC HEALTH MEDICINE AND COMMUNITY HEALTH SERVICES (HCHS) MEDICAL AND DENTAL CONSULTANTS Numbers (headcount) Full time equivalents
September 1997 21,474 19,661 September 1998 22,324 20,432 September 1999 23,321 21,410 September 2000 24,401 22,186 September 2001 25,782 23,064 September 2002 27,070 24,756 September 2003 28,750 26,341 September 2004 30,650 28,141 December 2004 30,863 28,419 March 2005 31,210 28,822 Source: NHSHealth and SocialCare Information Centre medical and dental workforc e census. 3178271005 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 66 Health Committee: Evidence Headcount , Salaried Doctors GMSUnrestricted between NHStrusts. V : ANALYSIS OF WORKFORCE (1) l services statistics census but was there in 2004, a leaver’s GMC number was in 2003 but not 2004. do they relate to the local level turnover of sta bers appear in consecutive years of the NHSWorkforce Census. Table 1.1.4a ly represent the national position at these times. PMSContracted GPs, PMSSalariedGPs, Restricted Principals, Assistants s published in the GP annual census results in previous years which covered ncludes Contracted GPs, GMSOthers and PMSOthers. 1997 1998 1999 2000 2001 2002 2003 2004 28,046 28,251 28,467 28,593 28,802 29,202 30,358 31,523 Leavers 1,331 1,268 1,282 1,528 1,712 1,491 1,765 of which Joiners 1,536 1,484 1,408 1,737 2,112 2,647 2,930 GENERAL MEDICAL PRACTITIONERS (EXCLUDING RETAINERS AND REGISTRARS) (1) NHSHealth and SocialCare Information Centre general and personal medica They do not cover movement in and out of the NHSbetween these two points, nor These figures are therefore snapshots from two specific points in time and on For example a joiner is a doctor whose GMC number was not observed in the 2003 Principals only. 3. The figures in the table above are arrived at by checking if Doctors GMC num 2. These figures are not directly compatible with GP joiner and leaver figure (Para 52 SFA), PMS Other, Flexible Career Scheme GPs and GP Returners. Prior to September 2004 this group included GMS Unrestricted Principals, England Notes 1. General Medical Practitioners (excluding retainers and registrars) i All Practitioners (excluding Registrars & Retainers) Source: 3178271007 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 67
1.1.5 What are the department’s projections for numbers of new doctors, nurses, midwives and radiographers completing training in the next five years? Answer 1. The projected numbers of doctors, nurses, midwives and radiographers completing undergraduate or pre-registration training programmes in England over the next five years is shown in Table 1.1.5.
Table 1.1.5 TOTAL PROJECTED NEW GRADUATESEACH YEAR 2005–06 2006–07 2007–08 2008–09 2009–10
Nurses1 17,824 18,708 19,737 19,394 19,394 Midwives2 1,185 1,205 1,296 1,205 1,205 Diagnostic Radiographers3 670 670 670 670 670 Therapeutic Radiographers3 178 178 187 187 187 Doctors4 4,050 4,350 5,050 5,650 5,750
Notes 1. Numbers entering training each year will remain at current levels and attrition rate during training is 18% 2. Numbers entering training each year will remain at current levels and attrition rate during training is 18% 3. Numbers entering training each year will remain at current levels and attrition rate during training is 15% 4. Based on actual intakes up to 2004–05 and planned 2005–06 intake, attrition rate during training is 8%
1.1.6 What is department’s estimates of the numbers reaching retirement age in the next five years in each of the following professions: doctors/ nurses/ midwives/ radiographers? Answer 1. The anticipated number of retirees from the Nursing, Midwifery, Radiographer, General Practice and HCHSdoctor workforces over the next five years is shown in Table 1.1.6.
Table 1.1.6 NURSING, MIDWIFERY, RADIOGRAPHER AND GP RETIREMENT PROJECTIONS 2005–06 2006–07 2007–08 2008–09 2009–10
Nurses(1) 4,181 4,651 5,103 5,683 6,224 Midwives (1) 457 462 485 512 538 Radiographers(1) 200 200 200 340 340 GPs(3) 832 833 837 840 846 HCHSdoctors (4) 1,602 1,524 1,468 1,435 1,401
Notes 1. Nursing and midwifery retirement projections are based on the probability by age group nurses are most likely to retire 2. Radiography projections assume a retirement age of 60 3. GP Projections are based on the numbers forecast to leave the workforce aged 55 and over. They assume that the proportion of leavers in each age group will remain the same as the average number of leavers over the period 1999 to 2004. 4. The figures show estimates of the current workforce who will leave in each year who in that year will be aged 55 or above. The current workforce is defined as those recorded on the September 2004 census. The figures will not include those doctors who join the workforce subsequently to September 2004 who then leave aged 55 or above. That the figures reduce over time may be indicative of the HCHSworkforce being more transient than other groups, with an additional number of doctors retiring who are not recorded on the 2004 census.
1.2 NHS Pay 1.2.1 What is the estimated cost of implementing Agenda for Change this year, and for the next three years? Answer 1. Table 1.2.1 shows the estimated cost of implementing Agenda for Change for the financial years 2005–06 to 2008–09. 3178271007 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 68 Health Committee: Evidence
Table 1.2.1 ESTIMATED COST OF IMPLEMENTING AGENDA FOR CHANGE
Year Cumulative total £ million(1)
2005–06 980 2006–07 1,390 2007–08 1,780 2008–09 2,200
Notes 1. Totals rounded to nearest £10 million
1.2.2 What is the estimated cost of implementing the new consultant contract this year, and for the next three years? For comparison, please could the Department also provide figures for the total cost of consultant pay under the old contract, for the two years preceding the implementation of the new consultant contract. Answer 1. Table 1.2.2(a) shows the estimated cost of the consultant contract in 2003–04 to 2005–06.
Table 1.2.2(a) ESTIMATED COST OF THE CONSULTANT CONTRACT Year Cumulative total £ million(1)
2003–04 133 2004–05 182 2005–06 250 Notes 1. Figures given are to the nearest £000 2. Figures for consultant pay for the years 2001–02 and 2002–03 are given in Table 1.2.2(b).
Table 1.2.2(b) CONSULTANT EARNINGS Year £ million(1) 2001–02 2,278 2002–03 2,537
Notes 1. Figures given are to the nearest £000
1.2.3 What is the estimated cost of implementing the new GMS contract this year, and for the next three years? Answer 1. The estimated cost of implementing the new GMScontract is given in Table 1.2.3. No estimate is available beyond 2005–06. The existing GMScontract is currently being re viewed and is the subject of negotiations with GPC. Negotiations are due to be completed around the end of 2005.
Table 1.2.3 ESTIMATED COST OF IMPLEMENTING NEW GMS CONTRACT
Financial Year Estimated cost £ billion 2003–04 5.8 2004–05(1) 6.9 2005–06(1) 7.5
Notes 1. Estimated cost subject to validation/agreement with GPC. 3178271008 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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1.2.4 Please could the Department provide an estimate of the total cost of GP services, including GPs paid under both PMS and GMS a) for the two years preceding the implementation of the new GP contract and b) for the first year of the new contract’s implementation. Answer 1. The information requested is given in Table 1.2.4.
Table 1.2.4 ESTIMATED TOTAL COST OF GP SERVICES
Year Cost £ million 2002–03 4,060 2003–04(1) 4,623 2004–05(1) (2) (3) 5,921
Notes 1. This figure is not comparable with the answer given to question 1.2.3. The cost of implementing the new GMScontract includes items of spend in addition to the cost of GP services, eg dispensing costs (which accounts for most of the diVerence), investment in premises, quality preparation etc. 2. This is an estimate and subject to audit. 3. The significant increase in cost since 2003–04 reflects the increase in resources agreed as part of the new GMScontract, in particular the Quality and Outcomes Framework (QOF) wher e, broadly, 15% of practice funding is based on achieving quality outcomes based on clinical or organisational best practice. The QOF rewards practices on the basis of how well they care for patients rather then simply the number of patients they treat.
1.2.5 What is the estimated cost of implementing the new pharmacy contract this year, and for the next three years? Answer 1. Funding of £1,776 million is available to support the new community pharmacy contractual framework for 2005–06 in England. Funding for future years has not yet been determined but will be uplifted by: — the GDP deflator; — the marginal cost of the increase in the volume of prescriptions; — the increased cost of staV salaries in excess of the GDP deflator; and, — an allowance for eYciency consistent with eYciency targets in the NHS. 1.2.6 Could the Department please supply data from 1997 to the present detailing the top (discretionary and non-discretionary, and including merit or distinction awards where appropriate) and bottom of payscales, and average remuneration levels, for each of the following professional groups/grades: Nursing and Midwifery Grades D—I Nursing/ midwifery/ health visitor consultants House OYcers Senior House OYcers Specialist Registrars Associate Specialists StaV Grade Consultants General Practitioners Salaried General Practitioners employed by PCTs Answer 1. Table 1.2.6(a) to Table 1.2.6(c) show salary information for medical and dental staV, and for nursing and midwifery staV. Information for salaried general practitioners is shown in Table 1.2.6(c). Information on non-salaried general practitioners is given in Table 1.2.6(d). 3178271009 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 70 Health Committee: Evidence
Table 1.2.6(d) AVERAGE NET INCOME LEVELSRECOMMENDED BY THE DDRB FOR GPS Year £ 1996–97 44,483 1997–98 46,031 1998–99 48,037 1999–2000 52,606 2000–01 54,219 2001–02 56,510 2002–03 61,618
Table 1.2.6(a) NURSING & MIDWIFERY STAFF GRADES D To I AND NURSE, MIDWIFE & HEALTH VISITOR CONSULTANTS PAY SCALES AND AVERAGE REMUNERATION SINCE 1997–98
1997–98(1) 1998–99(1) 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 Nurse Grade D Minimum £12,385 £12,855 £14,400 £14,890 £15,445 £16,005 £16,525 £17,060 Maximum £14,165 £14,705 £15,905 £16,445 £17,055 £17,670 £18,240 £18,830 Max with Discretionary points Average Full Time Earnings £18,100 £19,000 £20,400 £21,900
Nurse Grade E Minimum £14,165 £14,705 £15,395 £15,920 £16,510 £17,105 £17,660 £18,230 Maximum £16,410 £17,030 £17,830 £19,220 £19,935 £20,655 £21,325 £22,015 Max with Discretionary points Average Full Time Earnings £20,400 £21,900 £23,500 £25,200
Midwifery Scale(2) Minimum £17,105 £17,660 £18,230 Maximum £23,690 £24,455 £25,250 Max with Discretionary points Average Full Time Earnings £24,100 £26,700
Nurse Grade F Minimum £15,715 £16,310 £17,075 £17,655 £18,310 £18,970 £19,585 £20,220 Maximum £19,250 £19,985 £20,925 £21,635 £22,865 £23,690 £24,455 £25,250 Max with Discretionary points(3) £21,115 £22,105 £22,860 £23,710 £24,565 £25,360 £26,180 Average Full Time Earnings £23,000 £24,000 £26,100 £28,000
Nurse Grade G Minimum £18,535 £19,240 £20,145 £20,830 £21,605 £22,385 £23,110 £23,860 Maximum £21,440 £22,255 £23,300 £24,090 £25,420 £26,340 £27,190 £28,070 Max with Discretionary points(3) £23,410 £24,515 £25,350 £26,290 £27,245 £28,125 £29,035 Average Full Time Earnings £24,800 £25,800 £28,000 £29,900
Nurse Grade H Minimum £20,710 £21,495 £22,505 £23,270 £24,135 £25,005 £25,815 £26,650 Maximum £23,680 £24,580 £25,735 £26,610 £28,045 £29,065 £30,005 £30,975 Max with Discretionary points(3) £25,775 £26,990 £27,910 £28,945 £29,990 £30,960 £31,960 Average Full Time Earnings £26,600 £27,400 £30,000 £32,100
Nurse Grade I Minimum £22,925 £23,795 £24,920 £25,770 £26,725 £27,695 £28,590 £29,515 Maximum £25,975 £26,965 £28,240 £29,205 £30,720 £31,830 £32,860 £33,920 Max with Discretionary points(3) £28,160 £29,485 £30,490 £31,620 £32,760 £33,820 £34,920 Average Full Time Earnings £29,300 £30,100 £33,200 £35,200
Nurse, Midwife & Health Visitor Consultant Minimum £27,460 £28,395 £29,450 £33,940 £35,035 £36,165 Maximum £42,010 £43,440 £45,050 £46,675 £48,185 £49,740 Max with Discretionary points Average Full Time Earnings £35,300 £38,400 £40,100
Notes 1 1 December figure used for years where increase was staged). 2 Separate midwifery scale introduced from 1 April 2002. 3 Discretionary points introduced in September 1998. 3178271011 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Table 1.2.6(b) AGENDA FOR CHANGE: NATIONAL JOB PROFILESAND PAY BANDSFOR NURSING& MIDWIFERY STAFF 2004–05 AND 2005–06
2004–05 2005–06 Job Profile Pay Band Minimum Maximum Minimum Maximum Nurse (Community) 5 £18,114 £23,442 £18,698 £24,198 Nurse (GP Practice) 5 £18,114 £23,442 £18,698 £24,198 Nurse (Schools) 5 £18,114 £23,442 £18,698 £24,198 Dental Nurse Team Leader 5 £18,114 £23,442 £18,698 £24,198 Dental Nurse Specialist 5 £18,114 £23,442 £18,698 £24,198 Midwife Entry Level 5 £18,114 £23,442 £18,698 £24,198 Nurse 5 £18,114 £23,442 £18,698 £24,198 Nurse (Mental Health) 5 £18,114 £23,442 £18,698 £24,198 Theatre Nurse 5 £18,114 £23,442 £18,698 £24,198 Nurse Specialist (Community) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist (GP Practice) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist (Schools) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist (Special Schools) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist Mental Health 6 £21,630 £29,302 £22,328 £30,247 (Community) Dental Nurse team Manager 6 £21,630 £29,302 £22,328 £30,247 Dental Nurse Tutor 6 £21,630 £29,302 £22,328 £30,247 Health Visitor 6 £21,630 £29,302 £22,328 £30,247 Midwife (Community) 6 £21,630 £29,302 £22,328 £30,247 Midwife (Hospital) 6 £21,630 £29,302 £22,328 £30,247 Midwife (Integrated) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist (NHS Direct) 6 £21,630 £29,302 £22,328 £30,247 Nurse Specialist 6 £21,630 £29,302 £22,328 £30,247 Nurse Team Leader 6 £21,630 £29,302 £22,328 £30,247 Theatre Nurse Specialist 6 £21,630 £29,302 £22,328 £30,247 Nurse Team Manager (Community) 7 £26,106 £34,417 £26,948 £35,527 Nurse Team Manager (Mental 7 £26,106 £34,417 £26,948 £35,527 Health, Community) Nurse Team Manager (Schools) 7 £26,106 £34,417 £26,948 £35,527 Health Visitor Specialist 7 £26,106 £34,417 £26,948 £35,527 Health Visitor Team Manager 7 £26,106 £34,417 £26,948 £35,527 Nursing/Health Visitor Specialist 7 £26,106 £34,417 £26,948 £35,527 (Community Practice Teacher) Midwife Higher Level 7 £26,106 £34,417 £26,948 £35,527 Midwife Higher Level (Research 7 £26,106 £34,417 £26,948 £35,527 Projects) Midwife Team Manager 7 £26,106 £34,417 £26,948 £35,527 Nurse Team Manager (NHSDirect) 7 £26,106 £34,417 £26,948 £35,527 Nurse Advanced 7 £26,106 £34,417 £26,948 £35,527 Nurse Team Manager 7 £26,106 £34,417 £26,948 £35,527 Modern Matron 8A £33,298 £39,958 £34,372 £41,246 Midwife Consultant 8A-8C £33,298 £57,539 £34,372 £59,395 Nurse Consultant 8A-8C £33,298 £57,539 £34,372 £59,395 3178271011 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 72 Health Committee: Evidence £61,935 £42,985 £35,511 £22,907 £34,158 £28,307 £25,324 £20,295 £68,790 £72,882 £75,233 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 Table 1.2.6(c) (1) 1998–99 (1) MEDICAL AND DENTAL STAFF GRADES 1997–98 PAYSCALES AND AVERAGE REMUNERATIONS SINCE 1997–98 cers Y cers Y Max with Discretionary points Average Full Time Earnings £51,500 £57,000 £65,300 £71,200 Maximum £45,120 £46,180 £48,825 £50,435 £52,400 £56,105 £57,915 £60,000 Associate Specialists Minimum £25,945 £26,560 £28,065 £28,995 £30,125 £31,210 £32,220 £33,090 Average Full Time Earnings £40,000 £42,200 £52,900 £59,500 Maximum £31,400 £32,135 £33,965 £35,080 £36,460 £37,775 £39,000 £41,733 Specialist Registrars Minimum £21,530 £22,040 £23,300 £24,070 £25,015 £25,920 £26,760 £27,483 Average Full Time Earnings £32,100 £33,600 £41,200 £45,500 Maximum £24,440 £26,340 £27,845 £28,760 £29,880 £32,520 £33,570 £34,477 Minimum £19,260 £19,715 £20,845 £21,535 £22,380 £23,190 £23,940 £24,587 Senior House O Average Full Time Earnings £22,800 £24,000 £28,200 £32,100 Maximum £17,430 £17,840 £18,860 £19,480 £20,245 £20,975 £21,655 £22,240 House O Minimum £15,440 £15,800 £16,710 £17,260 £17,935 £18,585 £19,185 £19,703 3178271011 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 73 2 £30,808 0 £43,871 £46,955 £48,469 £70,710 £72,478 £74,816 £65,035 £67,133 £69,298 £88,000 £90,838 £93,768 £46,455 £47,710 £49,248 £155,180 £160,185 £165,351 0 £54,340 £55,699 n/a —continued £40,520 3,640 £66,120 £68,505 £70,715 £72,483 £74,658 0 £124,100 £128,935 £133,585 £137,895 £141,830 £146,241 continued 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 (1) Table 1.2.6(c)— 1998–99 (1) MEDICAL AND DENTAL STAFF GRADES 1997–98 PAYSCALES AND AVERAGE REMUNERATIONS SINCE 1997–98 Grade Practitioner V 1 December figure used for years where increase was staged. Maximum Minimum Salaried GPs Employed by PCTs Average Full Time Earnings £69,700 £71,600 £82,300 £93,900 CEAs Max 2003 contract with Distinction Awards/CEAs Awards/CEAs Maximum 2003 contract without Distinction Awards/CEAs Max pre 2003 contract with Distinction Awards/ £110,115 £113,890 £120,13 Maximum pre 2003 contract without Distinction £56,470 £57,800 £61,605 £6 Minimum 2003 contract Consultants Minimum pre 2003 contract £43,750 £44,780 £47,345 £48,905 £50,810 £52,64 Average Full Time Earnings £44,100 £45,100 £53,100 £58,100 Max with optional points post 1997 £44,970 £48,895 £52,860 £56,732 £58,56 Maximum post 1997 £39,620 £41,880 £43,270 £36,070 £39,675 £40,960 £42,50 Max with optional points pre 1997 Sta 1 Maximum pre 1997 £34,880 £35,700 £37,740 £38,990 £36,070 £41,980 £45,720 Minimum £23,390 £23,940 £25,320 £26,150 £27,170 £28,150 £29,060 £29,845 3178271013 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 74 Health Committee: Evidence
1.3 Treatment provided outside the NHS 1.3.1 Could the Department please update the information provided in response to last year’s questionnaire on NHS expenditure on health care purchased from independent UK providers, with figures broken down between acute and non-acute care and by specialty? [1.3.1] Answer 1. Overall spending on healthcare provided by non-NHSbodies has been risi ng. For 2002–03 an increase of £456 million on the previous year and for 2003–04 the increase was just over £1 billion. Figures are from annual financial returns and should be reliable. 2. Table 1.3.1 shows expenditure by NHSbodies on the purchase of healthcare from non-NHS bodies. The figures include expenditure on services provided by all non-NHSbodies , including local authorities and other statutory bodies, as well as independent healthcare providers. The figures cannot be broken down between acute and non-acute care.
Table 1.3.1 EXPENDITURE ON PURCHASE OF HEALTHCARE FROM NON-NHS BODIES
Year Expenditure on purchase of healthcare from non-NHS bodies (£000’s) 1999–2000 1,301,196 2000–01 1,549,172 2001–02 1,792,967 2002–03 2,249,331 2003–04 3,315,892 Source: Annual financial returns of NHStrusts, primary care trusts and health auth orities.
1.3.2 How do the most recent prices paid by the NHS for independently provided inpatient and day case treatment, provided both by ISTCs and elsewhere in the private sector, compare with NHS reference costs for the same treatments and procedures? [1.3.2] Answer 1. The information requested is given in Table 1.3.2 in respect of: — 2003–04 data for completed activity from operational IS-TC programme schemes. — 2004–05 data for completed activity from operational IS-TC programme schemes. 2. This quantitative data makes no reference to the varying commercial terms achieved under diVerent procurement arrangements, or the benefits delivered to the NHS. The figures cannot therefore be used as even a relative measure of value for money achieved.
Table 1.3.2 COMPLETED ACTIVITY FROM OPERATIONAL IS-TC PROGRAMME
Data range Nos of Cost from NHS DiVerence activities IS equivalent cost 2003–04 IS-TC 3,663 £3.3 million £3.0 million 9% programme 2004–05 IS-TC 46,000 £78.8 million £84.0 million "6.2% programme (1) Notes 1. Includes General Supplementary activity and BUPA Redwood contract amounts.
1.3.3 Could the Department please update the information provided in response to last year’s questionnaire concerning NHS spending on health care provided outside the UK? [1.3.4] Answer 1. There are two separate systems in operation. Regulations (EEC) 1408/71 and 574/72 co-ordinate the social security and health care systems of the member states of the European Union the European Economic Area and Switzerland. These Regulations cover, amongst other things, medically necessary health care for temporary visitors (the E111/European Health Insurance Card (EHIC) arrangements) and referral of patients specifically for treatments of pre-existing conditions (the E112 scheme). 3178271014 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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2. A direct referral scheme outside the scope of the European Community arrangements was available in England until 31 March 2005. Between January and April 2002 there was a pilot scheme in south east England whereby a number of surgical procedures were commissioned directly by the NHSfrom healthcare providers in France and Germany. One hundred and ninety patients were treated under this pilot at a cost of £1.1 million. Since November 2002 PCTs have powers to refer patients abroad directly at the NHSexpense if they wish/need to, but details of the costs and volumes of this activity are not collected centrally. 3. This was extended for orthopaedic treatment overseas, with patients drawn from five diVerent areas. A total of 917 patients have been referred for treatment abroad as part of the overseas treatment programme at a cost of £6.5 million. The option of receiving treatment abroad was also been oVered as part of two patient Choice pilot schemes. This includes all programme costs, for treatment, travel, comprehensive rehabilitation and outpatient clinics run within the UK by European clinicians. A total of 21 cardiac patients have also been treated abroad at a cost £300,000 4. The data in Table 1.3.3 below shows, in resource terms, costs of treatment provided under the terms of the Regulations to UK insured persons. Actual treatment costs are used for both medically necessary health care (E111/EHIC) and for patients referred specifically for treatment (E112) as well as some other categories of persons covered. But claims do not necessarily distinguish between categories so that no cost distribution between E111/EHIC and E112 arrangements is available. Patient numbers are not available since claims may cover several episodes of care for a single individual. However, the UK approved the following number of patient referrals under E112 arrangements as follows: 2004–05 % 232 5. Lump sum costs cover, in particular state pensioners who have relocated to other member states; the costs of their health care lie with the member state paying the pension (unless they also have a pension from the member state of residence). 6. No precise information is available on types of treatment covered. For E111/EHIC, medically necessary health care covers the range from minor ambulatory care to major trauma. E112s cover ongoing treatment begun in the UK, specialised care not available in the UK and care for which there is a long UK waiting time. 7. It is estimated that the overall resource requirement for treatment given to UK insured person under the Regulation in other EEA member states in 2005–06 will be £526 million.
Table 1.3.3 COSTS OF TREATMENT PROVIDED UNDER THE TERMS OF THE REGULATIONS TO UK INSURED PERSONS
Year Claim type Member States UK claims against claims against the Member States United Kingdom £000 £000
2002–03 Actual cost 26,500 14,200 Lump sums 233,200 17,300 Total 249,700 31,500 2003–04 Actual cost 40,091 15,248 Lump sums 273,909 9,926 Total 314,000 25,174 2004–05 Actual cost 49,500 18,700 Lump sums 331,900 12,500 Total 381,500 31,200
Notes 1. Figures are based on latest available information and used in the 2004–05 Resource Accounting and Budgeting (RAB) outturn exercise. This information is compiled in line with the requirements of “Government Accounting 2000“” and National Audit OYce (NAO). 2. Claims against UK are made in national currency and converted in sterling by using the quarterly mean exchange rates published by the EU commission; 3. Actual costs under Article 93 of Regulation 574/72 include E111s/EHIC (temporary visitors) and E112 cases (referred patients); 4. Lump sums under Articles 94 and 95 of Regulation 574/72 include E121s (pensioners). 5. Figures may not add up due to rounding. 1.3.4 What was the total cost paid to Alliance Medical for MRI scanning services, and how many scans have been performed by Alliance Medical? Over the same timescale, how many scans were performed by the NHS, and what was the cost to the NHS of this? 3178271014 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Answer 1. The contract with Alliance Medical is to provide 635,000 MRI scans over a contract term of five years or approximately 130,000 annually. The cost per scan is less than half the available estimated equivalent NHScost. The latest available information on MRI activity in the NHSis for 2003–04, which shows that 858,000 MRI scans were carried out over this period. Equivalent data for the period 2004–05 is not yet available. 2. The NHSdoes not currently collect separate cost data on the cost of MRI sc anning carried out as part of outpatient attendances and inpatient episodes of care in NHStrusts. Th e only collated NHScost information available is the MRI Direct Access TariV, applicable to MRI scans referred directly from primary care. This is an indicative tariV not mandated for use between commissioners and providers. The total cost of MRI scans in the NHScould be estimated by applying this tari V to the number of scans for 2003–04. However, this is not considered to be suYciently reliable to give an accurate picture to the Committee for the total cost of scanning in the NHSdue to the wide variation of possible scan types and patient acuities. The total cost of MRI scans delivered by Alliance Medical is commercially confidential in order to protect the tax payer’s position in the Wave 2 diagnostics procurement. 3. The Department is confident that the contract oVers value for money on the basis that a robust competition was conducted and because the price achieved was lower than the cost data which the Department does have, that is the MRI Direct Access TariV.
1.4 GP out-of-hours services 1.4.1 Following the introduction of new arrangements for funding and providing GP out-of-hours services, how much is now being spent on GP out-of-hours services? How does this compare to the cost of GP out-of- hours services under the previous system? Answer 1. This financial year, 2005–06, £322 million is available to PCTs for the provision of out-of-hours services. In addition to this, PCTs can use some of the increase in unified budgets amounting to a national total of £53.9 billion to invest in out-of-hours services. 2. As part of the new GMScontract negotiations which would provide GPs the o ption of transferring the responsibility for providing out-of-hours services to PCTs, it was agreed that where a GP practice opted- out, it would surrender 6% of its global sum. This is equivalent to around £6,000 per average GP. 3. Before the new GMScontract came into force in April 2004, GPs either prov ided out-of-hours services themselves, or contracted with a deputising company or GP co-operative. The cost of providing the services was carried by the GP and it varied significantly across the country depending on demand and the service provided. This meant that there was no means to identify the cost at a national level. 4. Since the new out-of-hours arrangements came into place in 2004, 90% of practices have opted out of providing out-of-hours services.
1.5 Choose and book 1.5.1 Please could the Department supply information about the costs to date of implementing the choose and book policy, including IT costs. Answer 1. The cost to date of developing and beginning to implement the system is £28.7 million. The total committed contract cost is £65 million. Trusts and PCTs will have incurred additional costs on preparation for Choose and Book but these are not collected centrally.
2. General expenditure issues 2.1 NHS Financial Balance 2.1.1 Could the Department confirm a definitive figure for the total deficit across the NHS in the last financial year. Answer 1. In 2004–05 the NHSfinished the year with a deficit of around £250 million. T his includes NHS foundation trusts. This is not definitive because a small number of organisations have not yet finalised their accounts. 3178271016 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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2.1.2 Can you list the 41 PCTs reporting an overspend and the 65 NHS trusts that made a deficit in 2003–04, along with details of the amounts involved before and after support. What sanctions will be taken against the 41 PCTs failing in their statutory duty? Are you confident that the 65 NHS trusts failing to break even will meet their statutory duty to break even taking one financial year with another in 2004–05? Answer 1. Table 2.1.2(a) shows the 41 primary care trusts (PCTs) reporting an overspend in their 2003–04 final accounts. Table 2.1.2(b) lists those PCTs reporting an overspend in their 2004–05 final accounts. Financial support for PCTs is not reported in their final accounts. 2. Table 2.1.2(c) shows the 65 NHStrusts reporting a deficit in their 2003–04 final accounts. Table 2.1.2(d) shows those NHStrusts reporting a deficit in their 2004–05 final accounts. T he figures shown in the tables include financial support. 3. If a PCT overspends in a given financial year, this funding is taken oV them the following year as part of the carry-forward regime. 4. In addition, PCTs in deficit are required to produce recovery plans in conjunction with strategic health authorities (SHAs). 5. In 2004–05, Secretary of State wrote to the Chair of all NHS organisations reporting a significant deficit. In conjunction, Sir Nigel Crisp wrote to the Chief Executives of every NHSorganisation reporting a deficit. The letters made clear to NHSorganisations that deficits are not a cceptable. 6. We are not expecting any of the 65 NHStrusts showing a deficit for 2003–04, as detailed in Table 2.1.2(c) to report a breach of Statutory Break-even Duty in 2004–05. However, although we do not expect the trust to report a deficit in 2004–05, we expect Ashford and St Peters NHS Trust to fail its statutory break even duty.
Table 2.1.2(a) PRIMARY CARE TRUSTS REPORTING AN OVERSPEND IN THEIR 2003–04 FINAL ACCOUNTS
Net Revenue Resource Limit Overspend PCT £’000 Bedfordshire Heartlands PCT "3,008 Bexley PCT "4,296 Blackwater Valley and Hart PCT "658 Broadland PCT "1,506 Cambridge City PCT "2,881 Central Cornwall PCT "4,390 Central SuVolk PCT "1,831 Chelmsford PCT "3,997 Cherwell Vale PCT "852 Dartford, Gravesham and Swanley PCT "5,592 East Elmbridge and Mid Surrey PCT "241 Eastbourne Downs PCT "3,533 Hammersmith and Fulham PCT "8,504 Harrow PCT "667 Hillingdon PCT "672 Hounslow PCT "372 Ipswich PCT "5,598 Kennet and North Wiltshire PCT "2,067 Kensington and Chelsea PCT "1,199 Milton Keynes PCT "388 New Forest PCT "1,326 North and East Cornwall PCT "3,353 North Devon PCT "5,381 North East Oxfordshire PCT "258 North Hampshire PCT "548 North Norfolk PCT "1,662 North Somerset PCT "1,452 North Tyneside PCT "816 Northumberland Care PCT "4,424 South and East Dorset PCT "386 South Huddersfield PCT "1,098 South Leicestershire PCT "100 South Wiltshire PCT "1,102 Southern Norfolk PCT "1,690 3178271017 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 78 Health Committee: Evidence
Net Revenue Resource Limit Overspend PCT £’000 SuVolk Coastal PCT "3,480 SuVolk West PCT "4,423 Waveney PCT "474 West Gloucestershire PCT "159 West Norfolk PCT "239 West of Cornwall PCT "3,416 Wolverhampton City PCT "2,821
Table 2.1.2(b) PRIMARY CARE TRUSTS REPORTING AN OVERSPEND IN THEIR 2004–05 FINAL ACCOUNTS
Net Revenue Resource Limit Overspend PCT £’000
Bedfordshire Heartlands PCT "14,536 Bexley Care Trust "2,749 Billericay, Brentwood and Wickford PCT "1,123 Blackwater Valley and Hart PCT "2,676 Broadland PCT "4,444 Burntwood, Lichfield and Tamworth PCT "2,111 Cambridge City PCT "7,621 Cannock Chase PCT "1,235 Canterbury and Coastal PCT "2,276 Central Cornwall PCT "5,294 Central SuVolk PCT "3,837 Charnwood and NW Leicestershire PCT "1,200 Chelmsford PCT "7,144 Cherwell Vale PCT "4,404 Cheshire West PCT "548 Chiltern and South Bucks PCT "1,494 Colchester PCT "1,470 Cotswold and Vale PCT "4,809 Dacorum PCT "4,840 Dartford, Gravesham and Swanley PCT "1,086 East Elmbridge and Mid Surrey PCT "2,563 East Hampshire PCT "5,199 East Lincolnshire PCT "4,483 Eastbourne Downs PCT "964 Eastleigh and Test Valley South PCT "1,283 Fareham and Gosport PCT "6,757 Guildford and Waverley PCT "5,887 Harrow PCT "969 Havering PCT "3,258 Hertsmere PCT "4,897 Hillingdon PCT "13,470 Hounslow PCT "6,171 Huntingdonshire PCT "1,516 Ipswich PCT "10,119 Isle of Wight PCT "361 Kennet and North Wiltshire PCT "10,159 Kensington and Chelsea PCT "17,976 Kingston PCT "1,853 Leicester City West PCT "957 Luton PCT "6,038 Maidstone Weald PCT "3,714 Maldon and South Chelmsford PCT "1,489 Medway PCT "196 Mid-Hampshire PCT "826 Milton Keynes PCT "4,860 New Forest PCT "8,592 Newbury and Community PCT "114 3178271018 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 79
Net Revenue Resource Limit Overspend PCT £’000 Newcastle-under-Lyme PCT "597 North and East Cornwall PCT "6,668 North Birmingham PCT "1,339 North Devon PCT "5,263 North East Oxfordshire PCT "1,938 North Hampshire PCT "890 North Hertfordshire and Stevenage PCT "3,860 North Norfolk PCT "5,294 North Somerset PCT "5,202 North Stoke PCT "6,810 Norwich PCT "108 Oldbury and Smethwick PCT "179 Selby and York PCT "6,598 South and East Dorset PCT "2,424 South Cambridgeshire PCT "2,583 South East Hertfordshire PCT "446 South Leicestershire PCT "966 South Stoke PCT "1,719 South West Oxfordshire PCT "5,172 South Western StaVordshire PCT "3,750 South Wiltshire PCT "1,535 Southern Norfolk PCT "7,152 St Albans and Harpenden PCT "1,526 StaVordshire Moorlands PCT "3,725 SuVolk Coastal PCT "6,174 SuVolk West PCT "12,510 Sussex Downs and Weald PCT "1,819 Swale PCT "449 Thurrock PCT "755 Vale of Aylesbury PCT "4,916 Waltham Forest PCT "2,538 Wandsworth PCT "8,237 Watford and Three Rivers PCT "1,928 Waveney PCT "1,533 Welwyn Hatfield PCT "128 West Gloucestershire PCT "3,110 West Norfolk PCT "1,482 West of Cornwall PCT "5,669 West Wiltshire PCT "2,803 Witham, Braintree and Halstead Care Trust "3,141 Wycombe PCT "429 Wyre Forest PCT "1,968 Yorkshire Wolds and Coast PCT "6,116
Table 2.1.2(c) NHSTRUSTSREPORTINGA DEFICIT IN THEIR 2003–04 FINAL ACCOUNTS
Financial Retained deficit support excluding included in financial NHS trust Retained deficit retained deficit support £’000 £’000 £’000 Addenbrooke’s NHSTrust "921 0 "921 Airedale NHSTrust "1,448 1,100 "2,548 Barnet and Chase Farm Hospitals NHSTrust "4,398 1,250 "5,648 Barnet, Enfield and Haringey MH NHSTrust "924 0 "924 Berkshire Healthcare NHSTrust "851 3,800 "4,651 Blackpool, Fylde and Wyre Hospitals NHSTrust "929 950 "1,879 Brighton and Sussex University Hospitals NHS Trust "7,912 3,500 "11,412 Buckinghamshire Hospitals NHSTrust "5,237 4,000 "9,237 Buckinghamshire Mental Health NHSTrust "1,689 0 "1,689 Burton Hospitals NHSTrust "179 0 "179 3178271019 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 80 Health Committee: Evidence
Financial Retained deficit support excluding included in financial NHS trust Retained deficit retained deficit support £’000 £’000 £’000 Chelsea and Westminster Healthcare NHSTrust "1,880 1,000 "2,880 East Kent Community NHSTrust "225 0 "225 East Lancashire Hospitals NHSTrust "3,934 3,810 "7,744 East Sussex County NHS Trust "1,025 0 "1,025 East Sussex Hospitals NHS Trust "1,787 2,411 "4,198 Essex Rivers Healthcare NHSTrust "5,843 0 "5,843 Frimley Park Hospital NHSTrust "524 2,700 "3,224 Good Hope Hospital NHSTrust "5,014 0 "5,014 Hampshire Ambulance Service NHS Trust "1,727 0 "1,727 Hereford Hospitals NHSTrust "18 0 "18 Ipswich Hospital NHSTrust "1,404 0 "1,404 Kettering General Hospital NHSTrust "1,197 650 "1,847 Kings Lynn and Wisbech Hospitals NHSTrust "5,358 0 "5,358 Leeds Teaching Hospitals NHSTrust "309 8,000 "8,309 Local Health Partnerships NHSTrust "489 0 "489 Maidstone and Tunbridge Wells NHSTrust "8,968 0 "8,968 Mayday Healthcare NHSTrust "163 0 "163 Mid StaVordshire General Hospitals NHSTrust "509 0 "509 Mid Yorkshire Hospitals NHSTrust "18,637 12,000 "30,637 Milton Keynes General Hospital NHSTrust "3,172 0 "3,172 North Cumbria Acute Hospitals NHSTrust "4,133 7,615 "11,748 North Middlesex University Hospital NHSTrust "989 0 "989 North West London Hospitals NHSTrust "3,099 0 "3,099 North West Surrey MH NHSPartnership NHSTrust "1,261 0 "1,261 Northampton General Hospital NHSTrust "4,922 0 "4,922 NuYeld Orthopaedic NHSTrust "309 0 "309 Papworth Hospital NHSTrust "252 0 "252 Peterborough Hospitals NHSTrust "969 0 "969 Plymouth Hospitals NHSTrust "7,753 3,200 "10,953 Princess Alexandra Hospital NHSTrust "495 4,300 "4,795 Rob Jones and A Hunt Orthopaedic NHSTrust "2,314 0 "2,314 Royal Cornwall Hospitals NHSTrust "5,845 9,435 "15,280 Royal Free Hampstead NHSTrust "961 1,000 "1,961 Royal Surrey County Hospital NHS Trust "1,549 9,710 "11,259 Royal United Hospital Bath NHSTrust "1,968 10,000 "11,968 Royal Wolverhampton Hospital NHSTrust "7,612 0 "7,612 Sandwell & West Birmingham Hospitals NHS Trust "1,593 0 "1,593 Shrewsbury and Telford Hospital NHS Trust "791 1,200 "1,991 South Tees Hospitals NHS Trust "1,712 5,950 "7,662 Southampton University Hospitals NHS Trust "5,418 2,950 "8,368 St George’s Healthcare NHS Trust "650 11,116 "11,766 St Mary’s NHS Trust "503 0 "503 Surrey and Sussex Healthcare NHS Trust "4,149 8,700 "12,849 Sussex Ambulance Service NHS Trust "229 0 "229 The Hillingdon Hospital NHSTrust "963 0 "963 The Royal West Sussex NHS Trust "3,572 2,600 "6,172 TraVord Healthcare NHSTrust "744 1,800 "2,544 Walsall Hospitals NHSTrust "1,057 0 "1,057 West Hertfordshire Hospitals NHSTrust "519 0 "519 West London Mental Health NHSTrust "1,369 0 "1,369 West SuVolk Hospitals NHSTrust "2,501 0 "2,501 Weston Area Health NHSTrust "1,514 0 "1,514 Whittington Hospital NHSTrust "3,400 500 "3,900 Worcestershire Acute Hospitals NHSTrust "12,801 0 "12,801 Worthing and Southlands Hospitals NHS Trust "27 400 "427 3178271020 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 81
Table 2.1.2(d) NHSTRUSTSREPORTINGA DEFICIT IN THEIR 2004–05 FINAL ACCOUNTS
Financial Retained deficit support excluding included in financial NHS trust Retained deficit retained deficit support £’000 £’000 £’000 Airedale NHSTrust "3,288 0 "3,288 Bedford Hospitals NHSTrust "8,480 0 "8,480 Birmingham Women’s Health Care NHSTrust "264 0 "264 Bolton Hospitals NHSTrust "2,706 0 "2,706 Brighton and Sussex University Hospitals NHS Trust "10,035 3,000 "13,035 Buckinghamshire Mental Health NHSTrust "1,049 1,700 "2,749 Burton Hospitals NHSTrust "2,507 0 "2,507 Cambs & Peterborough MH Partnership Trust "348 0 "348 Central Manchester/Manchester Child NHSTrust "7,727 0 "7,727 Dartford and Gravesham NHSTrust "1,146 0 "1,146 Devon Partnership NHSTrust "535 0 "535 East and North Hertfordshire NHSTrust "8,557 3,000 "11,557 East Lancashire Hospitals NHSTrust "4,025 5,000 "9,025 East Sussex Hospitals NHS Trust "4,983 0 "4,983 George Eliot Hospital NHSTrust "786 0 "786 Good Hope Hospital NHSTrust "3,576 0 "3,576 Great Ormond Street Hospital for Children NHS Trust "557 0 "557 Hammersmith Hospitals NHSTrust "17,819 0 "17,819 Hampshire Ambulance Service NHS Trust "2,537 2,000 "4,537 Heatherwood and Wexham Park Hospitals NHSTrust "4,186 0 "4,186 Hinchingbrooke Health Care NHSTrust "1,566 0 "1,566 Hull and East Yorkshire Hospitals NHSTrust "5,461 2,000 "7,461 Ipswich Hospital NHSTrust "6,443 0 "6,443 Kettering General Hospital NHSTrust "1,721 4,250 "5,971 King’s College Hospital NHSTrust "2,734 0 "2,734 Kings Lynn and Wisbech Hospitals NHSTrust "8,499 0 "8,499 Lancashire Teaching Hospitals NHSTrust "2,882 1,500 "4,382 Medway NHSTrust "279 0 "279 Mid Essex Hospital Services NHS Trust "2,299 1,000 "3,299 Mid StaVordshire General Hospitals NHSTrust "2,158 1,500 "3,658 Mid Yorkshire Hospitals NHSTrust "19,876 "637 "19,239 Morecambe Bay Hospitals NHSTrust "1,548 0 "1,548 North Middlesex University Hospital NHSTrust "4,106 1,000 "5,106 North West London Hospitals NHSTrust "11,744 0 "11,744 Northern Devon Healthcare NHSTrust "991 0 "991 Plymouth Hospitals NHSTrust "8,317 6,000 "14,317 Queen Elizabeth Hospital NHSTrust "9,186 4,473 "13,659 Queen Mary’s Sidcup NHS Trust "4,608 0 "4,608 Royal Bournemouth and Christchurch NHSTrust "250 0 "250 Royal Brompton and Harefield NHSTrust "3,217 0 "3,217 Royal Free Hampstead NHSTrust "10,217 7,000 "17,217 Royal United Hospital Bath NHSTrust "946 9,379 "10,325 Royal Wolverhampton Hospital NHSTrust "9,016 0 "9,016 Sandwell & West Birmingham Hospitals NHS Trust "7,806 0 "7,806 Scarborough and NE Yorkshire NHS Trust "4,506 1,800 "6,306 Shrewsbury and Telford Hospital NHS Trust "10,115 9,157 "19,272 South Tees Hospitals NHS Trust "8,898 12,000 "20,898 South Warwickshire General Hospitals NHS Trust "8,783 2,827 "11,610 Southampton University Hospitals NHS Trust "11,579 6,900 "18,479 Southport and Ormskirk Hospital NHS Trust "1,189 9,372 "10,561 St George’s Healthcare NHS Trust "21,656 0 "21,656 St Mary’s NHS Trust "3,219 0 "3,219 Surrey and Sussex Healthcare NHS Trust "30,657 1,719 "32,376 The Lewisham Hospital NHSTrust "7,505 0 "7,505 The Royal National Orthopaedic Hospital NHSTrust "3,793 0 "3,793 The Royal West Sussex NHS Trust "15,483 0 "15,483 TraVord Healthcare NHSTrust "3,490 2,989 "6,479 United Lincolnshire Hospitals NHSTrust "4,913 5,650 "10,563 3178271020 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 82 Health Committee: Evidence
Financial Retained deficit support excluding included in financial NHS trust Retained deficit retained deficit support £’000 £’000 £’000 Walsall Hospitals NHSTrust "1,845 0 "1,845 West Dorset General Hospitals NHSTrust "448 0 "448 West Hertfordshire Hospitals NHSTrust "9,978 0 "9,978 West Middlesex University NHSTrust "3,991 0 "3,991 West Midlands Ambulance NHSTrust "203 0 "203 West SuVolk Hospitals NHSTrust "7,638 0 "7,638 Weston Area Health NHSTrust "5,154 0 "5,154 Wrightington, Wigan and Leigh NHSTrust "743 0 "743
2.1.3 In addition, could you supply details of all deficits and surpluses occurring in NHS Trusts for each year since 1997?
Answer 1. The deficits and surpluses occurring in NHStrusts for each year from 1997 –98 to 2003–04 are shown in Table 2.1.3(a) to (h).
Table 2.1.3(a) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 1997–98
Retained surplus/(deficit) NHS trusts £’000 Addenbrookes NHSTrust (564) Aintree Hospitals NHSTrust 259 Airedale NHSTrust 61 Alexandra Health Care NHSTrust (893) Allington NHSTrust 13 Andover District Comm Health Care Trust (224) Anglian Harbours NHSTrust (1,230) Ashford Hospital NHSTrust (1,003) Avon Ambulance Service NHS Trust 26 Aylesbury Vale Comm Healthcare NHSTrust 94 Barnet Community Healthcare NHSTrust (11) Barnsley Comm and Priority Serv NHS Trust 50 Barnsley District General Hospital NHSTrust 36 Barts and the London NHSTrust (4,283) Basildon & Thurrock Uni Hosp NHSTrust 246 Bassetlaw Hosp and Comm Health Serv Trust 33 Bath and West Community NHSTrust 1 Bath Mental Health Care NHSTrust 4 B’Burn, H’Burn & R’Ble Valley NHSTrust (396) Bedford and Shires Health and Care NHS Trust (662) Bedford Hospital NHSTrust 36 Beds and Herts Ambulance and Paramedic Trust 118 BHB Community Health Care NHSTrust (981) Birmingham Children’s Hospital NHSTrust 202 Birmingham Heartland and Solihull NHS Trust 264 Birmingham Women’s Health Care NHSTrust 378 Bishop Auckland Hospitals NHSTrust 8 Black Country Mental Health NHSTrust (8) Blackpool Victoria Hospital NHSTrust (284) Blackpool, Wyre and Fylde Community Trust 502 Bolton Hospitals NHSTrust (472) Bournewood Community and MH NHSTrust 248 Bradford Community Health NHSTrust 1,246 Bradford Teaching Hosps NHSTrust (303) Brighton Health Care NHSTrust (1,456) Bromley Hospitals NHSTrust (924) Burnley Health Care NHSTrust 52 3178271022 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 83
Retained surplus/(deficit) NHS trusts £’000 Burton Hospitals NHSTrust 13 Bury Health Care NHSTrust 2 Calderdale Healthcare NHSTrust 482 Calderstones NHSTrust 1,102 Camden and Islington Comm Health NHSTrust 91 Canterbury and Thanet Community NHSTrust (383) Carlisle Hospitals NHSTrust 38 Central Manchester Healthcare NHSTrust (2,683) Central Middlesex Hospital NHSTrust 52 Central Nottinghamshire NHSTrust 151 Central SheYeld Univ Hosps NHSTrust 66 Chase Farm Hospitals NHSTrust (100) Chelsea and Westminster Healthcare Trust (1,100) Cheshire Community Healthcare NHSTrust 170 Chester and Halton Community NHSTrust 14 Chesterfield Royal Hospital NHSTrust 385 Cheviot and Wansbeck NHSTrust 49 Chorley and South Ribble NHS Trust 8 Christie Hospital NHSTrust (114) CHSSouthernDerbyshire NHSTrust 144 City and Hackney Comm Services NHS trust 30 City Hospital NHSTrust 9 City Hospitals Sunderland NHS Trust 53 Clatterbridge Centre for Oncology Trust 21 Cleveland Ambulance NHSTrust 38 Comm HC Serv (North Derbyshire) NHS Trust (531) Communicare NHSTrust 54 Community Health Care: N Durham NHSTrust 15 Community Health SheYeld NHSTrust 246 Community Healthcare Bolton NHSTrust (156) Cornwall Partnership NHSTrust 125 Countess of Chester Hosp NHSTrust (1,195) Coventry & Warwickshire Ambulance NHSTrust (111) Coventry Healthcare NHSTrust 55 Crawley Horsham NHSTrust (1,235) Croydon & Surrey Downs Community NHS Trust 0 Cumbria Ambulance Service NHS Trust 15 Darlington Memorial Hospital NHSTrust 237 Dartford and Gravesham NHSTrust 1,557 Derby City General Hospital NHSTrust 39 Derbyshire Ambulance Service NHS Trust 36 Derbyshire Royal Infirmary NHSTrust 121 Dewsbury Health Care NHSTrust 933 Doncaster Healthcare NHSTrust 116 Doncaster Royal Infirm and Montagu Trust 190 Dorset Ambulance NHSTrust (176) Dorset Community NHSTrust 0 Dorset Healthcare NHSTrust (19) Dudley Group of Hospitals NHSTrust 325 Dudley Priority Health NHSTrust (261) Durham County Ambulance NHSTrust 15 Ealing Hospital NHSTrust 354 East Anglian Ambulance NHSTrust (137) East Berkshire Community Health Trust 614 East Berkshire NHSTrust (PWLD) 78 East Cheshire NHSTrust 680 East Gloucestershire NHSTrust 339 East Hertfordshire NHSTrust (938) East Somerset NHS Trust (490) East SuVolk Local Services NHS Trust 26 East Surrey Hospital and CHC NHS Trust (1,059) East Surrey Priority Care NHS Trust (99) East Wiltshire Healthcare NHSTrust 124 3178271022 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 84 Health Committee: Evidence
Retained surplus/(deficit) NHS trusts £’000 East Yorkshire Comm Healthcare NHSTrust 55 East Yorkshire Hospitals NHSTrust 38 Eastbourne and CountY Healthcare NHSTrust (78) Eastbourne Hospitals NHSTrust (124) Enfield Community Care NHSTrust 10 Epsom Health Care NHSTrust (846) Essex Ambulance Service NHS Trust 14 Essex and Hertfordshire Comm NHSTrust (61) Essex Rivers Healthcare NHSTrust (2,384) Exeter and Dist Commty Hlth Serv NHS Trust 63 First Community NHSTrust 70 Forest Healthcare NHSTrust (5,296) Fosse Health, Leicestershire Comm Trust 33 Frenchay Healthcare NHSTrust 52 Frimley Park Hospital NHSTrust (41) Furness Hospitals NHSTrust (2,410) Gateshead Healthcare NHSTrust (396) Gateshead Hospitals NHSTrust 3 George Eliot Hospital NHSTrust 40 Glenfield Hospital NHSTrust 194 Gloucestershire Ambulance Services NHST 2 Gloucestershire Royal NHSTrust 0 Good Hope Hospital NHSTrust (1,574) Grantham and District Hospital NHSTrust (176) Great Ormond St Hosp for Children NHS Trust 801 Greater Manchester Ambulance NHSTrust (174) Guild Community Healthcare NHSTrust 71 Guy’s and St Thomas’ NHS Trust 1,111 Halton General Hospital NHSTrust 80 Hammersmith Hospitals NHSTrust (1,421) Hampshire Ambulance Service NHS Trust 73 Harefield Hospital NHSTrust 97 Haringey Health Care NHSTrust 511 Harrogate Healthcare NHSTrust 28 Harrow and Hillingdon Healthcare HSTrust (486) Hartlepool and East Durham NHSTrust 237 Hastings and Rother NHSTrust 13 Havering Hospitals NHSTrust 167 Heatherwood and Wexham Park Hosps Trust (182) Heathlands Mental Health Services Trust (2,444) Hereford and Worcester Ambulance NHSTRUST 44 Hereford Hospitals NHSTrust 61 Herefordshire Community Health NHSTrust (150) Hinchingbrooke Health Care NHSTrust (372) Homerton Univ Hospital NHSTrust 6 Horizon NHSTrust 637 Horton General Hospital NHSTrust (856) Hounslow and Spelthorne Comm and MH Trust (70) Huddersfield Health Care Srvs NHS Trust 205 Hull and Holderness Community Health Trust 5 Humberside Ambulance Service NHS Trust 0 Invicta Community Care NHSTrust 185 Ipswich Hospital NHSTrust 64 Isle of Wight Healthcare NHSTrust (859) James Paget Healthcare NHSTrust 277 Kent Ambulance NHSTrust 0 Kent and Canterbury Hospitals NHSTrust 42 Kent and Sussex Weald NHS Trust 8 Kettering General Hospital NHSTrust 220 Kidderminster Healthcare NHSTrust (549) King’s College Hospital NHSTrust (1,792) Kingston and District Community NHSTrust 90 Kingston Hospital NHSTrust 163 3178271022 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 85
Retained surplus/(deficit) NHS trusts £’000 Lambeth Healthcare NHSTrust 345 Lancashire Ambulance Service NHS Trust 267 Lancaster Acute Hospitals NHSTrust (131) Lancaster Priority Services NHS Trust (605) Leeds Mental Health Teaching NHSTrust (1,674) Leicester General Hospital NHSTrust 782 Leicester Royal Infirmary NHSTrust 531 Leicestershire AMB and Paramedic NHSTrust 51 Leicestershire Mental Health Service Trust 10 Lewisham and Guys Mental Health NHSTrust 40 Lifecare NHSTrust 3 Lifespan Health Care Cambridge NHSTrust 18 Lincoln and Louth NHSTrust 437 Lincoln District Healthcare NHSTrust 68 Lincolnshire Ambulance NHSTrust 6 Liverpool Womens Hosp NHSTrust 175 London Ambulance Service NHS Trust (163) Luton and Dunstable Hospital NHSTrust (729) Manchester Childrens Hospitals NHSTrust 75 Mancunian Community Health NHSTrust (98) Mayday Healthcare NHSTrust 107 Medway NHSTrust (53) Mental Health Serv of Salford NHS Trust 10 Mersey Regional Ambulance Service Trust 114 Merton and Sutton Community NHS Trust 134 Mid Anglia Community Health NHSTrust 5 Mid Essex Comm and Mental Health NHSTrust 6 Mid Essex Hospital Services NHS Trust 106 Mid Kent Healthcare NHSTrust (270) Mid StaVordshire Gen Hospitals Trust (721) Mid Sussex NHS Trust (236) Milton Keynes Community Health NHSTrust 167 Milton Keynes General Hospital NHSTrust (101) Moorfields Eye Hospital NHSTrust 752 Mount Vernon and Watford Hospitals Trust (4,527) Mulberry NHSTrust 85 N Birmingham Community Health NHSTrust 258 N Hampshire, Loddon Community NHSTrust 404 New Possibilities NHSTrust 3 Newcastle City Health NHSTrust 1,386 Newham Community Health Servs NHS Trust 375 Newham University Hospital NHSTrust (1,499) Norfolk & Waveney MH Partnership NHSTrust 192 Norfolk and Norwich Uni Hosp NHSTrust 579 North Downs Community Health NHSTrust (902) North Durham Acute Hospitals NHSTrust 16 North East Essex Mental Health NHSTrust 138 North East Lincolnshire NHSTrust (1,421) North Hampshire Hospitals NHSTrust 2 North Hertfordshire NHSTrust (460) North Kent Healthcare NHSTrust (223) North Lakeland Healthcare NHSTrust 140 North Manchester Healthcare NHSTrust 122 North Mersey Community NHSTrust 636 North Middlesex University Hosp NHSTrust (2,660) North StaVs Combined HC NHSTrust (9) North Tees Health NHSTrust 39 North Tyneside Health Care NHSTrust 67 North Warwickshire NHSTrust 0 North West Anglia Health Care NHSTrust (122) North Yorkshire Ambulance Service Trust 21 Northallerton Health Services NHS Trust 8 Northampton Comm Healthcare NHSTrust (1,171) 3178271022 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 86 Health Committee: Evidence
Retained surplus/(deficit) NHS trusts £’000 Northampton General Hospital NHSTrust (1,636) Northern Birmingham Mental Health Trust (45) Northern Devon Healthcare NHSTrust 199 Northern General Hospital NHSTrust 5 Northgate and Prudhoe NHSTrust 918 Northumberland Community Hlth NHSTrust 20 Northumberland Mental Health NHSTrust 51 Northumbria Ambulance Service NHS Trust 11 Northwick Park and St Marks NHS Trust (2,572) Norwich Comm Health Partnership NHSTrust 89 Nottingham City Hospital NHSTrust 56 Nottingham Community Health NHSTrust 28 Nottingham Healthcare NHSTrust 709 Nottinghamshire Ambulance Serv NHS Trust 94 NuYeld Orthopaedic Centre NHSTrust (762) NW London Mental Health NHSTrust 303 Oldham NHSTrust 36 Optimum Health Services NHS Trust 69 Oxford Learning Disability NHSTrust 32 Oxford RadcliVe Hospital NHSTrust (2,510) Oxfordshire Ambulance NHSTrust 36 Oxfordshire Community Health NHSTrust 504 Oxfordshire Mental Healthcare NHSTrust (3,311) Oxleas NHSTrust 34 Papworth Hospital NHSTrust 63 Parkside NHSTrust 13 P’Boro & Stamford Hosps NHS Trust (1,271) Phoenix NHSTrust 216 Pilgrim Health NHSTrust 682 Pinderfields and Pontefract Hosp NHSTrust (1,002) Plymouth Community Services NHS Trust 3 Plymouth Hospitals NHSTrust 1 Poole Hospital NHSTrust (1,249) Portsmouth Health Care NHSTrust 40 Portsmouth Hospitals NHSTrust 97 Premier Health NHSTrust 35 Preston Acute Hospitals NHSTrust (474) Princess Alexandra Hospital NHSTrust (930) Priority Healthcare Wearside NHSTrust 243 Queen Elizabeth Hospital NHSTrust 42 Queen Mary’s Sidcup NHS Trust 17 Queen Victoria Hospital NHSTrust 0 Queen’s Medical Notts Uni Hosp NHSTrust (3,060) Ravensbourne NHSTrust 6 Redbridge Health Care NHSTrust (1,641) Richmond, Twickenham and Roehampton Trust (2,787) Riverside Community Healthcare NHSTrust 9 Riverside Mental Health NHSTrust 341 Rob Jones and a Hunt Orthopaedic NHSTrust (3) Rochdale Healthcare NHSTrust 28 Rockingham Forest NHSTrust (124) Rotherham Priority Health Services Trust 126 Royal Berkshire Ambulance Service Trust 0 Royal Berkshire and Battle Hosps NHSTrust (629) Royal Brnmth and Christcrch Trust (112) Royal Brompton Hospital NHSTrust 180 Royal Cornwall Hospitals NHSTrust 27 Royal Devon & Exeter NHSTrust 119 Royal Free Hampstead NHSTrust (628) Royal Hull Hospitals NHSTrust 6 Royal Liverpool Broadgreen Univ Hosp Trust 333 Royal Liverpool Childrens NHSTrust 70 Royal London Homoeopathic Hosp NHSTrust (160) 3178271022 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 87
Retained surplus/(deficit) NHS trusts £’000 Royal Nat Hosp Rheum Disease NHSTrust 163 Royal Nat Orthopaedic Hosp NHSTrust 471 Royal Orthopaedic Hospital NHSTrust 267 Royal Shrewsbury Hospitals NHS Trust 21 Royal Surrey County HospitaL NHS Trust 8 Royal United Hospital Bath NHSTrust (578) Royal West Sussex NHS Trust 40 Royal Wolverhampton Hospital NHSTrust (612) Rugby NHSTrust (1,557) Salford Community Health Care NHS Trust 34 Salford Royal Hospitals NHS Trust (346) Salisbury Health Care NHS Trust 413 Sandwell Healthcare NHS Trust 235 Scarborough and NE Yorks NHS Trust 11 Scunthorpe and Goole Hospitals NHS Trust (1,068) Scunthorpe Community Health Care NHS Trust 61 Severn NHS Trust 71 SheYeld Children’s NHSTrust 9 Sherwood Forest Hospitals NHS Trust 90 Shropshire’s Community Health Serv Trust 144 Shropshire’s Mental Health NHS Trust 165 Solihull Healthcare NHS Trust (49) Somerset Partnership NHS and Soc Care Trust (60) South Bedfordshire Comm HC NHS Trust 34 South Birmingham Mental Health NHS Trust 150 South Buckinghamshire NHS Trust (749) South Cumbria Community and MH NHS Trust 7 South Devon Health Care NHS Trust 9 South Downs Health NHS Trust (154) South Durham NHS Trust (2,997) South Kent Commun Healthcare NHS Trust (1,228) South Kent Hospitals NHS Trust 8 South Lincolnshire Comm and MH Serv Trust 86 South Manchester Univ Hosp NHS Trust (6,399) South Tees Community and MH NHS Trust 72 South Tees Hospitals NHS Trust (141) South Tyneside Healthcare NHS Trust (1,244) South Warwickshire Gen Hosps NHS Trust 97 South Warwickshire Health Care NHS Trust 13 South Warwickshire Mntl Hlth Serv Trust 90 South Yorkshire Ambulance Service NHS Trust 70 Southampton Community Health Serv Trust 51 Southampton University Hosps NHS Trust (43) Southend Community Care Serv NHS Trust 523 Southend Hospital NHS Trust 300 Southern Birmingham Comm Hlth NHS Trust (352) Southern Derbyshire Mental Health Trust 25 Southmead Health Services NHS Trust 251 Southport and Formby Comm HS NHS Trust 70 Southport and Formby Hosp Servs NHS Trust (562) St Albans and Hemel Hempstead NHS Trust (299) St George’s Healthcare NHS Trust (1,223) St Helens and Knowsley Comm Health Trust 13 St Helens and Knowsley Hospitals NHS Trust 124 St Helier NHS Trust 142 St James’s and Seacroft Univ Hosp Trust (2,393) St Mary’s NHS Trust (5,967) St Peter’s Hospital NHS Trust (1,110) StaVordshire Ambulance Service Trust 77 Stockport Acute Services NHS Trust 338 Stockport Healthcare NHS Trust (245) Stoke Mandeville Hospital NHS Trust (562) Surrey Ambulance Service NHS Trust 1 3178271022 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 88 Health Committee: Evidence
Retained surplus/(deficit) NHS trusts £’000 Surrey Heartlands NHS Trust (471) Sussex Ambulance Service NHS Trust (6) Sussex Weald and Downs NHS Trust 53 SW London and St George’s Mental Hlth Trust 43 Swindon and Marlborough NHS Trust (3,789) Tameside and Glossop Acute Servs NHS Trust 423 Tameside and Glossop Community NHSTrust 21 Taunton and Somerset NHS Trust 51 Tavistock and Portman NHSTrust 29 Teddington Memorial Hosp and Comm NHSTrust 24 Thameside Community Healthcare NHSTrust 407 Thameslink Healthcare Services NHS Trust (698) Thanet Health Care NHSTrust 3 The Bethlem and Maudsley NHSTrust 989 The Cardiothoracic Cntr—Liverpool NHSTrust 12 The Foundation NHSTrust 88 The Freeman Group of Hosps NHSTrust 78 The Hillingdon Hospital NHSTrust (883) The Lewisham Hospital NHSTrust (107) The Mid Cheshire Hospitals NHSTrust (570) The Princess Royal Hospital NHSTrust 153 The Queen Eliz Hosp King’s Lynn NHSTrust (164) The RadcliVe Infirmary NHSTrust 221 The Rotherham NHSTrust (176) The Royal Marsden NHSTrust 323 The Royal Victoria Infirmary Trust (2,347) The West Lindsey NHSTrust 1 The Whittington Hospital NHSTrust (1,062) Tower Hamlets Healthcare NHSTrust (1,097) TraVord Healthcare NHSTrust 45 Trecare NHSTrust 30 Two Shires Ambulance NHS Trust 4 Uni Coll London Hosp NHSTrust (649) Uni Hospital Birmingham NHSTrust 10 United Bristol Healthcare NHSTrust 200 United Leeds Teachings Hospitals Trust (4,878) Univ Hosp North StaVordshire NHSTrust (1,199) Univ Hosps Coventry & Warwickshire NHSTrust (476) W Berkshire Priority Care Serv NHS Trust 462 Wakefield and Pontefract Comm Health Trust 52 Walsall Community Health NHSTrust 30 Walsall Hospitals NHSTrust 1,368 Walton Neurology Centre NHSTrust 49 Wandsworth Community Health NHSTrust 2 Warrington Community HC NHSTrust 38 Warrington Hosptial NHSTrust (524) Wellhouse NHSTrust (6,549) West Cumbria Health Care NHSTrust 31 West Dorset General Hospitals NHSTrust (104) West Herts Community Health NHSTrust 255 West Lancashire NHSTrust 20 West London Healthcare NHSTrust 312 West Middlesex University Hosp NHSTrust 43 West Midlands Ambulance Service NHS Trust (196) West SuVolk Hospitals NHSTrust (32) West Yorkshire Ambulance Service Trust 2 Westcountry Ambulance Services NHS Trust 29 Westmorland Hospital NHSTrust (176) Weston Area Health NHSTrust 60 Weston Park Hospital NHSTrust 62 Wigan and Leigh Health Services NHS Trust (10) Wiltshire Ambulance Service NHS Trust 6 Wiltshire Health Care NHSTrust 75 3178271022 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 89
Retained surplus/(deficit) NHS trusts £’000 Winchester and Eastleigh Hlthcre NHSTrust 0 Wirral and West Cheshire Comm NHSTrust 9 Wirral Hospital NHSTrust (217) Wolverhampton Health Care NHSTrust 83 Worcester Royal Infirmary NHSTrust 16 Worcestershire Comm Healthcare NHSTrust (145) Worthing and Southlands Hospitals Trust (1,817) Worthing Priority Care Services Trust (31) Wrightington Hospital NHSTrust 89 York Hospitals NHSTrust 9
Source: NHS Trust Summarisation Schedules 1997–98 Notes 1. NHStrusts are listed under their current name.
Table 2.1.3(b) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 1998–99
NHS trusts Retained surplus/(deficit) £000s Addenbrookes NHSTrust 30 Aintree Hospitals NHSTrust 456 Airedale NHSTrust 29 Alexandra Health Care NHSTrust 0 Allington NHSTrust (515) Andover District Community Health Care Trust 224 Ashford and St Peter’s Hospitals NHS Trust 82 Avon Ambulance Service NHS Trust 0 Aylesbury Vale Community Healthcare NHSTrust 27 Barnet Community Healthcare NHSTrust (1,179) Barnsley Community and Priority Services NHS Trust 61 Barnsley Hospital NHSTrust 45 Barts and The London NHSTrust (4,149) Basildon & Thurrock University Hosp NHSFoundation Trust 492 Bassetlaw Hospital and Community Health Services Trust 30 Bath and West Community NHSTrust 48 Bath Mental Health Care NHSTrust 2 Bay Community NHSTrust 3 B’burn, H’burn & R’ble Valley NHSTrust 630 Bedford and Shires Health and Care NHS Trust 365 Bedford Hospital NHSTrust 4 Beds and Herts Ambulance and Paramedic Trust 88 Bhb Community Health Care NHSTrust (28) Birmingham Children’s Hospital NHSTrust (849) Birmingham Heartland and Solihull NHS Trust 628 Birmingham Women’s Health Care NHSTrust (697) Black Country Mental Health NHSTrust (55) Blackpool Victoria Hospital NHSTrust (358) Blackpool, Wyre and Fylde Community Trust 420 Bolton Hospitals NHSTrust 1 Bournewood Community and MH NHSTrust (25) Bradford Community Health NHSTrust 167 Bradford Teaching Hospitals NHSTrust 352 Brighton Health Care NHSTrust 1,821 Bromley Hospitals NHSTrust (154) Burnley Health Care NHSTrust 918 Burton Hospitals NHSTrust 212 Bury Health Care NHSTrust 19 Calderdale Healthcare NHSTrust 2 Calderstones NHSTrust 99 Camden and Islington Community Health NHSTrust 94 3178271023 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 90 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s Carlisle Hospitals NHSTrust 25 Central Manchester Healthcare NHSTrust 869 Central Middlesex Hospital NHSTrust 161 Central Nottinghamshire NHSTrust 5 Central SheYeld University Hospitals NHSTrust 4,307 Chase Farm Hospitals NHSTrust 0 Chelsea and Westminster Healthcare Trust (4,688) Cheshire Community Healthcare NHSTrust 114 Chester and Halton Community NHSTrust 0 Chesterfield Royal Hospital NHSTrust 457 Chorley and South Ribble NHS Trust 31 Christie Hospital NHSTrust 17 CHSSouthernDerbyshire NHSTrust 161 City and Hackney Community Services NHS Trust (27) City Hospital NHSTrust (337) City Hospitals Sunderland NHS Trust (64) Clatterbridge Centre for Oncology Trust 74 Cleveland Ambulance NHSTrust 12 Community HC Services (North Derbyshire) NHS Trust 73 Communicare NHSTrust 84 Community Health SheYeld NHSTrust 69 Community Healthcare Bolton NHSTrust 25 Cornwall Partnership NHSTrust 2 Countess of Chester Hospital NHSTrust 1,405 County Durham and Darlington Prior SRV Trust 35 Coventry & Warwickshire Ambulance NHSTrust 11 Coventry Healthcare NHSTrust 29 Croydon & Surrey Downs Community NHS Trust 0 Cumbria Ambulance Service NHS Trust 35 Dartford and Gravesham NHSTrust 793 Derby Hospitals NHSTrust 399 Derbyshire Ambulance Service NHS Trust 15 Dewsbury Health Care NHSTrust 710 Doncaster Healthcare NHSTrust 512 Doncaster Royal Infirm and Montagu Trust 46 Dorset Ambulance NHSTrust 72 Dorset Community NHSTrust 0 Dorset Health Care NHSTrust 19 Dudley Group of Hospitals NHSTrust 41 Dudley Priority Health NHSTrust (117) Durham County Ambulance NHSTrust 5 Ealing Hospital NHSTrust 34 East Anglian Ambulance NHSTrust 47 East Berkshire Community Health Trust 259 East Berkshire NHSTrust (PWLD) 47 East Cheshire NHSTrust 51 East Gloucestershire NHSTrust 305 East Hertfordshire NHSTrust (1,119) East Kent NHSand SCPartnership Trust 458 East Somerset NHS Trust 3 East SuVolk Local Services NHS Trust (826) East Wiltshire Healthcare NHSTrust 235 East Yorkshire Comm Healthcare NHSTrust 20 East Yorkshire Hospitals NHSTrust 7 Eastbourne and County Healthcare NHSTrust 16 Eastbourne Hospitals NHSTrust (118) Enfield Community Care NHSTrust 30 Epsom Health Care NHSTrust (4,721) Essex Ambulance Service NHS Trust 54 Essex and Hertfordshire Community NHSTrust (150) Essex Rivers Healthcare NHSTrust (2,897) Exeter and Dist Community Hlth Services NHS Trust 12 First Community NHSTrust 136 Forest Healthcare NHSTrust (2,282) 3178271023 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 91
NHS trusts Retained surplus/(deficit) £000s Fosse Health, Leicestershire Community Trust 40 Frenchay Healthcare NHSTrust 13 Frimley Park Hospital NHSTrust 61 Gateshead Health NHSTrust 48 George Eliot Hospital NHSTrust (182) Glenfield Hospital NHSTrust 42 Gloucestershire Ambulance Services NHS Trust 14 Gloucestershire Royal NHSTrust (163) Good Hope Hospital NHSTrust 469 Grantham and District Hospital NHSTrust 16 Great Ormond St Hospital for Children NHS Trust 695 Greater Manchester Ambulance NHSTrust 388 Guild Community Healthcare NHSTrust 114 Guy’s and St Thomas’ NHS Trust 466 Halton General Hospital NHSTrust 106 Hammersmith Hospitals NHSTrust (77) Hampshire Ambulance Service NHS Trust 4 Haringey Health Care NHSTrust 15 Harrogate Healthcare NHSTrust 350 Harrow and Hillingdon Healthcare NHSTrust 176 Hartlepool and East Durham NHSTrust 2 Hastings and Rother NHSTrust 187 Havering Hospitals NHSTrust 45 Heatherwood and Wexham Park Hospitals Trust 508 Hereford and Worcester Ambulance NHSTrust 20 Hereford Hospitals NHSTrust 98 Herefordshire Community Health NHSTrust (219) Hinchingbrooke Health Care NHSTrust 206 Homerton University Hospital NHSTrust 64 Horizon NHSTrust 488 Hounslow and Spelthorne Community and MH Trust 36 Huddersfield Health Care Srvs NHS Trust 211 Hull and Holderness Community Health Trust 12 Humberside Ambulance Service NHS Trust 0 Invicta Community Care NHSTrust 283 Ipswich Hospital NHSTrust (769) Isle of Wight Healthcare NHSTrust 7 James Paget Healthcare NHSTrust 14 Kent Ambulance NHSTrust 0 Kent and Canterbury Hospitals NHSTrust (304) Kent and Sussex Weald NHS Trust 27 Kettering General Hospital NHSTrust 92 Kidderminster Healthcare NHSTrust 748 King’s College Hospital NHSTrust 47 Kingston and District Community NHSTrust (300) Kingston Hospital NHSTrust 76 Lambeth Healthcare NHSTrust (128) Lancashire Ambulance Service NHS Trust 68 Leeds Mental Health Teaching NHSTrust (2,332) Leeds Teaching Hospitals NHSTrust (5,800) Leicester General Hospital NHSTrust 415 Leicester Royal Infirmary NHSTrust 734 Leicestershire Ambulance and Paramedic NHSTrust (1) Leicestershire Mental Hlth Service Trust 27 Lewisham and Guys Mental Health NHSTrust (50) Lifecare NHSTrust (3,748) Lifespan Health Care Cambridge NHSTrust 85 Lincoln and Louth NHSTrust 241 Lincoln District Healthcare NHSTrust 18 Lincolnshire Ambulance NHSTrust 2 Liverpool Womens Hospital NHSTrust 236 London Ambulance Service NHS Trust 485 Luton and Dunstable Hospital NHSTrust (595) Manchester Childrens Hospitals NHSTrust 19 3178271023 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 92 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s Mancunian Community Health NHSTrust 100 Mayday Healthcare NHSTrust 31 Medway NHSTrust (107) Mental Health Service of Salford NHS Trust 1,017 Mersey Regional Ambulance Service Trust 5 Merton and Sutton Community NHS Trust (342) Mid Anglia Community Health NHSTrust (446) Mid Essex Community and Mental Health NHSTrust (263) Mid Essex Hospital Services NHS Trust (801) Mid Kent Healthcare NHSTrust 46 Mid StaVordshire General Hospitals Trust (73) Mid Sussex NHS Trust (599) Milton Keynes Community Health NHSTrust 0 Milton Keynes General Hospital NHSTrust (201) Moorfields Eye Hospital NHSTrust 0 Morecambe Bay Hospitals NHSTrust 175 Mount Vernon and Watford Hospitals Trust (2,503) Mulberry NHSTrust 33 North Birmingham Community Health NHSTrust 25 North Hampshire, Loddon Community NHSTrust 53 New Possibilities NHSTrust 21 Newcastle City Health NHSTrust 8 Newcastle upon Tyne Hospitals NHSTrust 128 Newham Community Health Services NHS Trust 123 Newham University Hospital NHSTrust (1,411) Norfolk & Waveney MH Partnership NHSTrust 227 Norfolk and Norwich University Hospital NHSTrust 33 North Durham Health Care NHSTrust 25 North East Essex Mental Health NHSTrust 188 North East Lincolnshire NHSTrust 338 North Hampshire Hospitals NHSTrust (46) North Hertfordshire NHSTrust (539) North LakeLand Healthcare NHSTrust 35 North Manchester Healthcare NHSTrust 248 North Mersey Community NHSTrust 210 North Middlesex University Hospital NHSTrust (987) North StaVs Combined HC NHSTrust (93) North Tees Health NHSTrust 1 North Warwickshire NHSTrust 0 North West Anglia Health Care NHSTrust 92 North Yorkshire Ambulance Service Trust 23 Northallerton Health Services NHS Trust 5 Northampton Community Healthcare NHSTrust (279) Northampton General Hospital NHSTrust (516) Northern Birmingham Mental Health Trust (94) Northern Devon Healthcare NHSTrust 25 Northern General Hospital NHSTrust 6 Northgate and Prudhoe NHSTrust 1,495 Northumberland Mental Health NHSTrust 18 Northumbria Ambulance Service NHS Trust (113) Northumbria Health Care NHSTrust 205 Northwick Park and St Marks NHS Trust (1,400) Norwich Community Health Partnership NHSTrust (161) Nottingham City Hospital NHSTrust 258 Nottingham Community Health NHSTrust 65 Nottingham Healthcare NHSTrust 614 Nottinghamshire Ambulance Service NHS Trust 65 NuYeld Orthopaedic Centre NHSTrust 15 North West London Mental Health NHSTrust 812 Oldham NHSTrust 76 Optimum Health Services NHS Trust 62 Oxford Learning Disability NHSTrust 6 Oxford RadcliVe Hospitals NHSTrust (1,638) Oxfordshire Ambulance NHSTrust (65) 3178271023 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 93
NHS trusts Retained surplus/(deficit) £000s Oxfordshire Community Health NHSTrust 26 Oxfordshire Mental Healthcare NHSTrust (1,855) Oxleas NHSTrust 17 Papworth Hospital NHSTrust 24 Parkside NHSTrust 27 Peterboro & Stamford Hospitals NHS Trust (652) Phoenix NHSTrust 71 Pilgrim Health NHSTrust 324 Pinderfields and Pontefract Hospital NHSTrust 15 Plymouth Community Services NHS Trust 1 Plymouth Hospitals NHSTrust 1 Poole Hospital NHSTrust 1,032 Portsmouth Health Care NHSTrust 85 Portsmouth Hospitals NHSTrust 450 Premier Health NHSTrust 154 Preston Acute Hospitals NHSTrust 18 Princess Alexandra Hospital NHSTrust (1,485) Priority Healthcare Wearside NHSTrust 150 Queen Elizabeth Hospital NHSTrust 1,319 Queen Mary’s Sidcup NHS Trust 11 Queen Victoria Hospital NHSTrust 143 Queen’s Medical Notts University Hospital NHSTrust 56 Ravensbourne NHSTrust 9 Redbridge Health Care NHSTrust 72 Richmond, Twickenham and Roehampton Trust (9,734) Riverside Community Healthcare NHSTrust 30 Riverside Mental Health NHSTrust 321 Rob Jones and A Hunt Orthopaedic NHSTrust 3 Rochdale Healthcare NHSTrust 6 Rockingham Forest NHSTrust 28 Rotherham General Hospitals NHSTrust 340 Rotherham Priority Health Services Trust 15 Royal Berkshire Ambulance Service Trust 49 Royal Berkshire and Battle Hospitals NHSTrust 666 Royal Brnmth and Christcrch Foun Trust 106 Royal Brompton and Harefield NHSTrust 297 Royal Cornwall Hospitals NHSTrust 5 Royal Devon & Exeter NHSTrust 134 Royal Free Hampstead NHSTrust (2,964) Royal Hull Hospitals NHSTrust 40 Royal Liverpool Broadgreen University Hospital Trust 215 Royal Liverpool Childrens NHSTrust 3 Royal London Homoeopathic Hospital NHSTrust (600) Royal National Hospital Rheum Disease NHSFoun Trust 52 Royal National Orthopaedic Hospital NHSTrust (274) Royal Orthopaedic Hospital NHSTrust 259 Royal Shrewsbury Hospitals NHS Trust 24 Royal Surrey County Hospital NHS Trust (1,238) Royal United Hospital Bath NHSTrust (190) Royal West Sussex NHS Trust 32 Royal Wolverhampton Hospital NHSTrust 599 Salford Community Health Care NHS Trust 162 Salford Royal Hospitals NHS Trust 712 Salisbury Health Care NHS Trust 0 Sandwell Healthcare NHS Trust 169 Scarborough and NE Yorks NHS Trust 9 Scunthorpe and Goole Hospitals NHS Trust 223 Scunthorpe Community Health Care NHS Trust 55 Severn NHS Trust 18 SheYeld Children’s NHSTrust 65 Sherwood Forest Hospitals NHS Trust 43 Shropshire’s Community and Mental HS NHS 111 Solihull Healthcare NHS Trust 39 Somerset Partnership NHS and Social Care Trust (8) 3178271023 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 94 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s South Bedfordshire Community HC NHS Trust 68 South Birmingham Mental Health NHS Trust 185 South Buckinghamshire NHS Trust (133) South Devon Health Care NHS Trust 6 South Downs Health NHS Trust 309 South Durham Health Care NHS Trust 67 South Kent Hospitals NHS Trust (655) South Lincolnshire Community and MH Service Trust 9 South Manchester University Hospital NHS Trust 3,545 South Tees Community and MH NHS Trust (6) South Tees Hospitals NHS Trust 151 South Tyneside NHS Trust 305 South Warwickshire Combined NHS Trust (152) South Warwickshire General Hospitals NHS Trust 36 South Yorkshire Ambulance Service NHS Trust 2 Southampton Community Health Service Trust 108 Southampton University Hospitals NHS Trust 34 Southend Community Care Service NHS Trust 231 Southend Hospital NHS Trust 159 Southern Birmingham Community Health NHS Trust 301 Southern Derbyshire Mental Health Trust 15 Southmead Health Services NHS Trust 2 Southport and Formby Community HS NHS Trust 13 Southport and Formby Hospital Services NHS Trust 14 St Albans and Hemel Hempstead NHS Trust (1,330) St George’s Healthcare NHS Trust (1,466) St Helens and Knowsley Community Health Trust 56 St Helens and Knowsley Hospitals NHS Trust 762 St Helier NHS Trust (154) St Mary’s NHS Trust (4,935) StaVordshire Ambulance Service Trust 46 Stockport Acute Services NHS Trust 485 Stockport Healthcare NHS Trust 21 Stoke Mandeville Hospital NHS Trust (64) Surrey Ambulance Service NHS Trust 2 Surrey and Sussex Healthcare NHS Trust 510 Surrey Hampshire Borders NHS Trust 29 Surrey Oaklands NHS Trust 143 Sussex Ambulance Service NHS Trust 28 Sussex Weald and Downs NHS Trust (323) SW London and St George’s Mental Hlth Trust 25 Swindon and Marlborough NHS Trust 813 Tameside and Glossop Acute Services NHS Trust 97 Tameside and Glossop Community NHSTrust 36 Taunton and Somerset NHS Trust 97 Tavistock and Portman NHSTrust 19 Teddington Memorial Hospital and Community NHSTrust (102) Thames Gateway NHSTrust 6 Thameside Community Healthcare NHSTrust 314 Thanet Health Care NHSTrust (998) The Bethlem and Maudsley NHSTrust (280) The Cardiothoracic Centre—Liverpool NHSTrust 42 The Foundation NHSTrust 3 The Hillingdon Hospital NHSTrust 561 The Lewisham Hospital NHSTrust (146) The Mid Cheshire Hospitals NHSTrust 680 The Princess Royal Hospital NHSTrust 30 The Queen Eliz Hospital King’s Lynn NHSTrust (133) The RadcliVe Infirmary NHSTrust 38 The Royal Marsden NHSTrust 514 The West Lindsey NHSTrust 8 The Whittington Hospital NHSTrust (485) Tower Hamlets Healthcare NHSTrust (514) TraVord Healthcare NHSTrust (200) 3178271023 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 95
NHS trusts Retained surplus/(deficit) £000s Trecare NHSTrust 36 Two Shires Ambulance NHS Trust 0 University Coll London Hospital NHSTrust (3,846) University Hospital Birmingham NHSTrust 17 United Bristol Healthcare NHSTrust (554) University Hospital North StaVordshire NHSTrust (1,246) University Hospitals Coventry & Warwickshire NHSTrust 11 W Berkshire Priority Care Service NHS Trust 59 Wakefield and Pontefract Community Health Trust (1,393) Walsall Community Health NHSTrust 0 Walsall Hospitals NHSTrust (461) Walton Neurology Centre NHSTrust 10 Wandsworth Community Health NHSTrust 51 Warrington Community HC NHSTrust 185 Warrington Hosptial NHSTrust 489 Wellhouse NHSTrust (1,859) West Cumbria Health Care NHSTrust 0 West Dorset General Hospitals NHSTrust (27) West Herts Community Health NHSTrust 164 West Lancashire NHSTrust (449) West London Healthcare NHSTrust 25 West Middlesex University Hospital NHSTrust (700) West Midlands Ambulance Service NHS Trust 138 West SuVolk Hospitals NHSTrust 28 West Yorkshire Ambulance Service Trust 111 West Country Ambulance Services NHS Trust 7 Weston Area Health NHSTrust 64 Weston Park Hospital NHSTrust 23 Wigan and Leigh Health Services NHS Trust 11 Wiltshire Ambulance Service NHS Trust 4 Wiltshire Health Care NHSTrust 5 Winchester and Eastleigh Healthcare NHSTrust (1) Wirral and West Cheshire Community NHSTrust 117 Wirral Hospital NHSTrust 273 Wolverhampton Health Care NHSTrust (8) Worcester Royal Infirmary NHSTrust 37 Worcestershire Community Healthcare NHSTrust 0 Worthing and Southlands Hospitals Trust 1,812 Worthing Priority Care Services Trust (198) Wrightington Hospital NHSTrust 47 York Hospitals NHSTrust 20
Source: NHS Trust Summarisation Schedules 1998–99. Notes: 1. NHSTrusts are listed under their current name.
Table 2.1.3(c) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 1999–2000
Retained Surplus/(Deficit) NHS Trusts £000s Addenbrooke’s NHSTrust (1,339) Aintree Hospitals NHSTrust 486 Airedale NHSTrust (86) Alexandra Healthcare NHSTrust (2,038) Andover District Community Healthcare Trust (918) Ashford & St Peter’s Hospitals NHS Trust (1,613) Avon & Wiltshire MHP NHSTrust 5 Avon Ambulance Service NHS Trust 5 Aylesbury Vale Community Healthcare NHSTrust 51 Barnet & Chase Farm Hospitals NHSTrust (2,376) 3178271024 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 96 Health Committee: Evidence
Retained Surplus/(Deficit) NHS Trusts £000s Barnet Community Healthcare NHSTrust (4,927) Barnsley Community & Priority Services NHS Trust 46 Barnsley District General Hospital NHSTrust 14 Barts & The London NHSTrust (2,979) Basildon & Thurrock General Hospital NHSTrust 164 Bassetlaw Hospital & Comm Health Serv Trust 28 Bath & West Community NHSTrust (138) Bay Community NHSTrust (131) B’burn, H’Burn & R’ble Valley NHSTrust 42 Bedford Hospitals NHSTrust 5 Bedfordshire & Luton Community NHSTrust 26 Bedfordshire & Hertfordshire Ambulance & Paramedic Trust 25 BHB Community Healthcare NHSTrust (266) Birmingham CHildren’s Hospital NHSTrust (859) Birmingham Heartlands & Solihull Trust (989) Birmingham Women’s Healthcare NHSTrust (668) Black Country Mental Health NHSTrust (34) Blackpool Victoria Hospital NHSTrust 535 Blackpool Wyre & Fylde Community Trust (63) Bolton Hospitals NHSTrust 2 Bournewood Community & MH Services Trust (32) Bradford Community Health NHSTrust 495 Bradford Hospitals NHSTrust 95 Brent Kensington Chelsea & Westminster MH Trust 23 Brighton Health Care NHSTrust (1,721) Bromley Hospitals NHSTrust 1,128 Burnley Healthcare NHSTrust 40 Burton Hospitals NHSTrust (326) Bury Health Care NHSTrust 16 Calderdale Healthcare NHSTrust 0 Calderstones NHSTrust 9 Camden & Islington Community Health NHSTrust 44 Carlisle Hospitals NHSTrust 22 Central Manchester Healthcare NHSTrust (4,659) Central Nottinghamshire NHSTrust 152 Central SheYeld University HospitalSNHSTrust 54 ChelseA & Westminster Healthcare Trust 459 Cheshire Community Healthcare NHSTrust 59 Chester & Halton Community NHSTrust 50 Chesterfield & North Derbyshire Hospital Trust 9 Chorley & South Ribble NHS Trust 21 Christie Hospital NHSTrust (249) CHSSouthernDerbyshire NHSTrust 0 City & Hackney Community Services NHS Trust 34 City Hospital NHSTrust (328) City Hospitals Sunderland NHS Trust 92 Clatterbridge Centre for Oncology Trust 1 CommuniCare NHSTrust 46 Community Health SheYeld NHSTrust 13 Community Health South London NHS Trust 152 Community Healthcare Bolton NHSTrust 9 Cornwall Healthcare NHSTrust 3 Countess of Chester Hospital NHSTrust 3 County Durham & Darlington Priority Services Trust 19 Coventry Healthcare NHSTrust 6 Croydon & Surrey Downs Community NHS Trust 114 Cumbria Ambulance Service NHS Trust 30 Dartford & Gravesham NHSTrust (152) Dewsbury Health Care NHSTrust 928 Doncaster & South Humber Healthcare NHS Trust 343 Doncaster Royal Infirmary & Montagu Trust 58 Dorset Ambulance NHSTrust 71 Dorset Community NHSTrust 0 Dorset Healthcare NHSTrust (4) 3178271024 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 97
Retained Surplus/(Deficit) NHS Trusts £000s Dudley Group of Hospitals NHSTrust (320) Dudley Priority Health NHSTrust 15 Ealing Hospital NHSTrust (1,328) Ealing, Hammersmith & Fulham MH NHSTrust 29 East Anglian Ambulance NHSTrust (499) East Berkshire Community Health Trust 131 East Berkshire NHSTrust (PWLD) 54 East Cheshire NHSTrust 76 East Gloucestershire NHSTrust 81 East Hertfordshire NHSTrust (5,167) East Kent Community NHSTrust (319) East Kent Hospitals NHSTrust (1,197) East Midlands Ambulance Service NHS Trust 21 East Somerset NHS Trust (784) East Wiltshire Healthcare NHSTrust (214) East Yorkshire Community Healthcare NHSTrust 5 East Yorkshire Hospitals NHSTrust 0 Eastbourne & County Healthcare NHSTrust (139) Eastbourne Hospitals NHSTrust 242 Enfield Community Care NHSTrust 20 Epsom & St Helier NHS Trust (271) Essex & Hertfordshire Community NHSTrust (228) Essex Ambulance Service NHS Trust 92 Essex Rivers Healthcare NHSTrust (2,705) Exeter & District Community Health Service NHS Trust 10 First Community NHSTrust (203) Forest Healthcare NHSTrust (4,811) Frimley Park Hospital NHSTrust (343) Gateshead Health NHSTrust 10 George Eliot Hospital NHSTrust (1,312) Glenfield Hospital NHSTrust (125) Gloucestershire Ambulance Services NHST (318) Gloucestershire Royal NHSTrust (33) Good Hope Hospital NHSTrust (139) Grantham & District Hospital NHSTrust 163 Great Ormond Street Hospital NHS Trust (334) Greater Manchester Ambulance NHSTrust (151) Greenwich Healthcare NHSTrust (7,909) Guild Community Healthcare NHSTrust 17 Guy’s & St Thomas’ NHS Trust 1,706 Halton General Hospital NHSTrust 73 Hampshire Ambulance Service NHS Trust (30) Haringey Healthcare NHSTrust 11 Harrogate Health Care NHSTrust 401 Harrow & Hillingdon Healthcare NHSTrust 352 Hastings & Rother NHSTrust (671) Havering Hospitals NHSTrust 24 Heatherwood & Wexham Park HospitalSTrust 6 Hereford & Worcester Ambulance NHSTrust (12) Hereford Hospitals NHSTrust 114 Herefordshire Community Health NHSTrust (299) Hinchingbrooke Healthcare NHSTrust (295) Homerton Hospital NHSTrust 497 Horizon NHSTrust (265) Hounslow & Spelthorne Community & MH Trust 28 Huddersfield Health Care Services NHS Trust 1,091 Hull & East Riding Community Health NHSTrust 1 Hull & East Yorkshire Hospitals NHSTR 85 Hull & Holderness Community Health Trust 0 Invicta Community Care NHSTrust 79 Ipswich Hospital NHSTrust 87 Isle of Wight Healthcare NHSTrust 36 James Paget Healthcare NHSTrust 20 Kent & Sussex Weald NHS Trust (487) 3178271024 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 98 Health Committee: Evidence
Retained Surplus/(Deficit) NHS Trusts £000s Kent Ambulance NHSTrust (80) Kettering General Hospital NHSTrust (800) Kidderminster Healthcare NHSTrust 60 King’s College Hospital NHSTrust (1,450) Kings Lynn & Wisbech Hospital NHSTrust (788) Kings Mill Centre HCSNHSTrust 80 Kingston & District Community NHSTrust (231) Kingston Hospital NHSTrust (1,030) Lancashire Ambulance Service NHS Trust 5 Leeds Community & MH ServiceS NHS Trust 80 Leeds Teaching Hospitals NHSTrust (4,132) Leicester General Hospital NHSTrust 90 Leicester Royal Infirmary NHSTrust 13 Leicestershire & Rutland Healthcare NHSTrust 5 Lifespan Healthcare NHSTrust 12 Lincoln & Louth NHSTrust (636) Lincoln District Healthcare NHSTrust 42 Lincolnshire Ambulance NHSTrust 0 Liverpool Womens Hospital NHSTrust 31 Local Health Partnerships NHSTrust 24 London Ambulance Service NHS Trust (1,073) Luton & Dunstable Hospital NHSTrust 128 Manchester Childrens Hospitals NHSTrust 41 Mancunian Community Health NHSTrust 341 Mayday Healthcare NHSTrust (300) Medway NHSTrust (550) Mental Health Services of Salford NHS Trust 192 Mersey RegionaL Ambulance Service Trust 11 Mid Essex Community & Mental Health NHSTrust (27) Mid Essex Hospital Services NHS Trust (4,232) Mid Kent Healthcare NHSTrust (595) Mid StaVordshire General Hospitals Trust 309 Mid Sussex NHS Trust (1,552) Milton Keynes Community Health NHSTrust 3 Milton Keynes GeneralL Hospital NHSTrust (637) Moorfields Eye Hospital NHSTrust 0 Morecambe Bay Hospitals NHSTrust (498) Mount Vernon & Watford Hospitals Trust (1,286) North Birmingham Community Health NHSTrust (1,003) North Hampshire, Loddon Community NHSTrust 66 North Sefton & W Lancashire Community NHS Trust 17 New Possibilities NHSTrust (152) Newcastle City Health NHSTrust 67 Newcastle upon Tyne Hospitals NHSTrust 146 Newham Community Health SERVS NHS Trust 114 Newham Healthcare NHSTrust (861) Norfolk & Norwich University Hospital NHSTrust 126 Norfolk Mental Health Care NHSTrust (172) North Bristol NHSTrust 90 North Derbyshire Community HC NHSTrust (86) North Durham Health Care NHSTrust 50 North East Ambulance Service NHS Trust 7 North East Essex Mental Health NHSTrust 251 North East Lincolnshire NHSTrust 237 North Hampshire Hospitals NHSTrust (221) North Hertfordshire NHSTrust (3,999) North Lakeland Healthcare NHSTrust 75 North Manchester Healthcare NHSTrust 29 North Mersey Community NHSTrust 477 North Middlesex Hospital NHSTrust (3,291) North StaVordshire Hospital NHSTrust 1,279 North StaVordshire Combined Healthcare NHSTrust 13 North Tees & Hartlepool NHSTrust 2 North Warwickshire NHSTrust 0 3178271024 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 99
Retained Surplus/(Deficit) NHS Trusts £000s North West Anglia Health Care NHSTrust 21 North West London Hospitals NHSTrust (668) Northallerton Health Services NHS Trust (805) Northampton Community Healthcare NHSTrust 53 Northampton General Hospital NHSTrust (2,420) Northern Birmingham Mental Health Trust (218) Northern Devon Healthcare NHSTrust 126 Northern General Hospital NHSTrust 11 Northgate & Prudhoe NHSTrust 2,082 Northumberland Mental Health NHSTrust 48 Northumbria Healthcare NHSTrust 208 Norwich Community Health Partnership NHSTrust 73 Nottingham City Hospital NHSTrust 5 Nottingham Community Health NHSTrust 51 Nottingham Healthcare NHSTrust 270 NuYeld Orthopaedic NHSTrust 161 Oldham NHSTrust 202 Oxford Learning Disability NHSTrust 11 Oxford RadcliVe Hospital NHSTrust (2,664) Oxfordshire Ambulance NHSTrust (647) Oxfordshire Community Health NHSTrust 86 Oxfordshire Mental Healthcare NHSTrust (2,153) Oxleas NHSTrust 810 Papworth Hospital NHSTrust 16 Parkside Health NHSTrust 5 Peterborough Hospitals NHSTrust 97 Phoenix NHSTrust (404) Pilgrim Health NHSTrust (66) Pinderfields & Pontefract Hospital NHSTrust (2,391) Plymouth Community Services NHS Trust 0 Plymouth Hospitals NHSTrust 0 Poole Hospitals NHSTrust 140 Portsmouth Healthcare NHSTrust (234) Portsmouth Hospitals NHSTrust (721) Premier Health NHSTrust 566 Preston AcutE Hospitals NHSTrust 32 Princess Alexandra Hospital NHSTrust (1,567) Priority Healthcare Wearside NHSTrust 103 Queen Mary’s Sidcup NHS Trust (255) Queen’s Medical Nottingham University Hospital NHSTrust 127 Ravensbourne NHSTrust 2 Redbridge Health Care NHSTrust (396) Riverside Community Healthcare NHSTrust 23 Rob Jones & A Hunt Orthopaedic NHSTrust 0 Rochdale Healthcare NHSTrust 1,650 Rockingham Forest NHSTrust (314) Rotherham General Hospitals NHSTrust 235 Rotherham Priority Health Services Trust 159 Royal Berkshire & Battle Hospitals NHSTrust (2,500) Royal Berkshire Ambulance Service Trust 1 Royal Bournemouth & Christchurch Trust (430) Royal Brompton & Harefield NHSTrust 50 Royal Cornwall Hospitals NHSTrust 10 Royal Devon & Exeter Healthcare NHSTrust 11 Royal Free Hampstead NHSTrust (4,613) Royal Hull Hospitals NHSTrust 30 Royal Liverpool Broadgreen Hospitals Trust (483) Royal Liverpool Childrens NHSTrust (334) Royal National Hospital Rheumatic Diseases NHSTrust 2 Royal Orthopaedic Hospital NHSTrust 207 Royal Shrewsbury Hospitals NHS Trust (646) Royal Surrey County Hospital NHS Trust 243 Royal United Hospital BATH NHSTrust 25 Royal Wolverhampton Hospital NHSTrust (1,285) 3178271024 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 100 Health Committee: Evidence
Retained Surplus/(Deficit) NHS Trusts £000s South Yorkshire Met Ambulance and Paramedica Services NHS Trust 61 Salford Community Healthcare NHS Trust 11 Salford Royal Hospitals NHS Trust 1,638 Salisbury Healthcare NHS Trust 0 Sandwell Healthcare NHS Trust 102 Scarborough & NE Yorkshire NHS Trust (150) Scunthorpe & Goole Hospitals NHS Trust 40 Scunthorpe Community Health NHS Trust 35 Severn NHS Trust 15 SheYeld Children’s Hospital NHSTrust 40 Shropshire’s Community & Mental HS NHS Trust 249 Solihull Healthcare NHS Trust 2 Somerset Partnership NHS & Soc Care Trust (273) South Birmingham Mental Health NHS Trust (488) South Buckinghamshire NHS Trust (567) South Devon Healthcare NHS Trust 3 South Downs Health NHS Trust (66) South Durham Health Care NHS Trust 15 South Lincolnshire Healthcare NHS Trust 13 South London and Maudsley NHS Trust (480) South Manchester University Hospital NHS Trust 16 South Tees Acute Hospitals NHS Trust (63) South Tyneside Healthcare NHS Trust 959 South Warwickshire Combined NHS Trust 0 South Warwickshire General Hospitals NHS Trust (133) South West London Community NHS Trust (314) Southampton Community Health Serv Trust 1 Southampton University Hospitals NHS Trust 163 Southend Community Care Serv NHS Trust (329) Southend Hospital NHS Trust 75 Southern Birmingham Community Hlth NHS Trust (1,617) Southern Derbyshire Acute Hospitals NHS Trust 10 Southern Derbyshire Mental Health Trust 144 Southport & Ormskirk Hospital NHS Trust (377) St Albans & Hemel Hempstead NHS Trust (2,755) St George’s Healthcare NHS Trust (5,753) St Helens & Knowsley Community Health Trust 34 St Helens & Knowsley Hospitals NHS Trust 283 St Mary’s NHS Trust (3,427) StaVordshire Ambulance Service Trust 3 Stockport Acute Services NHS Trust 440 Stockport Healthcare NHS Trust (1,156) Stoke Mandeville Hospital NHS Trust (866) Surrey & Sussex Healthcare NHS Trust (5,021) Surrey Ambulance Service NHS Trust 1 Surrey Hampshire Borders NHS Trust 17 Surrey Oaklands NHS Trust (274) Sussex Ambulance Service NHS Trust (1) Sussex Weald & Downs NHS Trust 62 SW London & St George’s Mental Health Trust 35 Swindon & Marlborough NHS Trust 1,268 Tameside & Glossop Acute Services NHS Trust 837 Tameside & Glossop Community NHSTrust 1,189 Taunton & Somerset NHS Trust (495) Tavistock & Portman NHSTrust 5 Teddington Memorial Hospital & Community NHSTrust 90 Tees & North East Yorkshire NHSTrust 63 Tees East & North Yorkshre Ambulance Services NHS Trust 19 Thames Gateway NHSTrust 20 Thameside Community Healthcare NHSTrust 49 The Cardiothoracic Centre—Liverpool NHSTrust 22 The Foundation NHSTrust 27 The Hammersmith Hospitals NHSTrust (1,947) The Hillingdon Hospital NHSTrust (426) 3178271024 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 101
Retained Surplus/(Deficit) NHS Trusts £000s The Lewisham Hospital NHSTrust (311) The Mid Cheshire Hospitals NHSTrust 576 The Princess Royal Hospital NHSTrust (826) The Queen Victoria Hospital NHSTrust (21) The RadcliVe Infirmary NHSTrust (121) The Royal Marsden Hospital NHSTrust 337 The Royal National Orthopaedic Hospital NHSTrust (184) The Royal West Sussex NHS Trust (526) Tower Hamlets Healthcare NHSTrust (483) TraVord Healthcare NHSTrust (316) Two Shires Ambulance NHS Trust 4 United Bristol Healthcare NHSTrust (323) Univ HospitalSCoventry & Warwickshire NHSTrust (1,516) University College London Hospital NHSTrust (4,992) University Hospital Birmingham NHSTrust 23 West Berkshire Priority Care Services NHS Trust 91 Wakefield & Pontefract Community Health Trust (1,910) Walsall Community Health NHSTrust 1,463 Walsall Hospitals NHSTrust 18 Walton Neurology Centre NHSTrust 12 Warrington Community HC NHSTrust 3 Warrington Hospital NHSTrust 49 Warwickshire Ambulance Service NHS Trust (27) West Cumbria Healthcare NHSTrust 0 West Dorset General Hospitals NHSTrust 137 West Hertfordshire Community Health NHSTrust 47 West Middlesex University NHSTrust 166 West Midlands Ambulance NHSTrust (752) West SuVolk Hospitals NHSTrust (286) West Yorkshire Ambulance Service Trust 0 Westcountry Ambulance Services NHS Trust 0 Weston Area Health NHSTrust (111) Whittington Hospital NHSTrust (1,433) Wigan & Leigh Health Services NHS Trust (65) Wiltshire & Swindon Healthcare NHS Trust 363 Wiltshire Ambulance Service NHS Trust 7 Wiltshire Health Care NHSTrust (92) Winchester & Eastleigh Healthcare NHSTrust (1,400) Wirral & West Cheshire Community NHSTrust 10 Wirral Hospital NHSTrust 64 Wolverhampton Health Care NHSTrust (64) Worcester Royal Infirmary NHSTrust (1,821) Worcestershire Community Healthcare NHSTrust (784) Worthing & Southlands Hospitals Trust (4,147) Worthing Priority Care Services Trust 55 Wrightington Hospital NHSTrust 45 York Health Services NHS Trust 23
Source: NHS Trust Summarisation Schedules 1999–2000. Notes 1. NHSTrusts are listed under their current name.
Table 2.1.3(d) DEFICITS and SURPLUSES OCCURRING IN NHS TRUSTS IN 2000–01
NHS trusts Retained surplus/(deficit) £000s Addenbrooke’s NHSTrust 4 Aintree Hospitals NHSTrust 62 Airedale NHSTrust 110 Ashford and St Peter’s Hospitals NHS Trust (4,846) 3178271025 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 102 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s Avon Ambulance Service NHS Trust 1 Avon and Wiltshire MHP NHSTrust 3 Aylesbury Vale Community Healthcare NHSTrust (523) Barnet and Chase Farm Hospitals NHSTrust (2,996) Barnet Community Healthcare NHSTrust (2,358) Barnsley Community and Priority Services NHS Trust 17 Barnsley District General Hospital NHSTrust 4 Barts and The London NHSTrust 10,149 Basildon and Thurrock University Hospital NHSTrust 150 Bassetlaw Hospital and Community Health Service Trust 46 Bath and West Community NHSTrust (208) Bay Community NHSTrust 3 B’burn, H’burn & R’ble Valley NHSTrust 11 Bedford Hospitals NHSTrust 10 Bedfordshire and Luton Community NHSTrust (360) Beds and Herts Ambulance and Paramedic Trust 25 BHB Community Health Care NHSTrust 18 Birmingham Children’s Hospital NHSTrust 35 Birmingham Heartlands and Solihull Trust 5 Birmingham Specialist Community Health NHS Trust 85 Birmingham Women’s Health Care NHSTrust 48 Black Country Mental Health NHSTrust 0 Blackpool Victoria Hospital NHSTrust 55 Blackpool, Wyre and Fylde Community Trust 4 Bolton Hospitals NHSTrust 0 Bournewood Community and MH NHSTrust 1 Bradford Community Health NHSTrust 80 Bradford Hospitals NHSTrust 0 Brighton Health Care NHSTrust 1,676 Bromley Hospitals NHSTrust 5 Burnley Health Care NHSTrust 37 Burton Hospitals NHSTrust 79 Bury Health Care NHSTrust 17 Calderdale Healthcare NHSTrust 45 Calderstones NHSTrust 54 Camden and Islington Community Health NHSTrust 76 Carlisle Hospitals NHSTrust 9 Central and North West London MH NHSTrust 35 Central Manchester Healthcare NHSTrust 857 Central Nottinghamshire NHSTrust 134 Central SheYeld University Hospitals NHSTrust 30 Chelsea and Westminster Healthcare Trust 285 Cheshire Community Healthcare NHSTrust 3 Chester and Halton Community NHSTrust 52 Chesterfield and N Derbyshire Hospital Trust 15 Chorley and South Ribble NHS Trust 16 Christie Hospital NHSTrust 0 CHSSouthernDerbyshire NHSTrust 0 City and Hackney Community Services NHS Trust 2 City Hospital NHSTrust 295 City Hospitals Sunderland NHS Trust 61 Clatterbridge Centre for Oncology Trust 8 Comm HC Services (North Derbyshire) NHS Trust 105 Communicare NHSTrust 3 Community Health SheYeld NHSTrust 7 Community Health South London NHS Trust 49 Community Healthcare Bolton NHSTrust 54 Cornwall Partnership NHSTrust 3 Countess of Chester Hospital NHSTrust 4 County Durham and Darlington Prior SRV Trust 29 Coventry Healthcare NHSTrust 8 Croydon & Surrey Downs Community NHS Trust 6 Cumbria Ambulance Service NHS Trust 9 Dartford and Gravesham NHSTrust (704) 3178271025 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 103
NHS trusts Retained surplus/(deficit) £000s Dewsbury Health Care NHSTrust 43 Doncaster and South Humber Healthcare NHS 61 Doncaster Royal Infirm and Montagu Trust 40 Dorset Ambulance NHSTrust 2 Dorset Community NHSTrust 0 Dorset Health Care NHSTrust 4 Dudley Group of Hospitals NHSTrust 0 Dudley Priority Health NHSTrust 0 Ealing Hospital NHSTrust 47 Ealing, Hammersmith and Fulham MH NHSTrust 13 East and North Hertfordshire NHSTrust (3,297) East Anglian Ambulance NHSTrust 4 East Berkshire Community Health Trust 110 East Berkshire NHSTrust (PWLD) 35 East Cheshire NHSTrust (180) East Gloucestershire NHSTrust 41 East Kent Community NHSTrust 280 East Kent Hospitals NHSTrust 601 East London and the City MH NHSTrust 67 East Midlands Ambulance Service NHS Trust 5 East Somerset NHS Trust 3 Eastbourne and County Healthcare NHSTrust 3 Eastbourne Hospitals NHSTrust 0 Enfield Community Care NHSTrust 5 Epsom and St Helier NHS Trust 0 Essex Ambulance Service NHS Trust 5 Essex and Hertfordshire Community NHSTrust (981) Essex Rivers Healthcare NHSTrust 8,505 Exeter and Dist Commty Hlth Serv NHS TR 4 First Community NHSTrust 2 Forest Healthcare NHSTrust (2,790) Frimley Park Hospital NHSTrust 104 Gateshead Health NHSTrust 19 George Eliot Hospital NHSTrust 349 Gloucestershire Ambulance Services NHS Trust 123 Gloucestershire Royal NHSTrust (27) Good Hope Hospital NHSTrust 48 Great Ormond Street Hospital NHS Trust 33 Greater Manchester Ambulance NHSTrust (109) Guild Community Healthcare NHSTrust 40 Guy’s and St Thomas’ NHS Trust 558 Halton General Hospital NHSTrust 11 Hammersmith Hospitals NHSTrust 134 Hampshire Ambulance Service NHS Trust 1 Haringey Health Care NHSTrust (17) Harrogate Health Care NHSTrust 6 Harrow and Hillingdon Healthcare NHSTrust 26 Hastings and Rother NHSTrust (87) Havering Hospitals NHSTrust 5 Heatherwood and Wexham Park Hosps Trust 7 Hereford and Worcester Ambulance NHSTrust 1 Hereford Hospitals NHSTrust 22 Herefordshire Community Health NHSTrust 2 Hinchingbrooke Health Care NHSTrust 6 Homerton University Hospital NHSTrust 33 Horizon NHSTrust 10 Hounslow and Spelthorne Community and MH Trust 5 Huddersfield Health Care Srvs NHS Trust 24 Hull and East Riding Community Health NHSTrust 24 Hull and East Yorkshire Hospitals NHSTrust 28 Invicta Community Care NHSTrust 9 Ipswich Hospital NHSTrust 620 Isle of Wight Healthcare NHSTrust 5 James Paget Healthcare NHSTrust 13 3178271025 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 104 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s Kent Ambulance NHSTrust 80 Kettering General Hospital NHSTrust 1,374 King’s College Hospital NHSTrust 25 Kings Lynn and Wisbech Hospitals NHSTrust 736 Kingston and District Community NHSTrust (873) Kingston Hospital NHSTrust 9 Lancashire Ambulance Service NHS Trust 1 Leeds Mental Health Teaching NHSTrust 29 Leeds Teaching Hospitals NHSTrust 36 Leicestershire Partnership NHSTrust 6 Lifespan Health Care Cambridge NHSTrust 6 Lincoln District Healthcare NHSTrust 17 Lincolnshire Ambulance NHSTrust 4 Liverpool Womens Hospital NHSTrust 27 Local Health Partnerships NHSTrust 58 London Ambulance Service NHS Trust 101 Luton and Dunstable Hospital NHSTrust 101 Maidstone and Tunbridge Wells NHSTrust 104 Manchester Childrens Hospitals NHSTrust 4 Mancunian Community Health NHSTrust 0 Mayday Healthcare NHSTrust 0 Medway NHSTrust (1,504) Mental Health Serv of Salford NHS Trust 28 Mersey Regional Ambulance Service Trust 11 Mid Essex Community and Mental Health NHSTrust (414) Mid Essex Hospital Services NHS Trust 1,374 Mid StaVordshire Gen Hospitals Trust 28 Mid Sussex NHS Trust (807) Milton Keynes Community Health NHSTrust (21) Milton Keynes General Hospital NHSTrust 126 Moorfields Eye Hospital NHSTrust 20 Morecambe Bay Hospitals NHSTrust 8 N Hampshire, Loddon Community NHSTrust (231) N Sefton and W Lancashire Comm NHS Trust 4 New Possibilities NHSTrust 124 Newcastle City Health NHSTrust (1,217) Newcastle upon Tyne Hospitals NHSTrust 17 Newham Community Health Services NHS Trust 156 Newham Healthcare NHSTrust 3,517 Norfolk and Norwich Uni Hosp NHSTrust 26 Norfolk Mental Health Care NHSTrust 81 North Bristol NHSTrust 44 North Durham Health Care NHSTrust 4 North East Ambulance Service NHS Trust 5 North East Essex Mental Health NHSTrust (105) North East Lincolnshire NHSTrust 22 North Hampshire Hospitals NHSTrust (35) North Lakeland Healthcare NHSTrust 0 North Manchester Healthcare NHSTrust 13 North Mersey Community NHSTrust 244 North Middlesex University Hosp NHSTrust 6,206 North StaVordshire Hospital NHSTrust 1,225 North StaVs Combined HC NHSTrust 8 North Tees and Hartlepool NHSTrust 5 North Warwickshire NHSTrust 0 North West Anglia Health Care NHSTrust 19 North West London Hospitals NHSTrust 21 Northallerton Health Services NHS Trust 12 Northampton Comm Healthcare NHSTrust 1,402 Northampton General Hospital NHSTrust 5,883 Northern Birmingham Mental Health Trust 8 Northern Devon Healthcare NHSTrust (1) Northern General Hospital NHSTrust 10 Northgate and Prudhoe NHSTrust 478 3178271025 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 105
NHS trusts Retained surplus/(deficit) £000s Northumberland Mental Health NHSTrust 12 Northumbria Health Care NHSTrust 3 Norwich Comm Health Partnership NHSTrust (100) Nottingham City Hospital NHSTrust 14 Nottingham Community Health NHSTrust 53 Nottingham Healthcare NHSTrust 68 NuYeld Orthopaedic NHSTrust (3,549) Oldham NHSTrust 33 Oxford Learning Disability NHSTrust 15 Oxford RadcliVe Hospital NHSTrust 6,819 Oxfordshire Ambulance NHSTrust 47 Oxfordshire Community Health NHSTrust 987 Oxfordshire Mental Healthcare NHSTrust 7,343 Oxleas NHSTrust 5 Papworth Hospital NHSTrust 17 Parkside NHSTrust 139 Peterborough Hospitals NHSTrust 22 Pinderfields and Pontefract Hosp NHSTrust 5 Plymouth Community Services NHS Trust 0 Plymouth Hospitals NHSTrust 0 Poole Hospitals NHSTrust 79 Portsmouth Health Care NHSTrust 57 Portsmouth hospitals NHSTrust 22 Premier Health NHSTrust 1 Preston Acute Hospitals NHSTrust 27 Princess Alexandra Hospital NHSTrust 1,412 Priority Healthcare Wearside NHSTrust 1 Queen Elizabeth Hospital NHSTrust (1,583) Queen Mary’s Sidcup NHS Trust 5 Queen’s Medical Notts UNI Hosp NHSTrust 54 Ravensbourne NHSTrust 4 Redbridge Health Care NHSTrust 19 Riverside Community Healthcare NHSTrust 56 Rob Jones and A Hunt Orthopaedic NHSTrust 0 Rochdale Healthcare NHSTrust 5 Rockingham Forest NHSTrust (354) Rotherham General Hospitals NHSTrust 15 Rotherham Priority Health Services Trust 24 Royal Berkshire Ambulance Service Trust 11 Royal Berkshire and Battle Hosps NHSTrust 2,750 Royal Bournemouth and Christchurch Trust 103 Royal Brompton and Harefield NHSTrust 148 Royal Cornwall Hospitals NHSTrust 3 Royal Devon and Exeter Healthcare NHSTrust 34 Royal Free Hampstead NHSTrust 1,866 Royal Liverpool Broadgreen University Hospital Trust 12 Royal Liverpool Childrens NHSTrust 0 Royal National Hosp Rheumatic Diseases NHSTrust 2 Royal Orthopaedic Hospital NHSTrust 229 Royal Shrewsbury Hospitals NHS Trust 607 Royal Surrey County Hospital NHS Trust 1,559 Royal United Hospital Bath NHSTrust (336) Royal West Sussex NHS Trust 0 Royal Wolverhampton Hospital NHSTrust 48 Salford Community Health Care NHS Trust 8 Salford Royal Hospitals NHS Trust 29 Salisbury Health Care NHS Trust 0 Sandwell Healthcare NHS Trust 40 Scarborough and NE Yorks NHS Trust 10 Scunthorpe and Goole Hospitals NHS Trust 0 Severn NHS Trust 16 SheYeld Children’s NHSTrust 30 Sherwood Forest Hospitals NHS Trust 88 Shropshire’s Community and Mental HS NHS 1 3178271025 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 106 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s Solihull Healthcare NHS Trust 13 Somerset Partnership NHS and SOC Care Trust 0 South Birmingham Mental Health NHS Trust 0 South Buckinghamshire NHS Trust 1,248 South Devon Health Care NHS Trust 11 South Downs Health NHS Trust (76) South Durham Health Care NHS Trust 8 South Essex Partnership NHS Trust 45 South Lincolnshire Healthcare NHS Trust 19 South London and Maudsley NHS Trust 22 South Manchester UNIV Hosp NHS Trust 9 South Tees Hospitals NHS Trust 21 South Tyneside Health Care NHS Trust 16 South Warwickshire Combined NHS Trust 0 South Warwickshire General Hosps NHS Trust 0 South West London Community NHS Trust 491 South Yorkshire Ambulance Service NHS Trust 9 Southampton Community Health Service Trust 516 Southampton University Hosps NHS Trust 24 Southend Hospital NHS Trust 105 Southern Derbyshire Acute Hosps NHS Trust 5 Southern Derbyshire Mental Health Trust 0 Southport and Ormskirk Hospital NHS Trust 3 St George’s Healthcare NHS Trust 0 St Helens and Knowsley Comm Health Trust 18 St Helens and Knowsley Hospitals NHS Trust 5 St Mary’s NHS Trust 12,901 StaVordshire Ambulance Service Trust 13 Stockport NHS Trust 33 Stoke Mandeville Hospital NHS Trust 559 Surrey Ambulance Service NHS Trust 3 Surrey and Sussex Healthcare NHS Trust (4,573) Surrey Hampshire Borders NHS Trust 16 Surrey Oaklands NHS Trust (94) Sussex Ambulance Service NHS Trust 0 Sussex Weald and Downs NHS Trust (1,271) South West London and St George’s Mental Health Trust 75 Swindon and Marlborough NHS Trust 1,496 Tameside and Glossop Acute Services NHS Trust 7 Tameside and Glossop Community NHSTrust 3 Taunton and Somerset NHS Trust 1 Tavistock and Portman NHSTrust 1 Teddington Memorial Hosp and Comm NHSTrust 0 Tees and North East Yorkshire NHSTrust 19 Tees East and North Yorkshire Ambulance Service NHS 0 Thames Gateway NHSTrust (377) The Cardiothoracic Centre—Liverpool NHSTrust 9 The Foundation NHSTrust 0 The Hillingdon Hospital NHSTrust 3 The Lewisham Hospital NHSTrust 3 The Mid Cheshire Hospitals NHSTrust 180 The Princess Royal Hospital NHSTrust 260 The Queen Victoria Hospital NHSTrust 3 The Royal Marsden NHSTrust 777 The Royal Nat Orthopaedic Hosp NHSTrust 11 The Whittington Hospital NHSTrust 0 Tower Hamlets Healthcare NHSTrust 0 TraVord Healthcare NHSTrust 959 Two Shires Ambulance NHS Trust 2 United Bristol Healthcare NHSTrust (1,150) United Lincolnshire Hospitals NHSTrust 9 Univ Hosps Coventry & Warwickshire NHSTrust 20 University College London Hosp NHSTrust 3 University Hospital Birmingham NHSTrust 30 3178271025 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 107
NHS trusts Retained surplus/(deficit) £000s University Hospitals of Leicester NHSTrust 47 W Berkshire Priority Care Serv NHS Trust 8 Wakefield and Pontefract Comm Health Trust 56 Walsall Community Health NHSTrust 1 Walsall Hospitals NHSTrust 3 Walton Neurology Centre NHSTrust 16 Warrington Community HC NHSTrust 13 Warrington Hospital NHSTrust 21 Warwickshire Ambulance Service NHS Trust 1 West Cumbria Health Care NHSTrust 0 West Dorset General Hospitals NHSTrust 7 West Hertfordshire Hospitals NHSTrust 17 West Herts Community Health NHSTrust 48 West Middlesex University NHSTrust 178 West Midlands Ambulance Service NHS Trust 186 West SuVolk Hospitals NHSTrust 290 West Yorkshire Ambulance Service Trust 1 Westcountry Ambulance Services NHS Trust 8 Weston Area Health NHSTrust (35) Wigan and Leigh Health Services NHS Trust (84) Wiltshire Ambulance Service NHS Trust 8 Wiltshire and Swindon Health Care NHS Trust 1 Winchester and Eastleigh Healthcare NHSTrust 1 Wirral and West Cheshire Community NHSTrust 16 Wirral Hospital NHSTrust 17 Wolverhampton Health Care NHSTrust 18 Worcestershire Acute Hospitals NHSTrust 9 Worcestershire MH Partnership NHSTrust 0 Worthing and Southlands Hospitals Trust (2,734) Worthing Priority Care Services Trust 13 Wrightington Hospital NHSTrust 9 York Health Services NHS Trust 6 Source: NHS Trust Summarisation Schedules 2000–01 Notes: 1. NHSTrusts are listed under their current name.
Table 2.1.3(e) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 2001–02
NHS trusts Retained surplus/(deficit) £000s
Addenbrooke’s NHSTrust 0 Aintree Hospitals NHSTrust 5 Airedale NHSTrust 27 Ashford and St Peter’s Hospitals NHS Trust (1,409) Avon Ambulance Service NHS Trust 4 Avon and Wiltshire Mhp NHSTrust (2,298) Barking, Havering and Redbridge Hosp NH 6 Barnet and Chase Farm Hospitals NHSTrust 0 Barnet, Enfield and Haringey MH NHSTrust 4 Barnsley Comm and Priority Serv NHS Trust 33 Barnsley District General Hospital NHSTrust 7 Barts and The London NHSTrust 38 Basildon and Thurrock Univ Hosp NHSTrust 12 B’Burn, H’Burn & R’Ble Valley NHSTrust 14 Bedford Hospitals NHSTrust (3,149) Bedfordshire and Luton Community NHSTrust (1,221) Beds and Herts Ambulance and Paramedic Trust 3 Berkshire Healthcare NHSTrust 96 Birmingham Children’s Hospital NHSTrust 11 3178271026 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 108 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s
Birmingham Heartlands and Solihull Trust (1) Birmingham Specialist Comm Health NHS Trust 4 Birmingham Women’s Health Care NHSTrust 372 Black Country Mental Health NHSTrust 3 Blackpool Victoria Hospital NHSTrust 39 Blackpool, Wyre and Fylde Community Trust 32 Bolton Hospitals NHSTrust 0 Bournewood Community and MH NHSTrust 6 Bradford Community Health NHSTrust 70 Bradford Hospitals NHSTrust 0 Brighton Health Care NHSTrust 946 Bromley Hospitals NHSTrust (1,392) Buckinghamshire Mental Health NHSTrust 8 Burnley Health Care NHSTrust 49 Burton Hospitals NHSTrust 9 Bury Health Care NHSTrust 4 Calderdale and Huddersfield NHSTrust 6 Calderstones NHSTrust 31 Camden and Islington Comm Health NHSTrust 62 Camden and Islington Mental Health NHSTrust 41 Cent Manchester/Manchester Child NHSTrust 3 Central and North West London MH NHSTrust 15 Chelsea and Westminster Healthcare Trust 401 Cheshire Community Healthcare NHSTrust 4 Chester and Halton Community NHSTrust 9 Chesterfield and N Derbyshire Hosp Trust 19 Chorley and South Ribble NHS Trust 14 Christie Hospital NHSTrust 1 City Hospital NHSTrust 10 City Hospitals Sunderland NHS Trust 47 Clatterbridge Centre for Oncology Trust 3 Comm HC Serv (North Derbyshire) NHS Trust 0 Communicare NHSTrust 4 Community Health SheYeld NHSTrust 4 Community Health South London NHS Trust 1 Community Healthcare Bolton NHSTrust 7 Cornwall Partnership NHSTrust (1,149) Countess of Chester Hospital NHSTrust 3 County Durham and Darlington Prior Service Trust 13 Coventry Healthcare NHSTrust 7 Croydon & Surrey Downs Community NHS Trust 26 Cumbria Ambulance Service NHS Trust 11 Dartford and Gravesham NHSTrust (1,798) Devon Partnership NHSTrust 0 Dewsbury Health Care NHSTrust 0 Doncaster and Bassetlaw Hospitals NHSTrust 4 Doncaster and South Humber HlthCare NHS 38 Dorset Ambulance NHSTrust 1 Dorset Health Care NHSTrust (4) Dudley Group of Hospitals NHSTrust 3 Dudley Priority Health NHSTrust 1 Ealing Hospital NHSTrust 98 East and North Hertfordshire NHSTrust 62 East Anglian Ambulance NHSTrust 39 East Berkshire Community Health Trust (1,216) East Cheshire NHSTrust 3 East Gloucestershire NHSTrust 45 East Kent Community NHSTrust 562 East Kent Hospitals NHSTrust 600 East London and The City MH NHSTrust 51 East Midlands Ambulance Servce NHS Trust 4 East Somerset NHS Trust 1,225 Eastbourne and County Healthcare NHSTrust 0 3178271026 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 109
NHS trusts Retained surplus/(deficit) £000s
Eastbourne Hospitals NHSTrust 0 Epsom and St Helier NHS Trust 46 Essex Ambulance Service NHS Trust 10 Essex Rivers Healthcare NHSTrust 30 Frimley Park Hospital NHSTrust (330) Gateshead Health NHSTrust 8 George Eliot Hospital NHSTrust 7 Gloucestershire Ambulance Services NHST (14) Gloucestershire Royal NHSTrust 24 Good Hope Hospital NHSTrust 53 Great Ormond Street Hospital NHS Trust 10 Greater Manchester Ambulance NHSTrust 19 Guild Community Healthcare NHSTrust 29 Guy’s and St Thomas’ NHS Trust 191 Hammersmith Hospitals NHSTrust 119 Hampshire Ambulance Service NHS Trust 1 Harrogate Health Care NHSTrust 34 Harrow and Hillingdon Healthcare NHSTrust 2 Hastings and Rother NHSTrust 17 Heatherwood and Wexham Park Hosps Trust 8 Hereford and Worcester Ambulance NHSTrust 0 Hereford Hospitals NHSTrust 13 Hertfordshire Partnership NHSTrust 296 Hinchingbrooke Health Care NHSTrust (220) Homerton University Hospital NHSTrust 41 Hounslow and Spelthorne Comm and MH Trust (382) Hull and East Riding Comm Health NHSTrust 0 Hull and East Yorkshire Hospitals NHSTrust 4 Invicta Community Care NHSTrust 15 Ipswich Hospital NHSTrust (992) Isle of Wight Healthcare NHSTrust (431) James Paget Healthcare NHSTrust 8 Kent Ambulance NHSTrust 0 Kettering General Hospital NHSTrust (107) King’s College Hospital NHSTrust 176 Kings Lynn and Wisbech Hospitals NHSTrust 0 Kingston Hospital NHSTrust 13 Lancashire Ambulance Service NHS Trust 10 Leeds Mental Health Teaching NHSTrust 20 Leeds Teaching Hospitals NHSTrust 0 Leicestershire Partnership NHSTrust 4 Lifespan Health Care Cambridge NHSTrust 0 Lincolnshire Ambulance NHSTrust 0 Lincolnshire Partnership NHSTrust 4 Liverpool Womens Hospital NHSTrust 0 Local Health Partnerships NHSTrust 20 London Ambulance Service NHS Trust 46 Luton and Dunstable Hospital NHSTrust 52 Maidstone and Tunbridge Wells NHSTrust (4,153) Mayday Healthcare NHSTrust 4 Medway NHSTrust 766 Mental Health Serv of Salford NHS Trust 0 Mersey Care NHSTrust 37 Mersey Regional Ambulance Service Trust 8 Mid Essex Hospital Services NHS Trust 71 Mid StaVordshire Gen Hospitals Trust 14 Mid Sussex NHS Trust (2,683) Milton Keynes General Hospital NHSTrust 776 Moorfields Eye Hospital NHSTrust 1 Morecambe Bay Hospitals NHSTrust 11 N Essex Mental Health Partnership NHSTrust (1,502) N Sefton and W Lancashire Comm NHS Trust 22 New Possibilities NHSTrust (4) 3178271026 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 110 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s
Newc, N Tyneside and N’Thumberlnd MH NHS3 Newcastle upon Tyne Hospitals NHSTrust 53 Newham Healthcare NHSTrust 11 Norfolk and Norwich UNI Hosp NHSTrust 82 Norfolk Mental Health Care NHSTrust 1 North Bristol NHSTrust (6,232) North Cheshire Hospitals NHSTrust 8 North Cumbria Acute Hospitals NHSTrust 6 North Durham Health Care NHSTrust 30 North East Ambulance Service NHS Trust 17 North East London Mental Health NHSTrust 7 North Hampshire Hospitals NHSTrust (625) North Lincolnshire and Goole Hosps NHSTrust 4 North Manchester Healthcare NHSTrust 2 North Mersey Community NHSTrust 40 North Middlesex University Hosp NHSTrust 0 North StaVordshire Hospital NHSTrust 18 North StaVs Combined HC NHSTrust 38 North Tees and Hartlepool NHSTrust 4 North Warwickshire NHSTrust 0 North West Anglia Health Care NHSTrust (2) North West London Hospitals NHSTrust 17 Northallerton Health Services NHS Trust 22 Northampton General Hospital NHSTrust (280) Northamptonshire Healthcare NHSTrust 32 Northern Birmingham Mental Health Trust 88 Northern Devon Healthcare NHSTrust 1 Northgate and Prudhoe NHSTrust 7 Northumbria Health Care NHSTrust 6 Nottingham City Hospital NHSTrust 83 Nottinghamshire Healthcare NHSTrust 35 North Cumbria MH and Learning Disab NHSTrust 1 NuYeld Orthopaedic NHSTrust (7) Oldham NHSTrust 5 Oxford Learning Disability NHSTrust 28 Oxford RadcliVe Hospital NHSTrust 5 Oxfordshire Ambulance NHSTrust 45 Oxfordshire Mental Healthcare NHSTrust 8 Oxleas NHSTrust 2 Papworth Hospital NHSTrust 14 Parkside NHSTrust 0 Peterborough Hospitals NHSTrust 23 Pinderfields and Pontefract Hosp NHSTrust 2,548 Plymouth Hospitals NHSTrust 0 Poole Hospitals NHSTrust 0 Portsmouth Health Care NHSTrust (1,154) Portsmouth Hospitals NHSTrust (755) Preston Acute Hospitals NHSTrust 21 Princess Alexandra Hospital NHSTrust (880) Priority Healthcare Wearside NHSTrust 6 Queen Elizabeth Hospital NHSTrust 288 Queen Mary’s Sidcup NHS Trust 23 Queen’s Medical Notts UNI Hosp NHSTrust 73 Riverside Community Healthcare NHSTrust (110) Rob Jones and A Hunt Orthopaedic NHSTrust 9 Rochdale Healthcare NHSTrust 2 Rotherham General Hospitals NHSTrust 49 Rotherham Priority Health Services Trust 7 Royal Berkshire Ambulance Service Trust (29) Royal Berkshire and Battle Hosps NHSTrust 0 Royal Bournemouth and Christchurch Trust 62 Royal Brompton and Harefield NHSTrust 50 Royal Cornwall Hospitals NHSTrust (4,225) 3178271026 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 111
NHS trusts Retained surplus/(deficit) £000s
Royal Devon and Exeter Healthcare NHSTrust 272 Royal Free Hampstead NHSTrust 5,216 Royal Liverpool Broadgreen University Hosp Trust 8 Royal Liverpool Childrens NHSTrust 0 Royal Nat Hosp Rheumatic Diseases NHSTrust 2 Royal Orthopaedic Hospital NHSTrust 219 Royal Shrewsbury Hospitals NHS Trust (494) Royal Surrey County Hospital NHS Trust (2) Royal United Hospital Bath NHSTrust 2,079 Royal West Sussex NHS Trust (1,722) Royal Wolverhampton Hospital NHSTrust 56 Salford Royal Hospitals NHS Trust 26 Salisbury Health Care NHS Trust 0 Sandwell Healthcare NHS Trust 7 Scarborough and NE Yorks NHS Trust 41 Severn NHS Trust 46 SheYeld Children’s NHSTrust 113 SheYeld Teaching Hospitals NHSTrust 2 Sherwood Forest Hospitals NHS Trust 2 Shropshire’s Community and Mental HS NHS 5 Somerset Partnership NHS and Soc Care Trust (1,774) South Birmingham Mental Health NHS Trust 0 South Buckinghamshire NHS Trust 125 South Devon Health Care NHS Trust 6 South Downs Health NHS Trust 214 South Durham Health Care NHS Trust 49 South Essex Partnership NHS Trust 2 South London and Maudsley NHS Trust 0 South Manchester Univ Hosp NHS Trust 14 South StaVordshire Healthcare NHSTrust 0 South Tees Hospitals NHS Trust 37 South Tyneside Health Care NHS Trust 13 South Warwickshire Combined NHS Trust (826) South Warwickshire Gen Hosps NHS Trust 87 South West London Community NHS Trust 35 South Yorkshire Ambulance Service NHS Trust 3 Southampton Community Health Service Trust (344) Southampton University Hosps NHS Trust (50) Southend Hospital NHS Trust 17 Southern Derbyshire Acute HospS NHS Trust 2 Southern Derbyshire Comm and MH Srvs NHS 0 Southport and Ormskirk Hospital NHS Trust 17 St George’s Healthcare NHS Trust 613 St Helens and Knowsley Comm Health Trust 0 St Helens and Knowsley Hospitals NHS Trust 3 St Mary’s NHS Trust 2 StaVordshire Ambulance Service Trust 0 Stockport NHS Trust 115 Stoke Mandeville Hospital NHS Trust (253) Surrey Ambulance Service NHS Trust 0 Surrey and Sussex Healthcare NHS Trust (193) Surrey Hampshire Borders NHS Trust (920) Surrey Oaklands NHS Trust 3 Sussex Ambulance Service NHS Trust 0 Sussex Weald and Downs NHS Trust (2,316) SW London and St George’s Mental Health Trust 24 Swindon and Marlborough NHS Trust 16 Tameside and Glossop Acute Services NHS Trust 1 Tameside and Glossop Community NHSTrust 4 Taunton and Somerset NHS Trust 7 Tavistock and Portman NHSTrust 0 Tees and North East Yorkshire NHSTrust 12 Tees East and North Yorkshire Ambulance Service NHS 28 3178271026 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 112 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s
Thames Gateway NHSTrust 0 The Cardiothoracic Centre—Liverpool NHSTrust 1 The Hillingdon Hospital NHSTrust 22 The Lewisham Hospital NHSTrust 4 The Mid Cheshire Hospitals NHSTrust 99 The Princess Royal Hospital NHSTrust (545) The Queen Victoria Hospital NHSTrust 0 The Royal Marsden NHSTrust 49 The Royal Nat Orthopaedic Hosp NHSTrust 0 The Whittington Hospital NHSTrust 8 TraVord Healthcare NHSTrust 5 Two Shires Ambulance NHS Trust 15 United Bristol Healthcare NHSTrust (7,659) United Lincolnshire Hospitals NHSTrust 3 Univ Hosps Coventry & Warwickshire NHSTrust 5 University College London Hosp NHSTrust 6,762 University Hospital Birmingham NHSTrust 39 University Hospitals of Leicester NHSTrust 13 Wakefield and Pontefract Comm Health Trust 3 Walsall Community Health NHSTrust 0 Walsall Hospitals NHSTrust 41 Walton Neurology Centre NHSTrust 15 Warrington Community HC NHSTrust 13 Warwickshire Ambulance Service NHS Trust 126 West Dorset General Hospitals NHSTrust 2 West Hampshire NHSTrust (12) West Hertfordshire Hospitals NHSTrust (11,487) West London Mental Health NHSTrust 3 West Middlesex University NHSTrust 3 West Midlands Ambulance Service NHS Trust 11 West SuVolk Hospitals NHSTrust (936) West Yorkshire Ambulance Service Trust 1 Westcountry Ambulance Services NHS Trust 5 Weston Area Health NHSTrust (450) Whipps Cross University Hosp NHSTrust 51 Wiltshire Ambulance Service NHS Trust 1 Wiltshire and Swindon Health Care NHS Trust 0 Winchester and Eastleigh Healthcare NHSTrust 0 Wirral and West Cheshire Comm NHSTrust 2 Wirral Hospital NHSTrust 13 Wolverhampton Health Care NHSTrust 8 Worcestershire Acute Hospitals NHSTrust 6 Worcestershire MH Partnership NHSTrust 0 Worthing and Southlands Hospitals Trust 14 Worthing Priority Care Services Trust (591) Wrightington, Wigan and Leigh NHSTrust 2 York Health Services NHS Trust 7 Source: NHS Trust Summarisation Schedules 2001–02 Notes 1. NHSTrusts are listed under their current name.
Table 2.1.3(f) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 2002–03
NHS trusts Retained surplus/(deficit) £000s
5 Boroughs Partnership NHSTrust 30 Addenbrookes NHSTrust 1,904 Aintree Hospitals NHSTrust 5 Airedale NHSTrust 7 3178271027 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 113
NHS trusts Retained surplus/(deficit) £000s
Ashford and St Peter’s Hospitals NHS Trust (1,328) Avon Ambulance Service NHS Trust 3 Avon and Wiltshire MHP NHSTrust (994) Barking, Havering and Redbridge Hosp NH 5 Barnet and Chase Farm Hospitals NHSTrust (2,145) Barnet, Enfield and Haringey MH NHSTrust (686) Barnsley District Gen Hospital NHSTrust 3 Barts and The London NHSTrust 24 Basildon & Thurrock Uni Hosp NHSFDTN Trust 4,765 B’Burn, H’Burn & R’Ble Valley NHSTrust 3 Bedford Hospital NHSTrust 2,741 Bedfordshire and Luton Community NHSTrust 1,561 Beds and Herts Ambulance and Paramedic Trust 19 Berkshire Healthcare NHSTrust (4,357) Birmingham Children’s Hospital NHSTrust 996 Birmingham Heartlands and Solihull Trust 0 Birmingham Women’s Health Care NHSTrust 282 Black Country Mental Health NHSTrust 11 Blackpool, Fylde and Wyre Hosps NHSTrust 62 Bolton Hospitals NHSTrust 0 Bradford District Care Trust 38 Bradford Teaching Hosps NHSTrust 0 Brighton and Sussex Univ Hosps NHS Trust 2,695 Bromley Hospitals NHSTrust 507 Buckinghamshire Mental Health NHSTrust (916) Burnley Health Care NHSTrust (626) Burton Hospitals NHSTrust 20 Calderdale and Huddersfield NHSTrust 13 Calderstones NHSTrust 45 Cambs & Peterborough MH Partnership Trust 1,371 Camden & Islington MH & Social Care Trust 29 Cent Manchester/Manchester Child NHSTrust 19 Central and North West London MH NHSTrust 7 Chelsea and Westminster Healthcare Trust 88 Cheshire and Wirral Partnership NHSTrust 3 Chesterfield and N Derbyshire Hosp Trust 20 Christie Hospital NHSTrust 6 City Hospitals Sunderland NHS Trust 63 Clatterbridge Centre for Oncology Trust 6 Co Durham & Darlington Acute Hosp NHSTrust 508 Community Health SheYeld NHSTrust 3 Cornwall Partnership NHSTrust 550 Countess of Chester Hosp NHSTrust 2 County Durham and Darlington Prior Service Trust 51 Coventry & Warwickshire Ambulance NHSTrust 0 Cumbria Ambulance Service NHS Trust 2 Dartford and Gravesham NHSTrust (2,710) Derby Hospitals NHSTrust 9 Derbyshire Mental Health Services NHS Trust 0 Devon Partnership NHSTrust 12 Doncaster & Bassetlaw Hosps NHSTrust 5 Doncaster and South Humber Healthcare NHS 38 Dorset Ambulance NHSTrust 1 Dorset Health Care NHSTrust 4 Dudley Group of Hospitals NHSTrust 4 Ealing Hospital NHSTrust (183) East and North Hertfordshire NHSTrust 2,495 East Anglian Ambulance NHSTrust 473 East Cheshire NHSTrust 10 East Kent Hospitals NHSTrust (11,371) East Kent NHSand SCPartnership Trust (310) East London and The CITY MH NHSTrust 48 East Midlands Ambulance Servce NHS Trust 0 3178271027 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 114 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s
East Somerset NHS Trust 11 East Sussex County Healthcare NHS Trust (747) East Sussex Hospitals NHS Trust (1,450) Epsom and St Helier Uni Hosps NHS Trust (2,193) Essex Ambulance Service NHS Trust (58) Essex Rivers Healthcare NHSTrust 22 Frimley Park Hospital NHSTrust (1,904) Gateshead Health NHSTrust 10 George Eliot Hospital NHSTrust 909 Gloucestershire Ambulance Services NHST 345 Gloucestershire Hospitals NHSTrust 37 Gloucestershire Partnership NHSTrust 1 Good Hope Hospital NHSTrust (839) Great Ormond St Hosp FOR Children NHS Trust 1,122 Greater Manchester Ambulance NHSTrust 8 Guy’s and St Thomas’ NHS Trust 124 Hammersmith Hospitals NHSTrust 82 Hampshire Ambulance Service NHS Trust 2 Hampshire Partnership NHSTrust 24 Harrogate Health Care NHSTrust 51 Heatherwood and Wexham Park Hosps Trust 11 Hereford and Worcester Ambulance NHSTrust 0 Hereford Hospitals NHSTrust 17 Hertfordshire Partnership NHSTrust 77 Hinchingbrooke Health Care NHSTrust 221 Homerton Univ Hospital NHSTrust 32 Hull and East Riding Comm Health NHSTrust 8 Hull and East Yorkshire Hospitals NHSTrust 18 Ipswich Hospital NHSTrust 992 Isle of Wight Healthcare NHSTrust (3,704) James Paget Healthcare NHSTrust 11 Kent Ambulance NHSTrust 57 Kettering General Hospital NHSTrust (6) King’s College Hospital NHSTrust 35 King’s Lynn and Wisbech Hospitals NHSTrust 1 Kingston Hospital NHSTrust 35 Lancashire Ambulance Service NHS Trust 10 Lancashire Care NHSTrust 9 Lancashire Teaching Hospitals NHSTrust 33 Leeds Mental Health Teaching NHSTrust 30 Leeds Teaching Hospitals NHSTrust 3,473 Leicestershire Partnership NHSTrust 9 Lincolnshire Ambulance NHSTrust 2 Lincolnshire Partnership NHSTrust 4 Liverpool Womens Hospital NHSTrust 9 London Ambulance Service NHS Trust 94 Luton and Dunstable Hospital NHSTrust 99 Maidstone and Tunbridge Wells NHSTrust (4,040) Manchester Mental Hlth & Social Care Trust 0 Mayday Healthcare NHSTrust 4 Medway NHSTrust (967) Mental Health Serv of Salford NHS Trust 11 Mersey Care NHSTrust 2,428 Mersey Regional Ambulance Service Trust 5 Mid Essex Hospital Services NHS Trust 1,062 Mid StaVordshire Gen Hospitals Trust 8 Mid Yorkshire Hospitals NHSTrust 3 Milton Keynes General Hospital NHSTrust (1,394) Moorfields Eye Hospital NHSTrust 0 Morecambe Bay Hospitals NHSTrust 18 N Essex Mental Health Partnership NHSTrust 5 New Possibilities NHSTrust (2,300) Newc, N Tyneside and N’Thumberlnd Mh NHS(1,941) 3178271027 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 115
NHS trusts Retained surplus/(deficit) £000s
Newcastle upon Tyne Hospitals NHSTrust 130 Newham University Hospital NHSTrust 0 Norfolk & Waveney MH Partnership NHSTrust 0 Norfolk and Norwich Uni Hosp NHSTrust 32 North Bristol NHSTrust (44,620) North Cheshire Hospitals NHSTrust 8 North Cumbria Acute Hospitals NHSTrust (1,803) North East Ambulance Service NHS Trust 304 North East London Mental Health NHSTrust 84 North Hampshire Hospitals NHSTrust 314 North Lincolnshire and Goole Hosps NHST 0 North Middlesex University Hosp NHSTrust 0 North StaVs Combined HC NHSTrust 11 North Tees and Hartlepool NHSTrust 23 North West London Hospitals NHSTrust 16 North West Surrey MH NHS Partnership Trust (2) Northampton General Hospital NHSTrust 6 Northamptonshire Healthcare NHSTrust 101 Northern Birmingham Mental Health Trust (2,245) Northern Devon Healthcare NHSTrust 0 Northgate and Prudhoe NHSTrust 27 Northumbria Health Care NHSTrust 55 Nottingham City Hospital NHSTrust 34 Nottinghamshire Healthcare NHSTrust 5 Nth Cumbria MH and Learning Disab NHSTrust 0 NuYeld Orthopaedic Centre NHSTrust 3,744 Oxford Learning Disability NHSTrust 3 Oxford RadcliVe Hospitals NHSTrust (179) Oxfordshire Ambulance NHSTrust 590 Oxfordshire Mental Healthcare NHSTrust 1 Oxleas NHSTrust 37 Papworth Hospital NHSTrust 3 P’Boro & Stamford Hosps NHS Trust 22 Pennine Acute Hospitals NHSTrust 10 Pennine Care NHSTrust 0 Plymouth Hospitals NHSTrust 0 Poole Hospital NHSTrust 0 Portsmouth Hospitals NHSTrust 20 Princess Alexandra Hospital NHSTrust (3,714) Queen Elizabeth Hospital NHSTrust 7,213 Queen Mary’s Sidcup NHS Trust (1,954) Queen Victoria Hospital NHSTrust 68 Queen’s Medical Notts Uni Hosp NHSTrust 61 Rob Jones and A Hunt Orthopaedic NHSTrust (792) Rotherham General Hospitals NHSTrust 22 Royal Berkshire Ambulance Service Trust 7 Royal Berkshire and Battle Hosps NHSTrust (786) Royal Bournemouth and Christchurch Trust 25 Royal Brompton and Harefield NHSTrust 20 Royal Cornwall Hospitals NHSTrust (5,210) Royal Devon & Exeter NHSTrust 37 Royal Free Hampstead NHSTrust (847) Royal Liverpool Broadgreen Univ Hosp Trust 0 Royal Liverpool Children’s NHSTrust 1 Royal Nat Hosp Rheumatic Diseases NHSTrust 13 Royal Nat Orthopaedic Hosp NHSTrust 0 Royal Orthopaedic Hospital NHSTrust 37 Royal Shrewsbury Hospitals NHS Trust (1,889) Royal Surrey County Hospital NHS Trust (3,563) Royal United Hospital Bath NHSTrust (24,784) Royal West Sussex NHS Trust (1,349) Royal Wolverhampton Hospital NHSTrust 457 Salford Royal Hospitals NHS Trust 230 3178271027 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 116 Health Committee: Evidence
NHS trusts Retained surplus/(deficit) £000s
Salisbury Health Care NHS Trust 0 Sandwell & West Birmingham HOSPS NHS Trust 5 Scarborough and NE Yorks NHS Trust 32 SheYeld Children’s NHSTrust 23 SheYeld Teaching Hosp NHSTrust 91 Sherwood Forest Hospitals NHS Trust 1 Somerset Partnership NHS and SOC Care Trust 2,555 South Birmingham Mental Health NHS Trust 0 South Buckinghamshire NHS Trust (2,974) South Devon Health Care NHS Trust 16 South Downs Health NHS Trust 216 South Essex Partnership NHS Trust 365 South London and Maudsley NHS Trust 1 South Manchester Univ Hosp NHS Trust (6,980) South of Tyne and Wearside MH NHS Trust 25 South StaVordshire Healthcare NHSTrust 0 South Tees Hospitals NHS Trust 74 South Tyneside Health Care NHS Trust 6 South Warwickshire Gen Hosps NHS Trust 19 South West Yorkshire Mental Health NHSTrust 18 South Yorkshire Ambulance Service NHS Trust 37 Southampton University Hosps NHS Trust 160 Southend Hospital NHS Trust 4 Southport and Ormskirk Hospital NHS Trust 7 St George’s Healthcare NHS Trust 4,280 St Helens and Knowsley Hospitals NHS Trust 2 St Mary’s NHS Trust 2 StaVordshire Ambulance Service Trust 0 Stockport NHS Trust 176 Stoke Mandeville Hospital NHS Trust (2,404) SuVolk Mental Health Partnership NHSTrust 9 Surrey Ambulance Service NHS Trust 4 Surrey and Sussex Healthcare NHS Trust 6,657 Surrey Hampshire Borders NHS Trust 46 Surrey Oaklands NHS Trust 216 Sussex Ambulance Service NHS Trust 2 Sw London and St George’s Mental Hlth Trust 73 Swindon and Marlborough NHS Trust 13 Tameside and Glossop Acute Servs NHS Trust 13 Taunton and Somerset NHS Trust 5 Tavistock and Portman NHSTrust 0 Tees and North East Yorkshire NHSTrust 19 Tees East and Nth Yorkshre Amb Serv NHS 0 The Cardiothoracic Cntr—Liverpool Nhst 0 The Hillingdon Hospital NHSTrust 20 The Lewisham Hospital NHSTrust 5 The Mid Cheshire Hospitals NHSTrust 23 The Princess Royal Hospital NHSTrust (1,188) The Royal Marsden NHSTrust 68 The Whittington Hospital NHSTrust (988) TraVord Healthcare NHSTrust 2 Two Shires Ambulance NHS Trust 2 Uni Coll London Hosp NHSTrust 47 Uni Hospital Birmingham NHSTrust 33 United Bristol Healthcare NHSTrust (9,281) United Lincolnshire Hospitals NHSTrust 79 Univ Hosp North StaVordshire NHSTrust 4 Univ Hosps Coventry & Warwickshire NHSTrust 6 University Hospitals of Leicester NHSTrust 18 Walsall Hospitals NHSTrust 8 Walton Neurology Centre NHSTrust 15 West Dorset General Hospitals NHSTrust 2 West Hertfordshire Hospitals NHSTrust 11,668 3178271027 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 117
NHS trusts Retained surplus/(deficit) £000s
West Kent NHSand SocialCare Trust 16 West London Mental Health NHSTrust 3 West Middlesex University Hosp NHSTrust (779) West Midlands Ambulance Service NHS Trust 88 West SuVolk Hospitals NHSTrust 947 West Sussex Health and Social Care NHSTrust (324) West Yorkshire Ambulance Service Trust 1 Westcountry Ambulance Services NHS Trust 7 Weston Area Health NHSTrust (190) Whipps Cross University Hosp NHSTrust 2 Wiltshire Ambulance Service NHS Trust 4 Winchester and Eastleigh Hlthcre NHSTrust 1,000 Wirral Hospital NHSTrust 19 Wolverhampton Health Care NHSTrust (67) Worcestershire Acute Hospitals NHSTrust (9,926) Worcestershire MH Partnership NHSTrust 0 Worthing and Southlands Hospitals Trust 6,292 Wrightington, Wigan and Leigh NHSTrust 2 York Hospitals NHSTrust 9 Source: Audited NHS Trust Summarisation Schedules 2002–03 Notes 1. NHSTrusts are listed under their current name.
Table 2.1.3(g) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 2003–04
Retained surplus/(deficit) NHS Trusts £000s 5 Boroughs Partnership NHSTrust 15 Addenbrookes NHSTrust (921) Aintree Hospitals NHSTrust 5 Airedale NHSTrust (1,448) Ashford and St Peter’s Hospitals NHS Trust 5 Avon Ambulance Service NHS Trust 241 Avon and Wiltshire MHP NHSTrust 99 Barking, Havering and Redbridge Hospital NH 4 Barnet and Chase Farm Hospitals NHSTrust (4,398) Barnet, Enfield and Haringey Mental Health NHSTrust (924) Barnsley District General Hospital NHSTrust 3 Barts and The London NHSTrust 43 Basildon & Thurrock University Hospital NHSFdtn Trust 12 Bedford Hospital NHSTrust 120 Bedfordshire and Luton Community NHSTrust 102 Bedfordshire and Hertfordshire Ambulance and Paramedic Trust 14 Berkshire Healthcare NHSTrust (851) Birmingham and Solihull Mental Health NHS Trust 0 Birmingham Children’s Hospital NHSTrust 9 Birmingham Heartlands and Solihull Trust 0 Birmingham Women’s Health Care NHSTrust 4 Blackpool, Fylde and Wyre Hospitals NHSTrust (929) Bolton Hospitals NHSTrust 3 Bolton Salford and TraVord Mental Health NHSTrust 367 Bradford District Care Trust 347 Bradford Teaching Hospitals NHSTrust 0 Brighton and Sussex University Hospitals NHS Trust (7,912) Bromley Hospitals NHSTrust 0 Buckinghamshire Hospitals NHSTrust (5,237) Buckinghamshire Mental Health NHSTrust (1,689) Burton Hospitals NHSTrust (179) Calderdale and Huddersfield NHSTrust 16 3178271028 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 118 Health Committee: Evidence
Retained surplus/(deficit) NHS Trusts £000s Calderstones NHSTrust 35 Cambs & Peterborough Mental Health Partnership Trust 1,649 Camden & Islington Mental Health & Social Care Trust 1,883 Cent Manchester/Manchester Child NHSTrust 128 Central and North West London Mental Health NHSTrust 16 Chelsea and Westminster Healthcare Trust (1,880) Cheshire and Wirral Partnership NHSTrusts 33 Chesterfield and N Derbyshire Hospital Trust 21 Christie Hospital NHSTrust 0 City Hospitals Sunderland NHS Trust 51 Clatterbridge Centre for Oncology Trust 22 Co Durham & Darlington Acute Hospital NHSTrust 179 Cornwall Partnership NHSTrust 471 Countess of Chester Hospital NHSTrust 1 County Durham and Darlington Prior Service Trust 6 Coventry & Warwickshire Ambulance NHSTrusts 0 Cumbria Ambulance Service NHS Trust 502 Dartford and Gravesham NHSTrust 61 Derby Hospitals NHSTrust 4 Derbyshire Mental Health Services NHS Trust 0 Devon Partnership NHSTrust 93 Doncaster & Bassetlaw Hospitals NHSTrust 18 Doncaster and South Humber Healthcare NHS 121 Dorset Ambulance NHSTrust 0 Dorset Health Care NHSTrust 15 Dudley Group of Hospitals NHSTrust 848 Ealing Hospital NHSTrust 7 East and North Hertfordshire NHSTrust 19 East Anglian Ambulance NHSTrust 747 East Cheshire NHSTrust 19 East Kent Hospitals NHSTrust 65 East Kent NHSand SCPartnership Trust (225) East Lancashire Hospitals NHSTrust (3,934) East London and The City Mental Health NHSTrust 37 East Midlands Ambulance Servce NHS Trust 1 East Somerset NHS Trust 4 East Sussex County Healthcare NHS Trust (1,025) East Sussex Hospitals NHS Trust (1,787) Epsom and St Helier University Hospitals NHS Trust 94 Essex Ambulance Service NHS Trust 22 Essex Rivers Healthcare NHSTrust (5,843) Frimley Park Hospital NHSTrust (524) Gateshead Health NHSTrust 6 George Eliot Hospital NHSTrust 8 Gloucestershire Ambulance Services NHST 14 Gloucestershire Hospitals NHSTrusts 40 Gloucestershire Partnership NHSTrust 5 Good Hope Hospital NHSTrust (5,014) Great Ormond St Hospital for Children NHS Trusts 1 Greater Manchester Ambulance NHSTrust 91 Guy’s and St Thomas’ NHS Trust 94 Hammersmith Hospitals NHSTrust 19 Hampshire Ambulance Service NHS Trust (1,727) Hampshire Partnership NHSTrust 1 Harrogate Health Care NHSTrust 7 Heatherwood and Wexham Park Hospitals Trust 36 Hereford and Worcester Ambulance NHSTrust 67 Hereford Hospitals NHSTrust (18) Hertfordshire Partnership NHSTrust 48 Hinchingbrooke Health Care NHSTrust 5 Homerton University Hospital NHSTrust 2 Hull and East Riding Comm Health NHSTrust 27 Hull and East Yorkshire Hospitals NHSTrust 17 Ipswich Hospital NHSTrust (1,404) 3178271028 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 119
Retained surplus/(deficit) NHS Trusts £000s Isle of Wight Healthcare NHSTrust 23 James Paget Healthcare NHSTrust 5 Kent Ambulance NHSTrust 0 Kettering General Hospital NHSTrust (1,197) King’s College Hospital NHSTrust 182 Kings Lynn and Wisbech Hospitals NHSTrust (5,358) Kingston Hospital NHSTrust 5 Lancashire Ambulance Service NHS Trust 12 Lancashire Care NHSTrust 8 Lancashire Teaching Hospitals NHSTrust 4 Leeds Mental Health Teaching NHSTrust 36 Leeds Teaching Hospitals NHSTrust (309) Leicestershire Partnership NHSTrust 9 Lincolnshire Ambulance NHSTrust 2 Lincolnshire Partnership NHSTrust 9 Liverpool Womens Hospital NHSTrust 7 London Ambulance Service NHS Trust 89 Luton and Dunstable Hospital NHSTrust 852 Maidstone and Tunbridge Wells NHSTrust (8,968) Manchester Mental Hlth & Social Care Trust 0 Mayday Healthcare NHSTrust (163) Medway NHSTrust 2,372 Mersey Care NHSTrust 0 Mersey Regional Ambulance Service Trust 6 Mid Essex Hospital Services NHS Trust 513 Mid StaVordshire Gen Hospitals Trust (509) Mid Yorkshire Hospitals NHSTrust (18,637) Milton Keynes General Hospital NHSTrust (3,172) Moorfields Eye Hospital NHSTrust 0 Morecambe Bay Hospitals NHSTrust 19 N Essex Mental Health Partnership NHSTrust 694 Newcastle, N Tyneside and Northumberland Mental Health NHS261 Newcastle upon Tyne Hospitals NHSTrust 63 Newham University Hospital NHSTrust 20 Norfolk & Waveney Mental Health Partnership NHSTrust 192 Norfolk and Norwich University Hospital NHSTrust 88 North Bristol NHSTrust 20 North Cheshire Hospitals NHSTrust 25 North Cumbria Acute Hospitals NHSTrust (4,133) North East Ambulance Service NHS Trust 28 North East London Mental Health NHSTrust 91 North Hampshire Hospitals NHSTrust 37 North Lincolnshire and Goole Hospitals NHSTrust 0 North Middlesex University Hospital NHSTrust (989) North StaVs Combined HC NHSTrust 62 North Tees and Hartlepool NHSTrust 6 North West London Hospitals NHSTrust (3,099) North West Surrey Mental Health NHS Partnership Trust (1,261) Northampton General Hospital NHSTrust (4,922) Northamptonshire Healthcare NHSTrust 51 Northern Devon Healthcare NHSTrust 372 Northgate and Prudhoe NHSTrust 8 Northumbria Health Care NHSTrust 26 Nottingham City Hospital NHSTrust 44 Nottinghamshire Healthcare NHSTrust 614 North Cumbria Mental Health and Learning Disability NHSTrust 0 NuYeld Orthopaedic Centre NHSTrust (309) Oxford Learning Disability NHSTrust 8 Oxford RadcliVe Hospitals NHSTrust 200 Oxfordshire Ambulance NHSTrust 1 Oxfordshire Mental Healthcare NHSTrust 2 Oxleas NHSTrust 11 Papworth Hospital NHSTrust (252) Peterborough & Stamford Hospitals NHS Trust (969) 3178271028 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 120 Health Committee: Evidence
Retained surplus/(deficit) NHS Trusts £000s Pennine Acute Hospitals NHSTrust 226 Pennine Care NHSTrust 0 Plymouth Hospitals NHSTrust (7,753) Poole Hospital NHSTrust 35 Portsmouth Hospitals NHSTrust 85 Princess Alexandra Hospital NHSTrust (495) Queen Elizabeth Hospital NHSTrust 917 Queen Mary’s Sidcup NHS Trust 41 Queen Victoria Hospital NHSTrust 39 Queen’s Medical Notts University Hospital NHSTrust 41 Rob Jones and A Hunt Orthopaedic NHSTrust (2,314) Rotherham General Hospitals NHSTrust 39 Royal Berkshire Ambulance Service Trust 17 Royal Berkshire and Battle Hospitals NHSTrust 5,486 Royal Bournemouth and Christchurch Trust 38 Royal Brompton and Harefield NHSTrust 6 Royal Cornwall Hospitals NHSTrust (5,845) Royal Devon & Exeter NHSTrust 44 Royal Free Hampstead NHSTrust (961) Royal Liverpool Broadgreen University Hospital Trust 0 Royal Liverpool Childrens NHSTrust 3 Royal Nat Hospital Rheumatic Diseases NHSTrust 8 RoyaL Nat Orthopaedic Hospital NHSTrust 0 Royal Orthopaedic Hospital NHSTrust 303 Royal Surrey County Hospital NHS Trust (1,549) Roya University Hospital Bath NHSTrust (1,968) Royal West Sussex NHS Trust (3,572) Royal Wolverhampton Hospital NHSTrust (7,612) Salford Royal Hospitals NHS Trust 231 Salisbury Health Care NHS Trust 0 Sandwell & West Birmingham Hospitals NHS Trust (1,593) Sandwell Mental Health NHS & Social CT 1 Scarborough and NE Yorks NHS Trust 62 SheYeld Care Trust 2 SheYeld Children’s NHSTrust 11 SheYeld Teaching Hospital NHSTrust 214 Sherwood Forest Hospitals NHS Trust 2 Shrewsbury & Telford Hospitals NHS Trust (791) Somerset Partnership NHS and Social Care Trust 2 South Devon Health Care NHS Trust 95 South Downs Health NHS Trust 124 South Essex Partnership NHS Trust 116 South London and Maudsley NHS Trust 38 South Manchester University Hospital NHS Trust 32 South of Tyne and Wearside Mental Health NHS Trust 7 South StaVordshire Healthcare NHSTrust 0 South Tees Hospitals NHS Trust (1,712) South Tyneside Health Care NHS Trust 28 South Warwickshire Gen Hospitals NHS Trust 2 South West Yorkshire Mental Health NHS Trust 21 South Yorkshire Ambulance Service NHS Trust 7 Southampton University Hospitals NHS Trust (5,418) Southend Hospital NHS Trust 57 Southport and Ormskirk Hospital NHS Trust 1 St George’s Healthcare NHS Trust (650) St Helens and Knowsley Hospitals NHS Trust 93 St Mary’s NHS Trust (503) StaVordshire Ambulance Service Trust 0 Stockport NHS Trust 38 SuVolk Mental Health Partnership NHSTrust (489) Surrey Ambulance Service NHS Trust 6 Surrey and Sussex Healthcare NHS Trust (4,149) Surrey Hampshire Borders NHS Trust 476 Surrey Oaklands NHS Trust 292 3178271028 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 121
Retained surplus/(deficit) NHS Trusts £000s Sussex Ambulance Service NHS Trust (229) SW London and St George’s Mental Hlth Trust 12 Swindon and Marlborough NHS Trust 11 Tameside and Glossop Acute Servs NHS Trust 8 Taunton and Somerset NHS Trust 5 Tavistock and Portman NHSTrust 0 Tees and North East Yorkshire NHSTrust 5 Tees East and Nth Yorkshre Amb Serv NHS 0 The Cardiothoracic Cntr—Liverpool NHST 0 The Hillingdon Hospital NHSTrust (963) The Lewisham Hospital NHSTrust 8 The Mid Cheshire Hospitals NHSTrust 3 The Royal Marsden NHSTrust 36 The Whittington Hospital NHSTrust (3,400) TraVord Healthcare NHSTrust (744) Two Shires Ambulance NHS Trust 3 University Coll London Hospital NHSTrust 9,394 University Hospital Birmingham NHSTrust 38 United Bristol Healthcare NHSTrust 80 United Lincolnshire Hospitals NHSTrust 66 University Hospital North StaVordshire NHSTrust 3 University Hospitals Covent & Warwickshire NHSTrust 5 University Hospitals of Leicester NHSTrust 52 Walsall Hospitals NHSTrust (1,057) Walton Neurology Centre NHSTrust 10 West Dorset General Hospitals NHSTrust 3 West Hertfordshire Hospitals NHSTrust (519) West Kent NHSand SocialCare Trust 24 West London Mental Health NHSTrust (1,369) West Middlesex University Hospital NHSTrust 137 West Midlands Ambulance Service NHS Trust 231 West SuVolk Hospitals NHSTrust (2,501) West Sussex Health and Social Care NHS Trust 757 West Yorkshire Ambulance Service Trust 0 Westcountry Ambulance Services NHS Trust 403 Weston Area Health NHSTrust (1,514) Whipps Cross University Hospital NHSTrust 3 Wiltshire Ambulance Service NHS Trust 4 Winchester and Eastleigh Healthcare NHSTrust 0 Wirral Hospital NHSTrust 16 Worcestershire Acute Hospitals NHSTrust (12,801) Worcestershire Mental Health Partnership NHSTrust 0 Worthing and Southlands Hospitals Trust (27) Wrightington, Wigan and Leigh NHSTrust 254 York Hospitals NHSTrust 4
Source: Audited NHS Trust Summarisation Schedules 2003–04. Notes 1. NHSTrusts are listed under their current name.
Table 2.1.3(h) DEFICITS AND SURPLUSES OCCURRING IN NHS TRUSTS IN 2004–05
Retained surplus/(deficit) NHS Trusts £000s
5 Boroughs Partnership NHSTrust 38 Aintree Hospitals NHSTrust 7 Airedale NHSTrust "3,288 Ashford and St Peter’s Hospitals NHS Trust 61 Avon Ambulance Service NHS Trust 5 Avon and Wiltshire MHP NHSTrust 43 3178271029 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 122 Health Committee: Evidence
Retained surplus/(deficit) NHS Trusts £000s
Barking, Havering and Redbridge Hosp NH 5 Barnet and Chase Farm Hospitals NHSTrust 0 Barnet, Enfield and Haringey MH NHSTrust 849 Barts and The London NHSTrust 21 Bedford Hospitals NHSTrust "8,480 Bedfordshire & Luton MH & SOC CAR NHS Trust 545 Beds and Herts Ambulance and Paramedic T 13 Berkshire Healthcare NHSTrust 1 Birmingham and Solihull MH NHS Trust 0 Birmingham Children’s Hospital NHSTrust 12 Birmingham Women’s Health Care NHSTrust "264 Blackpool, Fylde and Wyre Hosps NHSTrust 84 Bolton Hospitals NHSTrust "2,706 Bolton Salford and TraVord MH NHSTrust 163 Bradford District Care Trust 0 Brighton and Sussex University Hospitals NHS Trust "10,035 Bromley Hospitals NHSTrust 10,755 Buckinghamshire Hospitals NHSTrust 2,518 Buckinghamshire Mental Health NHSTrust "1,049 Burton Hospitals NHSTrust "2,507 Calderdale and Huddersfield NHSTrust 7 Calderstones NHSTrust 59 Cambs & Peterborough MH Partnership Trust "348 Camden & Islington MH & Social Care Trust 494 Cent Manchester/Manchester Child NHSTrust "7,727 Central and North West London MH NHSTrust 70 Chelsea and Westminster Healthcare Trust 105 Cheshire and Wirral Partnership NHSTrust 13 Christie Hospital NHSTrust 5 Clatterbridge Centre for Oncology Trust 32 Co Durham & Darlington Acute Hosp NHSTrust 338 Cornwall Partnership NHSTrust 481 County Durham and Darlington Prior Services Trust 22 Coventry & Warwickshire Ambulance NHSTrust 0 Cumbria Ambulance Service NHS Trust 15 Dartford and Gravesham NHSTrust "1,146 Derbyshire Mental Health Services NHS Trust 0 Devon Partnership NHSTrust "535 Doncaster & South Humber H’Care NHS Trust 456 Dorset Ambulance NHSTrust 0 Dorset Healthcare NHSTrust 5 Dudley Group of Hospitals NHSTrust 1,741 Ealing Hospital NHSTrust 1 East and North Hertfordshire NHSTrust "8,557 East Anglian Ambulance NHSTrust 1,103 East Cheshire NHSTrust 24 East Kent Hospitals NHSTrust 453 East Kent NHSand SCPartnership Trust 289 East Lancashire Hospitals NHSTrust "4,025 East London and The City MH NHSTrust 32 East Midlands Ambulance Service NHS Trust 1 East Somerset NHS Trust 3 East Sussex County Healthcare NHS Trust 9 East Sussex Hospitals NHS Trust "4,983 Epsom and St Helier Uni Hosps NHS Trust 588 Essex Ambulance Service NHS Trust 134 Essex Rivers Healthcare NHSTrust 293 Frimley Park Hospital NHSFound Trust 93 George Eliot Hospital NHSTrust "786 Gloucestershire Ambulance Services NHST 107 Gloucestershire Partnership NHSTrust 109 Good Hope Hospital NHSTrust "3,576 Great Ormond St Hosp for Children NHS Trust "557 3178271029 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Retained surplus/(deficit) NHS Trusts £000s
Greater Manchester Ambulance NHSTrust 20 Hammersmith Hospitals NHSTrust "17,819 Hampshire Ambulance Service NHS Trust "2,537 Hampshire Partnership NHSTrust 3 Heart of England NHSFoundation Trust 0 Heatherwood and Wexham Park Hosps NHSTrust "4,186 Hereford and Worcester Ambulance NHSTrust 0 Hereford Hospitals NHSTrust 20 Hertfordshire Partnership NHSTrust 821 Hinchingbrooke Health Care NHSTrust "1,566 Hull and East Riding Comm Health NHSTrust 1 Hull and East Yorkshire Hospitals NHSTrust "5,461 Ipswich Hospital NHSTrust "6,443 Isle of Wight Healthcare NHSTrust 12 James Paget Healthcare NHSTrust 14 Kent Ambulance NHSTrust 34 Kettering General Hospital NHSTrust "1,721 King’s College Hospital NHSTrust "2,734 Kings Lynn and Wisbech Hospitals NHSTrust "8,499 Kingston Hospital NHSTrust 503 Lancashire Ambulance Service NHS Trust 10 Lancashire Care NHSTrust 14 Lancashire Teaching Hospitals NHSTrust "2,882 Leeds Mental Health Teaching NHSTrust 24 Leeds Teaching Hospitals NHSTrust 178 Leicestershire Partnership NHSTrust 11 Lincolnshire Ambulance NHSTrust 3 Lincolnshire Partnership NHSTrust 11 Liverpool Womens Hosp NHSFOUND Trust 7 London Ambulance Service NHS Trust 332 Luton and Dunstable Hospital NHSTrust 171 Maidstone and Tunbridge Wells NHSTrust 87 Manchester Mental Health & Social Care Trust 89 Mayday Healthcare NHSTrust 252 Medway NHSTrust "279 Mersey Care NHSTrust 9 Mersey Regional Ambulance Service Trust 15 Mid Essex Hospital Services NHS Trust "2,299 Mid StaVordshire General Hospitals NHSTrust "2,158 Mid Yorkshire Hospitals NHSTrust "19,876 Milton Keynes General Hospital NHSTrust 943 Morecambe Bay Hospitals NHSTrust "1,548 N Essex Mental Health Partnership NHSTrust 616 Newc, N Tyneside and N’Thumberlnd MH NHS1,724 Newcastle upon Tyne Hospitals NHSTrust 192 Newham University Hospital NHSTrust 3 Norfolk & Waveney MH Partnership NHSTrust 527 Norfolk and Norwich Uni Hosp NHSTrust 92 North Bristol NHSTrust 2,402 North Cheshire Hospitals NHSTrust 84 North Cumbria Acute Hospitals NHSTrust 13 North East Ambulance Service NHS Trust 46 North East London Mental Health NHSTrust 151 North Hampshire Hospitals NHSTrust 94 North Lincolnshire and Goole Hosps NHST 0 North Middlesex University Hosp NHSTrust "4,106 North StaVs Combined HC NHSTrust 215 North Tees and Hartlepool NHSTrust 66 North West London Hospitals NHSTrust "11,744 North West Surrey MH NHS Partnership Trust 7 Northampton General Hospital NHSTrust 46 Northamptonshire Healthcare NHSTrust 153 Northern Devon Healthcare NHSTrust "991 3178271029 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Retained surplus/(deficit) NHS Trusts £000s
Northgate and Prudhoe NHSTrust 43 Northumbria Health Care NHSTrust 10 Nottingham City Hospital NHSTrust 31 Nottinghamshire Healthcare NHSTrust 140 Nth Cumbria MH and Learning Disab NHSTrust 0 NuYeld Orthopaedic Centre NHSTrust 82 Oxford Learning Disability NHSTrust 64 Oxford RadcliVe Hospitals NHSTrust 1,580 Oxfordshire Ambulance NHSTrust 50 Oxfordshire Mental Healthcare NHSTrust 2 Oxleas NHSTrust 378 Pennine Acute Hospitals NHSTrust 1,398 Pennine Care NHSTrust 7 Plymouth Hospitals NHSTrust "8,317 Poole Hospital NHSTrust 0 Portsmouth Hospitals NHSTrust 882 Princess Alexandra Hospital NHSTrust 156 Queen Elizabeth Hospital NHSTrust "9,186 Queen Mary’s Sidcup NHS Trust "4,608 Queen’s Medical Notts Uni Hosp NHSTrust 52 Rob Jones and A Hunt Orthopaedic NHSTrust 0 Royal Berkshire Ambulance Service Trust 17 Royal Berkshire and Battle Hosps NHSTrust 2 Royal Bournemouth and Christchurch NHSTrust "250 Royal Brompton and Harefield NHSTrust "3,217 Royal Cornwall Hospitals NHSTrust 13,581 Royal Free Hampstead NHSTrust "10,217 Royal Liverpool Broadgreen Univ Hosp Trust 0 Royal Liverpool Childrens NHSTrust 10 Royal NAT Hosp Rheum Disease NHSFoun Trust 15 Royal Orthopaedic Hospital NHSTrust 608 Royal Surrey County Hospital NHS Trust 262 Royal United Hospital Bath NHSTrust "946 Royal Wolverhampton Hospital NHSTrust "9,016 Salford Royal Hospitals NHS Trust 450 Salisbury Health Care NHS Trust 0 Sandwell & West Birmingham Hosps NHS Trust "7,806 Sandwell Mental Health NHS & Social CT 6 Scarborough and NE Yorks NHS Trust "4,506 SheYeld Care Trust 72 SheYeld Children’s NHSTrust 39 Sherwood Forest Hospitals NHS Trust 8 Shrewsbury and Telford Hospital NHS Trust "10,115 Somerset Partnership NHS and Soc Care Trust 0 South Devon Health Care NHS Trust 81 South Downs Health NHS Trust 69 South Essex Partnership NHS Trust 217 South London and Maudsley NHS Trust 39 South Manchester Univ Hosp NHS Trust 59 South of Tyne and Wearside MH NHS Trust 2 South StaVordshire Healthcare NHSTrust 4 South Tees Hospitals NHS Trust "8,898 South Warwickshire Gen Hosps NHS Trust "8,783 South West Yorkshire Mental Health NHSTrust 129 South Yorkshire Ambulance Service NHS Trust 5 Southampton University Hosps NHS Trust "11,579 Southend Hospital NHS Trust 17 Southport and Ormskirk Hospital NHS Trust "1,189 St George’s Healthcare NHS Trust "21,656 St Helens and Knowsley Hospitals NHS Trust 9 St Mary’s NHS Trust "3,219 StaVordshire Ambulance Service Trust 0 SuVolk Mental Health Partnership NHSTrust 1,004 3178271029 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Retained surplus/(deficit) NHS Trusts £000s
Surrey Ambulance Service NHS Trust 2 Surrey and Sussex Healthcare NHS Trust "30,657 Surrey Hampshire Borders NHS Trust 33 Surrey Oaklands NHS Trust 116 Sussex Ambulance Service NHS Trust 298 SW London and St George’s Mental Health Trust 114 Swindon and Marlborough NHS Trust 4 Tameside and Glossop Acute Servs NHS Trust 5 Taunton and Somerset NHS Trust 3 Tavistock and Portman NHSTrust 0 Tees and North East Yorkshire NHSTrust 120 Tees East and North Yorkshire Ambulance Service NHS 0 The Cardiothoracic Centre—Liverpool NHSTrust 0 The Hillingdon Hospital NHSTrust 23 The Lewisham Hospital NHSTrust "7,505 The Mid Cheshire Hospitals NHSTrust 31 The Rotherham NHSFoundation Trust 13 The Royal Nat Orthopaedic Hosp NHSTrust "3,793 The Royal West Sussex NHS Trust "15,483 The Whittington Hospital NHSTrust 1,998 TraVord Healthcare NHSTrust "3,490 Two Shires Ambulance NHS Trust 184 United Bristol Healthcare NHSTrust 52 United Lincolnshire Hospitals NHSTrust "4,913 Univ Hosp North StaVordshire NHSTrust 41 Univ Hosps Coventry & Warwickshire NHSTrust 7 University Hospitals of Leicester NHSTrust 64 Walsall Hospitals NHSTrust "1,845 Walton Neurology Centre NHSTrust 10 West Dorset General Hospitals NHSTrust "448 West Hertfordshire Hospitals NHSTrust "9,978 West Kent NHSand SocialCare Trust 28 West London Mental Health NHSTrust 10 West Middlesex University NHSTrust "3,991 West Midlands Ambulance NHSTrust "203 West SuVolk Hospitals NHSTrust "7,638 West Sussex Health and Social Care NHS Trust 34 West Yorkshire Ambulance Service Trust 20 Westcountry Ambulance Services NHS Trust 35 Weston Area Health NHSTrust "5,154 Whipps Cross University Hosp NHSTrust 7 Wiltshire Ambulance Service NHS Trust 9 Winchester and Eastleigh Healthcare NHSTrust 76 Wirral Hospital NHSTrust 25 Worcestershire Acute Hospitals NHSTrust 2 Worcestershire MH Partnership NHSTrust 243 Worthing and Southlands Hospitals Trust 51 Wrightington, Wigan and Leigh NHSTrust "743 York Hospitals NHSTrust 1 Source: Audited NHS Trust Summarisation Schedules 2004–05 Notes 1. The 2004–05 data must be treated as provisional until signed oV by the NAO/Chief Executive 2. NHSTrusts are listed under their current name.
2.1.4 Can you comment on the fact that the number of bodies failing to achieve balance increased from 2002–03, as did the number of bodies incurring significant deficits. Does this trend appear to have been continued in 2004–05? Answer 1. NHSbodies are expected to plan for, and achieve, financial balance each a nd every year. 2. The Department no longer allows unplanned support to be given to NHSorga nisations. This has made the deficit position of individual NHSorganisations more transparent. 3178271030 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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3. With the high levels of investment in the NHS, all organisations should be able to manage their funding, deliver service improvements, and achieve financial balance. 4. In 2004–05, we anticipate an increase in the number of NHSorganisations failing to achieve financial balance and those incurring deficits. The majority of organisations are living within budget, but a minority of organisations have not exercised suYcient eVective financial control. This must be addressed locally in conjunction with the strategic health authority.
2.1.5 Have plans been put in place to improve the financial position of those NHS bodies struggling with significant deficits? Are these judged to be realistic by the Audit Commission? Answer 1. SHAs are responsible for delivering financial balance at a local level. SHAs work with NHS organisations to agree recovery plans, where appropriate. Recovery plans can be phased in over a number of years. Any recovery plans would be subject to the consent of other local providers, as implementing them would require other organisations within the health economy to underspend over the same period. 2. The Audit Commission is responsible for appointing external auditors to health bodies and, thereafter, providing them with support in the delivery of their statutory audit and reviewing the quality of their audit work. The Commission itself has no remit to review recovery plans prepared by individual health bodies. 3. The appointed auditors are required to plan their audits taking account of the significant business risks faced by the audited body. The financial performance of a health body may well be considered a significant business risk, both by the body and the auditor, and in those circumstances the auditor may well review the existence and content of a financial recovery plan. 4. If the auditor concludes that the body is not managing its financial position appropriately and does not believe that the recovery plan will achieve the necessary improvements, the Audit Commission has advised the auditor that they should consider issuing a report in the public interest under S8 of the Audit Commission Act 1998.
2.1.6 Do you expect the NHS to achieve financial balance in 2004–05? What action are you taking to achieve balance? Answer 1. We are anticipating a deficit in 2004–05 of around £250 million. The majority of NHSorganisations are, however, living within their budget. 2. The following action was taken with the aim of achieving financial balance across NHSorganisations in 2004–05: — NHSorganisations were expected to produce robust and deliverable financ ial plans; — towards the end of the financial year, when it became apparent that the NHSw as facing a deficit, to minimise the overspend, we set challenging control totals for SHAs. These were used to bring SHAs as close as possible to financial balance in 2004–05, for their economies; and — with a view to achieving financial balance, towards the end of the financial year, we increased the number of monitoring data collections from monthly collections to weekly collections for the high risk areas.
2.1.7 Could the Department supply information about the financial plans and projected position for 2005–06? What action is being taken to achieve balance in 2005–06? Answer 1. All NHSorganisations are expected to plan for and achieve financial bala nce every year. However, the anticipated deficit for 2004–05 may have an impact upon the 2005–06 position. 2. With a view to delivering the best financial position for 2005–06: — as part of the LDP process, we have agreed with SHAs challenging but deliverable financial plans; — we have re-emphasised to all SHAs the importance of sound financial management, and the key role that system reform will play to achieve this goal; and — we have also increased the level of monitoring and analysis, and have developed a more active way of challenging SHAs about their financial performance.
2.1.8 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 Commission1 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?
1 Financial Management in the NHS: NHS (England) summarised accounts 2003–04, National Audit OYce & Audit Commission, 24 June 2005, para 4.9. 3178271030 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Answer 1. We have adopted a more comprehensive approach to monitoring. We now require more data from all NHSbodies, and we will be more active in analysing the data, and engaging NH Sbodies about the quality of the data. We will also be targeting specific requirements towards high risk bodies. 2. We already have in place a process to bring forward the date by which final accounts are published. This will ensure that more of the work to consolidate the figures will be completed earlier in the year. We are also considering options for closer integration of monitoring and the production of accounts, including the possible production of in-year accounts. 3. The problems with in-year forecasting identified by the Audit Commission is partly due to over- pessimistic forecasting by NHSbodies. The measures set out above aim to ma ke the forecasting more reliable.
2.2 Overall expenditure 2.2.1 Could the Department provide an updated version of Table 2.2.1, and of the Department’s commentary which accompanied it? Could it also show this data in graphical form? Could the Department provide a brief commentary, explaining what expenditure is included under each section of the table? Can the footnote to table 2.2.1 explain the measures and their applications for lines D to G? [2.2.1] Answer 1. Expenditure in Table 2.2.1(a) and Figure 2.2.1(a) is shown on a Stage Two Resource Budgeting basis. Table 2.2.1(a) is consistent with the presentation of the data in Figure 3.4 of the 2005 Departmental Report (CM6524). 2. Table 2.2.1(b) gives a brief explanation of the main areas of expenditure in Table 2.2.1(a).
Table 2.2.1(a) TRENDSIN ACTUAL AND PLANNED EXPENDITURE ON THE HEALTH AND PERSONAL SOCIAL SERVICES 2003–04 TO 2007–08 BY AREA OF EXPENDITURE (1) (2) (3) (4) (STAGE TWO RESOURCE BUDGETING) £million 2003–04 2004–05 2005–06 2006–07 2007–08 estimated outturn outturn Plan Plan Plan
Central Government Expenditure National Health Service Hospitals, community health, family health (discretionary) and related services Current A. Net spending(13) 57,083 62,768 69,117 76,716 83,937 B. Charges and receipts(5) 2,146 2,572 2,616 2,616 2,616 C. Total spending 59,230 65,340 71,733 79,332 86,553 D. Change over previous year in cash (%) 10.3 9.8 10.6 9.1 E. Change over previous years in real terms (%) (total) 8.1 7.1 7.7 6.2 F. Change over previous years in real terms (%) (net) 7.7 7.4 8.1 6.5 Capital A. Net spending 2,415 3,367 4,206 5,131 6,101 B. Charges and receipts(5) 270 582 200 200 200 C. Total spending 2,686 3,949 4,406 5,331 6,301 D. Change over previous year in cash (%) 47.0 11.6 21.0 18.2 E. Change over previous years in real terms (%)(total) 44.0 8.8 17.8 15.1
National Health Service family health services (non-discretionary)(7) Current A. Net spending 2,141 2,095 1,660 1,108 1,162 B. Charges and receipts 912 858 682 682 682 C. Total spending 3,052 2,953 2,342 1,790 1,844 3178271031 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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£million 2003–04 2004–05 2005–06 2006–07 2007–08 estimated outturn outturn Plan Plan Plan
D. Change over previous year in cash (%) "3.3 "20.7 "23.6 3.0 E. Change over previous years in real terms (%) (total) "5.2 "22.6 "25.6 0.3
Departmental administration (8) (14) Current A. Net spending 317 328 283 265 262 B. Charges and receipts 23 62 56 56 56 C. Total spending 340 390 339 321 318 D. Change over previous year in cash (%) 14.8 "13.1 "5.5 "0.7 E. Change over previous years in real terms (%) (total) 12.5 "15.2 "7.9 "3.3 Cost of Collecting NHS element of NI contributions 19 17 15 15 15
Central health and miscellaneous services (15) Current A. Net spending 1,008 1,123 1,091 1,073 1,149 B. Charges and receipts 94 150 113 113 113 C. Total spending 1,103 1,273 1,205 1,186 1,263 D. Change over previous year in cash (%) 15.4 "5.3 "1.6 6.4 E. Change over previous years in real terms (%) (total) 13.1 "7.7 "4.1 3.7
Other NHS Capital A. Net spending 36 29 31 32 32 B. Charges and receipts 0 0 0 0 0 C. Total spending 36 29 31 32 32 D. Change over previous year in cash (%) "20.4 8.3 2.4 0.0 E. Change over previous years in real terms (%) (total) "22.0 5.7 "0.3 "2.6
NHS Total A. Net spending 63,001 69,710 76,388 84,324 92,643 B. Charges and receipts(5) 3,445 4,224 3,668 3,668 3,668 C. Total spending 66,446 73,934 80,056 87,992 96,311 D. Change over previous year in cash (%) 11.3 8.3 9.9 9.5 E. Change over previous years in real terms (%) (total) 9.0 5.6 7.0 6.6 F. Change over previous years in real terms (%) (net) 8.4 6.9 7.5 7.0
Central Government Personal Social Services(16) A. Net spending 200 222 246 262 284 B. Charges 52 38 46 46 46 C. Total spending 252 260 292 308 330 D. Change over previous year in cash (%) 3.0 12.4 5.3 7.3 E. Change over previous year in real terms (%) 0.9 9.6 2.5 4.4
Central Government (specific and special) grants to local authorities A. Net spending 1,450 1,925 1,917 1,620 1,658 B. Charges 0 0 0 0 0 C. Total spending 1,450 1,925 1,917 1,620 1,658 D. Change over previous year in cash (%) 32.8 "0.4 "15.5 2.3 E. Change over previous year in real terms (%) 30.1 "2.9 "17.7 "0.4 3178271031 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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£million 2003–04 2004–05 2005–06 2006–07 2007–08 estimated outturn outturn Plan Plan Plan
Credit Approvals (LA capital) A. Net spending 49 56 53 53 53 B. Charges 0 0 0 0 0 C. Total spending 49 56 53 53 53
D. Change over previous year in cash (%) 13.5 "4.6 0.0 0.0 E. Change over previous year in real terms (%) 11.2 "7.0 "2.6 "2.6
Health and Personal Social Services Total A. Net spending 64,700 71,913 78,604 86,259 94,639 B. Charges and receipts(5) 3,497 4,262 3,714 3,714 3,714 C. Total spending 68,197 76,175 82,318 89,973 98,353
D. Change over previous year in cash (%) 11.7 8.1 9.3 9.3 G. Change over previous years in real terms (%) (total) 9.4 5.4 6.4 6.4 H. Change over previous years in real terms (%) (net) 8.9 6.6 6.9 6.8
Local Authority Personal Social Services Current(9) (10) (11) A. Net spending 14,763 15,586 n/a n/a n/a B. Charges and receipts 2,077 2,800 n/a n/a n/a C. Total spending 16,839 18,386 n/a n/a n/a
Local Authority Personal Social Services Capital(9) (10) (11) A. Net spending 186 222 n/a n/a n/a B. Charges and receipts 75 77 n/a n/a n/a C. Total spending 261 299 n/a n/a n/a
Local Authority Personal Social Services Total A. Net spending 14,949 15,808 n/a n/a n/a B. Charges and receipts 2,152 2,877 n/a n/a n/a C. Total spending 17,100 18,685 n/a n/a n/a
Local Authority, Health and Personal Social Services Total(12) A. Net spending 79,649 87,721 n/a n/a n/a B. Charges and receipts(5) 5,649 7,139 n/a n/a n/a C. Total spending 85,298 94,860 n/a n/a n/a
GDP deflator w 30 June 2005 98.0 100.0 102.5 105.3 108.1
Notes: 1. Figures may not sum due to rounding. 2. Percentages are rounded to one decimal place. 3. Real terms growth figures diVer from those given last year because of subsequent changes in GDP deflators. Where not otherwise specified, the figures are calculated on total expenditure figures and therefore diVer from the Departmental Report, where increases are calculated on net expenditure. 4. The measures in changes in expenditure shown in lines D to F are as follows: Line D shows the percentage change in total expenditure; Line E shows the percentage change in total expenditure after accounting for inflation in the overall economy as measured by the GDP deflator; Line F shows the percentage change in net expenditure after accounting for inflation in the overall economy as measured by the GDP deflator. 5. Includes NHStrust charges and receipts. 6. Input Cost Data is not available for years where outturn data is not available. 7. With the introduction of PMEds allocation in 2004–05, there is no longer any GMSnon discretionary funding. All GMSfunding is now discretionary. 8. Include Trading Funds—Medicines Control Agency (MCA) and NHSEstates A gency. 9. Net budget figures are taken from Local Authority Revenue Accounts returns. 3178271031 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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£million 2003–04 2004–05 2005–06 2006–07 2007–08 estimated outturn outturn Plan Plan Plan
10. Net budget figures are taken from Local Authority Revenue Account returns. Current figures are for Adult services only. Capital figures show spend on Adult and Children services (as this cannot be broken down further). 11. Local Authorities do not forecast expenditure for future years. Figures for 2003–04 are available, but expenditure on Adults’ services cannot be seperately identified. 12. Local Authority, Health and Personal Social Services total excludes Central Government (Specific and Special) grants to Local Authorities and Credit Approvals (LA Capital) to avoid double counting. The total still does include an element of double counting (unquantifiable) with regard to joint working between hospitals and local authorities. 13. Less HCFHSdepreciation of: 354 511 611 675 750 14. Less Dept Admin depreciation of: 12 13 17 17 17 15. Less CHMSdepreciation of: 15 17 18 19 19 16. Less PSS depreciation of: 11 10 16 10 10
Figure 2.2.1(a) TRENDS IN TOTAL EXPENDITURE 2003-04 TO 2007-08 (STAGE TWO RESOURCE BUDGETING) LA Total 120,000 PSS Total NHS Total
100,000
80,000
60,000 £ MILLION
40,000
20,000
- 2003-04 2004-05 2005-06 2006-07 2007-08 YEARS
Table 2.2.1(b) EXPLANATION OF MAIN AREASOF EXPENDITURE IN TABLE 2.2.1(a)
Area of Expenditure Description
NHSHospital and Community This covers hospital and community health serv ices, prescribing costs Health Services and for drugs and appliances and General Medical Services (which include discretionary family health reimbursements of GMSGPs’ practice sta V, premises, out of hours services (HCHS) and IM&T expenses). It also includes other centrally funded initiatives, services and special allocations managed centrally by the Department of Health (such as service specific levies which fund activities in the areas of education and training and research and development); HCFHSincludes all GMSfunding. This is because of the introduction of the GP contract in April 2004, which means that there is no longer any GMSnon discretionary funding. Capital Capital expenditure is that used on the acquisition of land and premises, individual works for the provision, adaptation, renewal, replacement or demolition of buildings, items or groups of equipment and vehicles etc. 3178271032 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Area of Expenditure Description
NHSFamily Health Services This covers demand-led family health services , such as the cost of (FHS) (non-cash limited) general dental and ophthalmic services, dispensing remuneration and income from dental and prescription charges. Departmental Administration The administrative costs of running the Department of Health. Central health and These are a wide range of activities funded from the Department of miscellaneous services (CHMS) Health’s spending programmes whose only common feature is that they receive funding direct from the Department and not via health authorities. Some of the services are managed directly by Departmental staV; some by non-departmental public bodies, or other separate executive organisations. Other NHSCapital Includes the capital elements of Departmental administ ration and CHMS. NHSTotal The sum of HCHScurrent and capital expenditure, FHS, Departmental administration, CHMScurrent expenditure and other NHScapital.
Table 2.2.1(b) EXPLANATION OF MAIN AREASOF EXPENDITURE IN TABLE 2.2.1(a)
Personal Social Services Personal care services for vulnerable people, including those with special needs because of old age or physical or mental disability. Examples are residential care homes for the elderly, home help and home care services, and social workers that provide help and support for a wide range of people. Central Government (specific Cash grants targeted at services which require a higher priority, where and special) grants to local pump priming is appropriate or where the service is needed in only authorities some authorities. Credit Approvals (LA capital) Central government permission for individual local authorities to borrow or raise other forms of credit for capital purposes. Local Authority Personal Personal care services for vulnerable people, including those with Social Services special needs because of old age or physical or mental disability. Examples are residential care homes for the elderly, home help and home care services, and social workers that provide help and support for a wide range of people. Health and Personal Social The sum of NHS total, central Government personal social services, Services Total central Government (specific and special) grants to local authorities, credit approvals (LA capital), and civil defence. Local Authority, Health and The sum of Health and Personal Social Services Total and Local Personal Social Services Total Authority Personal Social Services Total.
2.2.2 What is the Department’s assessment of each programme’s performance in 2003–04 against plans for that year, and anticipated performance in 2004–05 against plans for that year and outturn in 2003–04? [2.2.2] Answer 1. Table 2.2.2 outlines the significant changes (ie over £10 million) between estimated outturn report in last years evidence and outturn expenditure in Table 2.2.1(a) of this years evidence for 2003–04. 2. Table 2.2.2 also shows the significant changes (ie over £10 million) planned expenditure in last years evidence and estimated outturn expenditure in Table 2.2.1(a) of this years evidence for 2004–05.
Table 2.2.2 COMPARISON OF NET EXPENDITURE PLANS FOR 2003-04 AND 2004-05 WITH THOSE ON PAGES43–45 OF LASTYEAR’SHEALTH COMMITTEE WRITTEN EVIDENCE (HC 1113) The main areas of change (£10 million or over) to the spending plans for various parts of the programme other than LAPSS are as follows. The grant to local authorities for central government is unhypothecated. Local authorities determine their own expenditure. 3178271033 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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£ million DiVerence 2003–04 HCFHScurrent "511 "£706 million slippage on unified NHS/central budget programme spending £153 million overspend on demand led non discretionary GMS(now classed as HCFHS) £47 million shortfall in NHSTrusts achievement of profit and loss targets compared to estimate "£3 million underspend on NDPBs outside the boundary HCFHScapital "164 "£155 million slippage on HCHSSHA/centralbudget capital programme "£44 million grants to LAs less than estimated £34 million NHSTrusts spending more than provision FHSCurrent 44 £22 million pharmaceutical services overspend £12 million pharmaceutical charges shortfall in income £5 million general dental services shortfall in income £5 million general ophthalmic services overspend Departmental Administration "9 No changes less than £10 million to report CHMScurrent "2 No changes less than £10 million to report Central Government PSS 32 "£10 million underspends on a number of central budgets that include the national training strategy and social work development and welfare regulation grants £42 million overspend on budgeting for NDPBs outside the resource accounting boundary PSS Grants to Local Authorities "13 £13 million underspend on preserved rights grant and deferred payments grant following adjustments in respect of local authority expenditure in previous years PSS Credit Approvals "1 No changes less than £10 million to report DiVerence 2004–05 HCFHScurrent 127 449 Take up of 2003–04 End Year Flexibility (EYF) 250 Transfer from HCFHScapital "189 Transfer to FHSnon discretionary "58 Net transfers to and from Other Government Departments "97 Transfer to CHMSRevenue "24 Transfer to DH Admin Revenue "200 Forecast underspend HCFHScapital 105 355 Take up of 2003–04 EYF "250 Transfer to HCFHScurrent FHScurrent 189 189 Transfer to HCFHScurrent Departmental Admin Current 49 23 Brought forward from 2005–06 11 Brought forward from 2006–07 14 Take up of EYF from 2003–04 CHMScurrent 10 "100 Transfer to PSS 97 Transfer from HCFHS 12 Transfers from Other Government Departments Central Government PSS 2 No changes less than £10 million to report PSS Grants to Local Authorities 94 PSS Credit Approvals 3 No changes less than £10 million to report
Notes 1 Changes less than £10 million are not listed and may slightly aVect totals.
2.2.3 Could the Department provide a breakdown of what the additional NHS expenditure in 2004–05 as compared with 2003–04 has been spent on? The impacts on expenditure of additional staV, increased pay levels, medicines, capital and other expenditures should be distinguished where possible. [2.2.3] Answer 1. Total NHSexpenditure in 2004–05 rose by £6.7 billion, of which £5.8 bill ion was increased revenue expenditure and £0.9 billion increased capital expenditure (taking account of underspend on capital in 2003–04). 2. In summary, of the additional £5.8 billion in 2004–05, was accounted for in the following proportions: — Extra StaV, Drugs and good and services 48%. — Pay accounted for 30%. 3178271034 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 133
— Capital and training 17%. — Cost pressures 5%. 3. This extra funding has been used to: — Improve access to, and quality of services—£3.2 billion of the increase has been used to employ additional staV, increase prescribing and purchase more goods and services. Approximately £1.4 billion was spent on additional staV and £0.8 billion on increased prescribing. The balance was used to purchase more goods and services. — To achieve world class service standards, the NHSneeds to invest in peopl e and infrastructure. Investment in training, capital and research increased during the year by £1.15 billion. Capital investment in 2004–05 was £4.5 billion compared to £3.2 billion in 2003–04, a real terms increase of over 40%. 16 new hospital schemes signed contracts and proceeded to construction in 2004–05 compared to 11 in 2003–04. 70% of CT scanners and well over half of all MRI scanners and Linacs now in use in the NHSare new since January 2000 and since publication of the N HSplan in July 2000, over £430 million has been invested in equipment for the diagnosis and treatment of cancer. — There are now more students in training at medical school than ever before and NHS commissioning plans are for a further significant increase in the number of students entering nurse training in 2004–05. — Ensure that pay levels are suYcient to attract and retain staV—around £2 billion has been invested in pay and this is having a direct impact on staV numbers with increases of 8,040 doctors, and 11,160 nurses compared to the previous year. — Meet unavoidable cost pressures—such as inflation on goods and services.
2.2.4 Could the Department provide information on NHS income from charges over the last 10 years by type of charge? [2.2.4] Answer 1. The information requested is given in Table 2.2.4. 3178271034 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 134 Health Committee: Evidence 8 .9 52.4 £million 295.4 404.1 259.8 394.9 o 2003–04 HSLogistics. B’s ongoing students record function for rom resource data in Summarised Accounts. .1 36.7 41.3 1.5 24.5 61.6 72.2 6 1.2 1.6 2.5 3.5 30.0 75.8 98.3 105.0 105.6 1.6 1.6 1.6 2.3 6.2 2.2 1.8 1.6 0.9 0.5 Table 2.2.4 6.3 67.7 90.15.0 92.0 4.8 113.8 65.8 8.8 3.5 9.5 4.7 9.8 6.2 2.5 0.2 0.2 0.2 0.3 0.4 0.4 44.1 39.1 36.1 20.3 0.4 0.2 0.2 0.8 295.7 320.9 341.3 366.7 386.9 413.1 423.0 428.3 383.0 388.4 419.6 431.2 453.1 472.1 486.7 483.6 1,158.7 1,302.6 1,446.7 1,520.7 1,665.3 1,732.5 2,176.2 2,473.4 1996–97 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 ings together work of Medical Device Agency & Medicines Control Agency. ies Agency and NHSLogistics. All fees for forward years score against the N ted nursing homes. Health Authorities no longer collect the Fee income. be charged and that ETR fees held in reserve should be utilised to fund the EN ata in Appropriation Accounts. 2001–02 and subsequent years’ data drawn f ust income from Local Authorities and PCT income separately. e in 2002–03. h Authorities on 1 October 2002. (13)(14) (2) (7) (12) (15) (5) (6)(8) (11) (7) (9) BREAKDOWN OF NHSINCOME FROM CHARGESBY CHARGE TYPE FOR THE PERIOD 1996–97 t (9) c accident income Y (16) (3) the final year of its operation. 16. Medicines & Healthcare Regulatory Agency (MHRA) formed in 2003–04—br 15. From April 2002, the National Care Standards Commission (NCSC) regula 14. In 2001–02 the Department of Health has directed that no ETR fees should 10. 11. No income generated12. prior to The 1997–98. Agency was13. established in Figures September prior 1994. to 1998–99 are not available. 9. Dental and prescription charge income prior to 2001–02 drawn from cash d 8. From 2000–01 NHS Supplies Authority split into NHS Purchasing and Suppl 6. 7. Income from Local Authorities was separately identified for the first tim 3. PCTs were established4. from 1 April 2000. 5. Figures were not collected prior to 1999–2000. 2. Health Authorities were established on 1 April 1996 and Strategic Healt NHSPensions Agency fees Youth Treatment Service income 3.5 4.5 4.7 4.6 0.1 English National Board for Nursing (ENB): registration fees Medicines Control Agency—licences and inspections 26.8 28.1 26.6 29.4 34 NHSTrusts—Local Authorities Charges Health Authority—fees and charges Footnotes: 1. The table has been restated to include NHStrust private patients, NHStr Road tra Subsidised dried milk 2.2 2.5 2.6 2.4 2.3 3.0 2.9 2.1 Nursing home inspection fees Prescription charges Human Fertilisation and Embryology Authority: licence fees 1.5 1.3 1.4 1. NHSTrusts—private patients 235.7 273.2 290.8 304.8 316.6 340.8 366.7 383 Dental charges Medical Devices Agency Fees PCTs—Local Authorities NHSTrusts—fees and charges 152.4 169.6 216.7 224.2 266.0 268.2 126.3 136. MHRA PCTs NHSSuppliesAuthority fees Total 3178271036 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 135
2.2.5 Could the Department provide comparative information about total NHS spending in England in relation to total NHS spending in Wales, total NHS spending in Scotland and total spending in Northern Ireland? [2.2.5] Answer 1. Table 2.2.5 shows net NHSexpenditure in England, Wales and Scotlandfor 2004–05. Figu res are unavailable for net NHSexpenditure in Northern Ireland for 2004–05 (2003 –04 figures are included for information). The table also shows net NHSexpenditure per head of populat ion for each of these countries.
Table 2.2.5 TOTAL NET NHSEXPENDITURE FOR ENGLAND, WALESAND SCOTLAND2004–05
Net NHS Expenditure per Net NHS Expenditure(1)(2) head of population(3)(4) £ million £
England 69,382 1,390 Scotland(4) 8,026 1,590 Wales(4) 4,305 1,470 N.Ireland(5) Under Review Under Review
Notes: 1. Estimated outturn on a stage 2 Resource Budgeting basis. 2. Figures exclude expenditure on departmental administration. 3. Figures are rounded to the nearest £10. 4. Expenditure figures for Wales and Scotland have been provided by NHS Finance, The Welsh Assembly Government and The Scottish Executive Health Department, respectively. 5. Northern Ireland figures for 2004–05 are under review—figures are supplied for 2003–04, source: Department of Health, Social Services and Public Safety (NI)
2003–04 NI 2,327 1,370
2.3 Programme Budgets 2.3.1 The Schedule 5 table produced in the resource accounts 2003–04 provides a consideration of where money is being spent by the Department. A sizeable amount of money is listed under Other Areas of Spend/ Conditions: Miscellaneous. Can you provide more details of the types of expenditure included within this category and advise whether the data will become more specific over time as improvements in Programme Budgeting are achieved. Answer 1. Expenditure in this category includes spend on Departmental Programmes and arm’s length bodies such as: — DH Central Budgets — NHSPensions agency — NHSPurchasing and SupplyAuthority — NHSLitigation Authority — Family Health Services Appeals Authority — Health Development Agency — National Institute for Clinical Excellence — National Patient Safety Agency — National Treatment Agency — NHSAppointments Commission — NHSInformation Authority — Prescriptions Pricing Authority — Retained Organs Commission — UK Transplant — NHSCounter Fraud Management Service. 3178271038 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 136 Health Committee: Evidence
2. The implementation of Programme Budgeting will be a process that will require refinement over a long period. In particular, figures produced in the early years will be a best estimate rather than a precise measurement of expenditure. Within this context, the Department will be looking for year-on-year improvements, on both the process and outcomes of Programme Budgeting, rather than year one being absolutely right.
2.3.2 Over what timescale do you expect to move to a position in which Schedule 5 will show expenditure against key objectives as well as conditions? Answer 1. As part of the 2004–05 resource accounts the Department will publish a Schedule 5 assigning expenditure to key objectives, as well as to each of the 23 Programme Budgeting categories.
2.4 Expenditure on Community Care 2.4.1 Could the Department provide a table showing, by service, net expenditure in real terms by central and local government on community care, broken down by residential and non-residential care (taking into account relevant service pay and price increases), over the most recent five year period for which such data are available? Could this data include Social Security and Housing expenditures contributing to Community Care objectives? Could it also show this data in graphical form? [2.4.1] Answer 1. Table 2.4.1 provides details of central and local government net expenditure on services for community care in England, for 1999–2000 to 2003–04, the latest year for which information is available. All figures have been adjusted to 2003–04 prices using the latest Gross Domestic Product deflator. 2. Community care expenditure is taken to mean expenditure on non-residential and residential care provided or arranged by local authorities for adults; community health services provided by the NHSfor adults; certain social security benefits which support community care objectives; and certain expenditure on housing. Calculation of local authority expenditure by client group involves a degree of estimation. 3. The data in the table are set out in graphical form in Figure 2.4.1. The graph shows that since 1999–2000 there has been real terms growth in expenditure on all services, with the exception of the Department for Work and Pensions (DWP) supported residential care. The reason for the decline in the DWP supported residential care expenditure was as a direct result of the April 1993 community care reforms. These reforms transferred care management and funding responsibility for new admissions to independent sector care homes to local authorities and ended the former system of higher Income Support payments for people in such homes unless they had preserved rights. Notes Sections A and C 1. Local Authority expenditure for 2000–01 and later years is obtained from the PSS EX1 return; individual service lines include overhead costs. For years prior to 2000–01 it is obtained from the RO3 current expenditure return but with a share of overhead costs allocated to service lines on a pro-rata basis. Figures for 2000–01 and later years are therefore not strictly comparable with those for earlier years. The RO3 return was redesigned in 1998–99 and equipment and adaptations and meals were made memorandum items leading to some under-recording and consequent inflation of the other services expenditure; data for these items for 1998–99 and 1999–2000 are therefore not strictly comparable with those for earlier years. Expenditure on direct payments was only recorded from 1998–99 onwards. 2. Assessment and care management, although included under local authority non-residential care in Part A, also includes expenditure which is relevant to residential care (Part C). Section B 3. As it is not possible to supply net expenditure figures from the Hospital and Community Health Services (HCHS) programme budget, expenditure figures are shown gross and this may mean that they are slightly overstated. 4. For figures derived from the HCHSprogramme budget analysis, it has been a ssumed that the following has been spent on adults: approximately 90% of chiropody, 95% of family planning, 1% of immunisation and surveillance, 100% of screening, 35% of professional advice and support, 95% of total general patient care, 95% of community mental illness nursing, 80% of community learning disability nursing, 70% of health promotion and services to GPs under open access and other community spending. It has also been assumed that 100% of maternity care is spent on the delivery and no costs are associated with the mother, and that 100% of community dental is spent on children. 5. The above have been taken from the Expenditure Per Head Of Population exercise. 3178271038 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 137
6. Administration costs for community health services are not separately identifiable and are not included in the community health figures. 7. In 1996–97 several categories of the programme budget were aVected by the changes to accounting practice and the changing structure of the NHS. Included in these was the need to capitalise redundancy payments and recharges were no longer included. Sections D and E 8. Expenditure is based on Preserved Rights Residential Care and Nursing Home cases and Residential Allowance cases for England. Expenditure has been updated since last years return. 9. From April 2002 claimants in Residential Care and Nursing Homes had preserved rights abolished and became the responsibility of local authorities. With the introduction of Pension Credit residential allowance rate of Income Support was withdrawn in October 2003. 10. Data excludes unemployed claimants who are provided for by Jobseekers Allowance. 11. Figures for 1999–2000 onwards are on a Resource Accounting and Budgeting basis. 2003–04 figures are based on latest actual data. 12. All figures are based on information received from DWP Information Directorate on caseload and average weekly amounts. 13. Disability Living Allowance replaced Attendance Allowance (for people under 65) from 1992 onwards. 14. Invalid Carers Allowance was renamed Carer’s Allowance in April 2003. Section F 15. Source is Housing Investment Programme (HIP) Annual Plan returns (section 5), and HIP Business Plan Statistical Appendix—Annual Monitoring from 2001 onwards (reported data only hence missing figures from non respond LAs). 16. Disabled Facilities Grants are paid by LAs to the private sector tenants , including RSL tenants and non registered HA tenants; figures shown represent totals of mandatory and discretionary grants under relevant Acts. From 2003–04, discretionary DFG are not included Source: HIP or Housing Strategy Statistical Appendix (HSSA) return from 1997–98 onwards (P1D return before that). 17. Housing Corporation ADP approvals for schemes by Registered Social Landlords (mostly housing associations) in respect of homes for rent and sale to certain “special needs” groups (frail elderly, people with mental health problems, learning, or physical disabilities) and one “general needs” group (elderly with warden support). This covers the Corporation’s own programme and joint schemes, but excludes local authority-sponsored schemes using LA Social Housing Grant (LASHG). Figures are approved and not actual expenditure. 18. Approved LASHG related to the same five “caring needs” groups in 3. 19. Source for 17 and 18 is Housing Corporation Stewardship Reports: elderly and disabled categories only.
Table 2.4.1 NET EXPENDITURE ON SERVICES FOR COMMUNITY CARE (2003–04 PRICES) ENGLAND
£ million 1999–2000 2000–01 2001–02 2002–03 2003–04
A. Local Authority Domiciliary Care(1) (2) Assessment and Care Management 969 1,022 1,105 1,200 1,337 Direct Payments 45 53 59 84 123 Home Care 1,485 1,526 1,572 1,627 1,777 Day Care for Older People 216 255 274 279 285 Day Care for Other Adults 629 660 678 711 749 Equipment and Adaptations 78 117 129 129 145 Meals 56 63 61 58 58 Other Services 447 368 374 357 372 Total A 3,924 4,064 4,252 4,445 4,846 B. Community Health(3–7) Chiropody 109 117 150 215 209 Family Planning 73 80 99 132 123 Immunisation & surveillance 44322 Screening 74 80 94 136 149 Professional advice & support 130 132 61 40 48 General Patient Care 1,087 1,061 785 729 686 3178271039 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 138 Health Committee: Evidence
£ million 1999–2000 2000–01 2001–02 2002–03 2003–04
Community MI Nursing 700 798 815 892 981 Community LD Nursing 426 447 410 434 512 Community Maternity 229 207 299 168 193 Health Promotion 64 66 31 62 75 Community Dental 107 116 75 188 169 Services to GPs 305 373 484 720 713 Other CHS423 487 481 876 1,008 Total B 3,728 3,969 3,786 4,594 4,870 Total A plus B 7,6528,033 8,038 9,040 9,716 C. Local Authority Residential Care for(1) (2) Older People (Aged 65 or over) 2,425 2,392 2,428 2,782 2,882 Adults aged under 65 with: A Physical Disability or Sensory 197 204 212 282 273 Impairment Learning Disabilities 760 829 877 1,151 1,197 Mental Health Needs 187 208 222 274 271 Total C 3,569 3,633 3,739 4,489 4,623 D. Income Support: Residential Care, 1,544 1,486 1,432 664 260 Nursing Homes and Residential Allowance Cases(8–11) Total C plus D 5,113 5,119 5,171 5,153 4,883 E. Other Social Security Benefits(8–14) Attendance Allowance(13) 2,553 2,643 2,729 2,744 2,840 Disability Living Allowance(13) 5,009 5,292 5,626 5,826 6,074 Invalid Care Allowance(14) 766 787 823 849 872 Independent Living Fund(12) 111 116 127 139 153 Social Fund Community Care Grants 85 86 86 87 92 Total E 8,524 8,924 9,391 9,645 10,031 F. Housing Adaptations to all LA Dwellings for 102 101 112 117 111 Older People and Disabled Adults(15) LA Grants; Disabled Facilities 129 142 154 179 195 Grants(16) Housing Corporations; Approved 144 131 123 141 176 Development Programme (ADP)(17) LA Sponsored RSL (LASHG)(18) 52 62 53 52 47 Total F 427 436 442 489 529 Total E plus F 8,951 9,360 9,833 10,134 10,560 Grand Total A to F 21,716 22,512 23,042 24,326 25,159 3178271039 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 139
Figure 2.4.1 Expenditure on Community Care
140
120 LA Non Residential 100 Care Community Health 80 LA Residential Care 60 DWP Funded 40 Residential Care Other DWP Benefits 20
Where 1998-99 is equal to 100 Housing 0 1999/00 2000/01 2001/02 2002/03 2003/04
2.5 Payment by results
2.5.1 How much NHS expenditure was paid to trusts via HRGtari V based payments in 2004–05? How much activity did it purchase? What are expected expenditure and activity under “payment by results” in 2005–06 and 2006–07? [3.10.1] Answer
1. Table 2.5.1 shows expenditure and activity in 2004–05 and 2005–06 covered by the national tariV. The 2006–07 tariV has not yet been set so figures for that year are not available.
Table 2.5.1 NATIONAL TARIFF EXPENDITURE AND ACTIVITY
Activity
Year Expenditure Inpatient Outpatient A&E £ billion spells(3) attendances(4) Attendances(4)
2004–05 3.3(1) 2,200,000 6,600,000 0 2005–06 (forecast) 9.6(2) 6,800,000 8,700,000 2,700,000
Notes 1. 2004–05 Payment by Results baseline exercise. 2. 2005–06 Payment by Results baseline exercise. 3. 2003–04 Hospital Episode Statistics (HES) uplifted for outturn and projected growth. 4. 2003–04 Reference Costs uplifted for outturn and projected growth.
2.5.2 What (a) additional money and (b) non-financial assistance is being provided to NHS bodies to assist with the gradual introduction of Payment by Results in the period to 2007–08, given the increased financial uncertainty this will bring? Answer
1. Table 2.5.2 shows the additional support that certain PCTs, NHStrusts and NHSfoundat ion trusts are receiving to assist with the gradual introduction of Payment by Results in 2005–06. 3178271040 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 140 Health Committee: Evidence
Table 2.5.2 ADDITIONAL SUPPORT
Year Total support to high cost providers Total support to PCTs that pay Total (NHS foundation trusts, NHS trusts higher tariVs under PbR compared (£ million) and PCTs) to local prices (£ million) (£ million)
2005–06 140 660 800
Source 1. 2005–06 Payment by Results baseline exercise.
2. In the period to 2007–08, the phased transition will continue to take place for NHSproviders to minimise the financial instability caused by Payment by Results.
3. Another baseline exercise will be taking place in autumn 2005. From this, the support for NHStrusts, NHSfoundation trusts and PCTs in 2006–07 and 2007–08 will be calculated.
Non-financial support
4. A major new component of an IT system (Secondary Uses Service, SUS) has been developed to apply the complex Payment by Results rules to activity information submitted by providers and pass this information on to the relevant commissioners. This will help reduce the bureaucracy, notifying commissioners of how much they should be funding each provider under Payment by Results, as frequently as is desired. It will also enable commissioners and providers to identify any changes in treatment patterns.
2.5.3 You announced a delay in the full implementation of Payment by Results in January 2005. What eVect has this decision had on NHS bodies’ financial and operational plans for 2005–06 given the relatively short notice provided to them? How confident are you that NHS bodies will be suYciently prepared to begin using the full scope of PbR from 1 April 2006? Answer
1. Our decision to amend the phasing-in of Payment by Results to include elective care only in 2005–06 was a direct response to information we received from the NHS, as part of the baseline setting exercise for transition to a national tariV. The exercise revealed instability in activity data and inconsistency in the way the data had been collected. As a result we announced on 10 January 2005 our decision to limit the roll-out of Payment by Results, in order to manage the financial risk in 2005–06. This would have been factored into the financial plans submitted to the Department by the NHStwo months later, in March 2005.
2. Our feedback from the NHSreveals that almost all organisations are runn ing Payment by Results for non-electives, out-patients and accident & emergency in “shadow” form in 2005–06. This gives us greater confidence about the viability of the extended scope in 2006–07. We are also re-running the baseline setting exercise for 2006–07, with extensive NHSinput, to avoid the problems of la st year’s exercise and to provide a more robust basis for the transition from local prices to national tariV.
3. The overall implementation timetable remains unchanged with 90% of hospital care set to be covered by 2008–09. In eVect a new step is being introduced to the phasing-in with non-electives, out-patients and accident & emergency deferred by one year. This reduction in scope does not apply to NHSfoundation trusts and other early adopters.
2.5.4 How many extra staV are going to have to be employed by the NHS in order to implement payment by results? Answer
1. We do not believe that it will be necessary for any extra staV to be employed by the NHSspecifically to implement Payment by Results. Payment by Results creates a strong incentive for providers to improve their costing and coding, to ensure they accurately record activity undertaken. There is also a strong incentive for commissioners to manage demand for treatment, in order to mitigate financial risk. They will also wish to assure the appropriateness of the payments they are required to make. Many organisations will already have adequate arrangements in place to achieve these objectives. Those who do not can make the necessary changes in diVerent ways, for example through training and development of existing staV,or redeployment within the organisation. Where recruitment is deemed necessary, this may be to fill existing vacancies—for example, many providers currently report problems filling vacancies for coding staV. 3178271040 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 141
2. The Department also has a programme of work underway to support the NHSin implementing Payment by Results, and this will help avoid the need to recruit. For example, the Assurance Framework which is currently in development will help commissioners to perform their scrutiny of payment requests by providing checklists and national data analysis. There are economies of scale in national benchmarking which mean that individual commissioning organisations will not be required to duplicate this work.
3. NHS Resources and Activity
3.1 General
3.1.1 Could the Department update tables 3.1.1 showing gross expenditure on HCHS by service sector and age group for the latest year for which data are available? [3.1.1] Answer
1. The data requested is given in Table 3.1.1(a).
2. The latest year for which disaggregated data are available is 2003–04 since the allocation of programme-age related activity data is reliant on patient level data from the Hospital Episode Statistics (HES).
3. Table 3.1.1(b) shows the proportion of HCHSexpenditure by programme of care.
Table 3.1.1(b) PROPORTION OF HCHSEXPENDITURE BY PROGRAMME OF CARE
Programme of Care Proportion of expenditure Acute services 56% Mental health 13% Services intended primarily 6% for the elderly Other services 16% Learning disability 4% Maternity 3%
Notes: 1. Total in above table does not sum to 100% due to rounding.
4. Table 3.1.1(c) shows the proportion of HCHSexpenditure by age group.
Table 3.1.1(c) PROPORTION OF HCHSEXPENDITURE BY AGE GROUP
Age band Proportion of expenditure All births 4% Age 0–4 6% Age 5–15 4% Age 16–44 24% Age 45–64 18% Age 65–74 15% Age 75–84 18% Age 85! 10%
Notes: 1. Total in above table does not sum to 100% due to rounding.
5. Services aimed specifically, or mainly, at the elderly account for 6% of total HCHSexpenditure. However, those aged 65 and over accounted for 43% of total expenditure despite being only 16% of the population. This is mainly due to high levels of spend in other sectors, with 56% of acute expenditure, and significant proportions of expenditure on services for mentally ill people being used by this age group. 3178271042 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Ev 142 Health Committee: Evidence
Table 3.1.1(a) HCHSEXPENDITURE BY SECTORAND AGE GROUP, 2003–04 £ million Service sector All births Age 0–4 Age 5–15 Age 16–44 Age 45–64 Age 65–74 Age 75–84 Age 85! TOTAL
Acute 0 1,596 726 4,400 4,202 4,048 4,268 2,271 21,510 Geriatrics(1) 0 11 26 157 219 398 850 685 2,346 Mental Health 0 3 61 2,086 1,139 635 785 379 5,088 Other 90 130 64 518 435 390 439 246 2,312 Other Community 136 551 418 1,122 469 213 291 176 3,376 Learning Disability 0 51 144 827 453 119 29 4 1,627 Maternity(2) 1,327 0 0 0 0 0 0 0 1,327 HQ Admin(3) 23 35 22 137 104 87 100 56 564 TOTAL 1,577 2,376 1,461 9,245 7,021 5,890 6,763 3,818 38,151
Notes: 1. Expenditure on those under 65 occurs in the elderly sector due to the allocation of general community patient care (which includes district nursing) and chiropody to this sector. Both of these initially provided services aimed at the elderly although their role has now become more widespread across diVerent age groups. 2. In calculating expenditure by age it has been assumed that all expenditure in Maternity is spent on the baby. No allocation from the total has been allocated to the costs incurred by the mother (eg hotel costs, complications, etc). 3. HQ administration has been allocated according to the expenditure already known within the relevant age groups.
3.1.2 Could the Department update tables 3.1.2, showing gross expenditure on Family Health Services? [3.1.2] Answer 1. The information requested showing gross expenditure on FHSin 2002–03 t o 2004–05 is contained in Table 3.1.2.
Table 3.1.2 FAMILY HEALTH SERVICES GROSS EXPENDITURE 2002–03 to 2004–05
£ million 2002–03 2003–04 2004–05(5)
Drugs Total (1) 6,345 6,948 7,376 GMSNon-Discretionary 2,068 1,903 N/A(8) GMSDiscretionary 840 781 N/A(8) Total GMS of which: 2,908 2,684 N/A(8) PMS(discretionary) (2) 1,152 1,939 N/A(8) GDS(4) 1,709 1,767 1,670 PDS(discretionary) (2) (3) 41 48 220 Dispensing Costs(6) 918 959 953 GOS304 322 337 Total Other FHS 4,124 5,035 3,180 Total FHS(7) 13,377 14,667 10,556
Notes: 1. Drugs data source: Prescription Pricing Authority, England. Figures include amounts paid to pharmacy and appliance contractors by the PPA and amounts authorised for dispensing doctors and personal administration in England, for financial years April to March. The data do not cover costs for drugs prescribed in hospital but dispensed in the community or private prescriptions. 2. Personal Medical Services (PMS) and Personal Dental Services (PDS) schemes are Primary Care Act pilots designed to test locally-managed approaches to the delivery of primary care. PDSand PMS expenditure figures exclude any related capital investment by NHStrusts. 3. PDSexpenditure figures are also gross of patient charge income. 4. The gross GDScosts include the cost of refunds to patients who incorrect ly paid income charges. 5. Figures for 2004–05 are provisional or forecast outturn figures as audited accounts data are still to be received. 6. Growth in dispensing costs is aVected by the inclusion of an increasing element (around £30 million in 2003–04) in PMSdiscretionary expenditure. 7. All figures are resource figures. 8. Following new GP contract status from 1 April 2004, G/PMSpractice based data is not comparable with former GP only 2003–04 GMSfigures. 3178271045 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 143
3.1.3 Could the Department update tables 3.1.3, integrating expenditure on HCHS and FHS? Could this integrated information also be provided by Strategic Health Authority area? [3.1.3] Answer
1. The information requested is contained in Table 3.1.3.
2. It is not possible to produce the HCHSprogramme budget figures at strateg ic health authority area level.
Table 3.1.3 HCFHSPROGRAMME BUDGET EXPENDITURE 2003–04 PRICES (Real Terms)
£ million 1999–2000 2000–01 2001–02 2002–03 2003–04 Acute IP — — — — — Acute IP (Pats using a bed) including DC 11,498 12,187 13,215 14,164 15,061 Acute OP ————— Acute OP without Day Cases 4,519 4,731 5,103 5,685 6,449 Obstetric IP 885 922 800 879 918 Obstetric OP 174 185 161 188 216 Geriatric IP 1,343 1,428 1,397 1,290 1,223 Units for YD — — — — — Geriatric & YD OP 59 62 65 70 74 Learning Disability IP 943 970 960 868 854 Learning Disability OP 23 22 25 44 84 Mental Health IP 2,257 2,513 2,601 2,767 2,857 Mental Health OP 408 448 521 674 882 Non Psychiatric DP (general and acute) 127 138 102 88 94 Learning Disability Day Pats ) 68 68 53 60 49 Mental Illness DP 362 369 339 354 316 Other Hospital 1,116 1,712 1,661 1,608 1,137
TOTAL HOSPITAL 23,781 25,755 27,003 28,738 30,214
Chiropody 121 130 168 238 232 Family Planning 77 84 105 139 129 Immunisation and surveillance 359 384 256 224 224 Screening 74 80 94 135 149 Professional advice and support 373 380 174 113 138 General Patient Care 1,149 1,124 830 764 722 Community MI Nursing 740 845 862 937 1,033 Community MH Nursing 534 561 515 541 640 Community Maternity 230 209 301 167 193 Health Promotion 91 95 44 89 107 Community Dental 107 117 75 188 169 Services to GP’s 437 536 695 1,025 1,019 Other CHS606 700 691 1,248 1,441
TOTAL COMMUNITY 4,900 5,246 4,810 5,808 6,197 Ambulances 779 882 991 959 1,176 HQ Administration 863 870 1,171 599 564 Joint Finance 186 99 58 0 0 TOTAL HCHS 30,509 32,851 34,033 36,104 38,151
Total GMS of which: 3,719 3,761 3,347 2,908 2,684 Non-Discretionary 2,732 2,737 2,435 2,068 1,903 Discretionary 987 1,025 912 864 781
Total Other FHS of which: 8,269 8,585 9,579 10,469 11,983 Drugs 5,409 5,637 5,916 6,345 6,948 PMS(discretionary) (1) 635 1,152 1,939 3178271046 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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£ million 1999–2000 2000–01 2001–02 2002–03 2003–04 GDS1,646 1,696 1,734 1,709 1,767 PDS(discretionary) (1) 38 41 48 Dispensing Costs 900 933 933 919 959 GOS313 319 321 304 322 Total HCFHS 42,496 45,197 46,959 49,481 52,818
Notes 1. Personal Medical Services (PMS) and Personal Dental Services (PDS) schemes are Primary Care Act pilots designed to test locally-managed approaches to the delivery of primary care. PDSand PMS expenditure figures exclude any related capital investment by NHStrusts; PDSexpenditure figures are also gross of patient charge income. 2. FHSfigures are on a cash basis for the years 1998–99 to 2001–02, whereas fr om 2002–03 is a resource basis.
3.1.4 Could the Department give an account of the funding streams for the General Medical Services budget and provide a trend analysis? [3.1.4] Answer 1. The two funding streams that make up the GMSbudget are the discretionary —(cash-limited) and non- discretionary (non cash-limited) budgets. Table 3.1.4 gives a trend analysis. 2. GMSGPs as a whole receive an average level of pay per GP plus reimbursemen t of all expenses. Some of these expenses are reimbursed directly in whole or part. Of these direct reimbursements, some eg a proportion of staV, premises and IT costs are met from discretionary spending; pay and remaining expenses are delivered through non-discretionary spend. Actual expenditure each year may deliver more or less than the profession’s entitlement to pay or expenses. This outcome can only be finalised when a firm estimate of GMSexpenses is available some two to three years after year-end. Over or un derpayments are then normally corrected in subsequent years. 3. PCT, discretionary expenditure on reimbursing GMSGPs’ practice sta V, premises and IM & T expenses is protected by “GMSexpenditure floors” which where introduced i n 1998–99 and requires each PCT to deliver year-on-year increases in GMSdiscretionary spend which ar e at least in line with GDP. 4. All elements of a PMSPilot’s allocation are funded by transfers of money from the national GMSnon- discretionary budget and a PCT’s unified budget. 5. Please note that GMSDiscretionary and Non-Discretionary data lines ar e taken from the latest Departmental report. All spend up to 2001–02 is cash based. Due to changes in Government accounting regulations, spend from 2002–03 and including 2003–04 onwards will be on a resource (I & E) basis.
Table 3.1.4 TREND ANALYSIS OF FUNDING STREAMS OF THE GMS BUDGET £m 1996-97 1997-98 1998-99 1999-2000 2000-01 2001-02 2002-03 2003-04 GMSNon-Discretionary 2,073 2,198 2,243 2,451 2,510 2,288 2,068 1,903 GMSDiscretionary 800 835 878 897 940 857 840 781 PMSN/A N/A 37 84 174 569 1,152 1,939 Total GMS Including PMS spend) 2,873 3,033 3,158 3,432 3,624 3,714 4,060 4,623 Percentage change total year-on-year 5.57% 4.12% 8.68% 5.59% 2.48% 9.32% 13.87%
Source: GMSdiscretionary and non-discretionary financial returns from the forme r 90 Family Health Service Authorities (up to 1995–96) Notes: 1. Up to 2000–01 data is from the 95 England health authorities. For 2001-02 PCTs were introduced but were only reporting on GMSdiscretionary expenditure. 2. 2002–03 spend is based on combined 28 SHA Qtr 1–2 and Qtr 3–4 303 PCT spend. Owing to PCTs not having non-discretionary banking rights until September 2003. 2003–04 spend is based on 304 audited PCT returns. 3. PMSPilots funding covers wave 1–5B funding 4. PMSspend includes both local transfers from the Unified budget discreti onary amounts and GMSnon- discretionary transfers. 3178271048 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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5. Discretionary and non-discretionary GMSfigures reflect the growth over the period in GP and practice staV numbers, and the rise in pay and expenses. 6. All figures up to 2001–02 are based on cash only spend. Due to changes in accounting regulations figures for 2002–03 and 2003–04 are resource based.
3.2 Inflation 3.2.1 Could the Department give an explanation as to the level of funding set aside for inflation in 2005–06? In particular, can it give the average pay awards to each (subjective) staV group and the inflation assumptions for non pay including capital charges? [3.2.1] Answer 1. NHSfunding will rise by £6.7 billion in 2005–06 equivalent to 6.9% real t erms growth. This funding will help the NHSto meet healthcare pressures reflected in Local Delivery P lans. However, it is for health economies, including strategic health authorities in partnership with NHStrusts, primary care trusts and local authorities to determine how best to use their funds to meet national and local priorities for improving health and modernising services; to provide greater choice and better access for patients. The significant additional resources available will aid them in this process. 2. In 2005–06, for the majority of NHStrusts, the scope of Payment by Result s (PbR) includes only elective care. The national price tariV underpinning the system is adjusted annually for unavoidable cost pressures. The uplift is based on the same assumptions that underpin the revenue allocations to PCTs. The uplift includes: — the expected impact on pay, including Agenda for Change and the consultant contract; — increases in the cost of drugs and other technology, including increases arising from NICE appraisal and guidelines; — price inflation for goods and services; and — an overall 1.7% eYciency gain assumption. 3. For 2005–06 the total uplift for the national tariV is 5.3%. The components of this are shown in Table 3.2.1(a).
Pay 4. Table 3.2.1(b) shows the settlements awarded to those staV whose pay arrangements are determined by the Review Bodies.
Table 3.2.1(b) REVIEW BODY PAY SETTLEMENTS 2005
Group Settlement Nursing and Midwifery 3.225% Allied Health Professionals 3.225% Consultants on the new contract 3.225% Consultants on the old contract 3.000% Juniors 3.000% NCCGs 3.225% FHSdoctors 3.225%
Prices 5. The GDP deflator is used as a proxy for underlying non-pay inflation in the NHS. This needs to be adjusted for assumptions about the level of procurement and other eYciency savings that the NHSis expected to make.
Capital Charges 6. At national level, the cost of capital charges paid by the NHSis a circula r flow of funds. The total of the capital charges estimates made by NHStrusts forms part of the total cas h resources available through PCT allocations. 7. Indices for land, buildings and equipment are produced for the Department each year by the Valuation OYce, in order that the NHSmay calculate capital charges in advance of the fina ncial year. 8. The aggregate index used to uplift capital charges from 2003–04 to 2004–05 levels was 4.8%. 3178271050 Page Type [E] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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Table 3.2.1(a) NHSTARIFF UPLIFT 2005–06
2005–06 (over 2004–05 baseline) £m % Baseline 46,162 Increase in pay and prices Pay Awards 956 2.1 Pay Drift 202 0.4 Pensions indexation 154 0.3 Non-pay inflation (prices) 257 0.6 Clinical Negligence Costs 58 0.1 Secondary care drugs (price) 199 0.4 Capital Charges 56 0.1 PFI 49 0.1 Gross pay and price increase 1,931 4.2 EYciency w 1.7% "785 "1.7 Net pay and price increase 1,146 2.5 Reform and quality Junior Doctors Contract 0 0.0 Consultant Contract 200 0.4 Agenda for Change 460 1.0 Working time directive 0 0.0 Estimates Cost of NICE appraisals 96 0.2 Estimates Cost of NICE guidelines 231 0.5 Investment in new capital 184 0.4 Total reform and quality 1,1722.5 Technical adjustments Capital charges revaluation 134 0.3 Total technical adjustments 134 0.3 Overall 5.3
3.2.2 Could the Department please update the information provided in response to last year’s questionnaire in relation to the components of the health specific inflation indices for revenue spending on HCHS and Family Health Services respectively, together with capital spending on HCHS? The tables for the HCHS should show separate inflation indices for Review Body staV and non-Review Body staV pay, and whatever other breakdowns of staV are available. [3.2.2] Answer HCHSpay and prices inflation
Prices 1. Increases in the cost of goods and services within the Hospital and Community Health Service (ie the non-pay components) of inflation are measured by the Health Service Cost Index (HSCI). The HSCI weights together price increases for a broad range of items used by the health service—for example, drugs, medical equipment, fuel, telephone charges—using weights derived from expenditure on these various goods and services reported in financial returns. Pay Table 3.2.2(a) INFLATION FOR SPECIFIC ITEMS OF HCHS REVENUE EXPENDITURE
2002–03 2003–04 2004–05 %%% Total staV pay 5.0 7.3 (2) 5.9 Review Body staV 5.1 8.3 (2) 5.8 Non-Review Body staV 4.8 4.1 (2) 6.2 Prices (1) 1.0 (1) 1.5 1.0 HCHS Total (1) 3.5 (1) 5.2 (2) 4.1
Notes 1. Prices and total HCHSinflation for 2002–03 and 2003–04 have been updated following a validation exercise. 3178271051 Page Type [O] 27-04-06 16:18:04 Pag Table: COENEW PPSysB Unit: PAG1
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2. Pay inflation for 2004–05 have been estimated by considering pay pressures in 2004–05 (eg paybill increase and pay reform) from the baseline year of 2003–04. These figures will be updated when actual paybill figures become available.
FHSInflation 2. The components of the Family Health Service (FHS) inflation index are set out in Table 3.2.2(b). For General Medical and Personal Medical Services (GMS/PMS) and General Dental and Personal Dental Services (GDS/PDS), service specific inflation is calculated as the increase year on year in the average cost per practitioner. For both services, the changes in unit costs include volume and quality eVects (eg increase in practice staV numbers or the provision of a changing range of services) as well as pure price eVects. For the Pharmaceutical Service (PhS) and General Ophthalmic Service (GOS), service inflation is assumed equal to movements in the GDP deflator. 3. Due to the increasing significance of Personal Medical and Dental Services as elements of primary care, the medical and dental indices have been recalculated to combine GMSand PM Sexpenditure, and GDS and PDSexpenditure. This, together with some retrospective revisions to the GDP deflator, will have altered some of the inflation factors compared to previous versions of the index. The reforms undertaken in the GMS, and planned in the GDS, including the growth in PMS and PDS services and the transition from non discretionary services to local commissioning by PCTs, mean the present structure of the FHSinflation index may need to be reviewed.
Table 3.2.2(b) COMPONENTSOF THE FHSINFLATION INDEX
2001–02 2002–03 2003–04 %%% GMS/PMS 1.0 5.2 (1) 9.7 GDS/PDS 2.8 4.0 1.8 PhS2.5 3.2 2.6 GOS2.5 3.2 2.6 FHS Total 2.1 3.9 4.6
Notes 1. The comparatively high GMS/PMS inflation figure for 2003-04 is due to a significant increase in expenditure on PMSbetween 2002–03 and 2003–04. 4. For 2003–04 to 2005–06, an uplift for unavoidable cost pressure on the Payment by Results national tariV has also been calculated. The tariV includes such areas as pay, prices and capital charges. For 2004–05 the national tariV has been calculated to be 8.7%. 5. The uplift includes: — the expected impact from pay and workforce reform through Agenda for Change and the consultant contract; — increases in the cost of drugs and other technology, including increases arising from NICE appraisals and guidance; — price inflation for goods and services; and — an overall 1.7% eYciency gain assumption.
3.2.3 Could the Department please update the information provided in response to last year’s questionnaire in relation to the increases in expenditure on the NHS in cash terms, real terms (GDP deflator) and real terms (NHS deflator)? [3.2.3] Answer 1. The information requested is given in Table 3.2.3. 2. Between 1993–94 and 2003–04, the latest year for which NHSspecific indic es are available, net NHS expenditure has increased by: — 109.4% in cash terms; — 59.6% in real terms adjusted by the GDP deflator; and — 42.0% after accounting for NHSspecific inflation. 3. Between 2003–04 and 2007–08, net NHSresources increase by: — 60.6% in cash terms; and — 41.8% in real terms adjusted by the GDP deflator. 3178271052 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Table 3.2.3 CHANGE IN NET NHSEXPENDITURE 1993–94 TO 2007–08
Net NHS Percentage Real terms Change after adjusting expenditure(3) Change change(1) for NHS specific inflation(2) £m % % % Cash 1993-94 Outturn 28,942 — — — 1994–95 Outturn 30,590 5.7 4.1 3.0 1995–96 Outturn 31,985 4.6 1.7 0.8 1996–97 Outturn 32,997 3.2 "0.4 0.3 1997–98 Outturn 34,664 5.1 2.0 2.9 1998–99 Outturn 36,608 5.6 2.9 1.6 1999–2000 Outturn 39,881 8.9 6.8 4.1 Stage 1 Resource Basis 1999–2000 Outturn 40,201 — — — 2000–01 Outturn 43,932 9.3 7.9 5.0 2001–02 Outturn 49,021 11.6 8.9 6.5 2002–03 Outturn 53,850 9.9 6.5 6.1 Stage 2 Resource Basis 2002–03 Estimated outturn 55,724 — — — 2003–04(4) Plan 63,001 13.1 10.2 8.0 2004–05 Plan 69,710 10.6 8.4 2005–06 Plan 76,388 9.6 6.9 2006–07 Plan 84,324 10.4 7.5 2007–08 Plan 92,643 9.9 7.0
Notes 1. Change after adjusting for the GDP deflator (30 June 2005). 2. NHSspecific inflation index is available of the period up to 2003–04. 3. NHSExpenditure Figures for the period 1999-2000 to 2007-08 are consite nt with Table 2.2.1. 4. NHSexpenditure figures for 2002–03 to 2007–08 have been adjusted for cla ssification changes by HMT. As a result, growth in NHSexpenditure in 2003–04 is distorted. Once these a re adjusted for, real terms growth in NHSexpenditure in 2003–04 is 7.3%.
3.2.4 Could the Department please update the information provided in response to last year’s questionnaire in relation to the construction of the NHS inflation index from main sub-indices of pay and other factor costs since 1992, and comment on the assumptions underlying this construct? Would the Department provide the weights used for each sub-index, for each year? [3.2.4] Answer 1. The NHSinflation is constructed using 5 sub-indices. These are listed be low and shown in Table 3.2.4(a). — HCHS pay index: This measures the change in average pay-bill per head of those employed within the HCHS; — HCHS price inflation: This measures the change in the price of goods and services supplied to the HCHS, it is measured by the Health Service Cost Index; — HCHS Capital Inflation Index: This reflects the changes in prices experienced in HCHScapital projects and is calculated using a mixture of the construction price index and the GDP deflator; — FHS Index: This is produced using diVerent assumptions for each of the main groups. For general medical services and general dental services, inflation is calculated as the increase in the average cost per practitioner. For both services, the change in unit costs includes volume and quality eVects as well as pure price eVects. For pharmaceutical services and general ophthalmic services, service inflation is assumed equal to movements in the GDP deflator; — The “other” Index: This comprises of the revenue and capital expenditure on Central Health Miscellaneous Services (CHMS) and Departmental Administration (including the Medicines Control Agency and NHSEstates). The GDP deflator is used in the absence of se rvice specific deflators. 2. The weights attached to each of the elements for each of the years are showninTable 3.2.4(b). 3. The weights attached to each of the elements are similar in magnitude to last year, however, they have changed considerably since 2001–02. This is due to an increase in the number of PCTs from 164 to 304. PCTs have progressively taken over the commissioning of healthcare from health authorities but also the 3178271053 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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provision of some services from NHStrusts. The revenue expenditure for th e provider function cannot be accurately eliminated from the total revenue expenditure hence year on year increases in total revenue expenditure are not comparable. 4. Change in weights (specifically FHSand HCHS)from 2003–04 is due to a shif t in responsibility of healthcare to PCTs.
Table 3.2.4(a) NHSINFLATION SUB-INDICES
Year HCHS HCHS HCHS FHS Other NHS Pay Prices Capital total 1992–93 100.0 100.0 100.0 100.0 100.0 100.0 1993–94 104.2 101.4 104.4 100.6 102.5 102.7 1994–95 107.7 102.3 112.9 102.9 103.8 105.4 1995–96 112.5 105.6 118.0 105.5 106.8 109.3 1996–97 116.2 107.2 119.7 109.0 110.2 112.4 1997–98 119.1 107.6 124.7 112.2 113.6 114.8 1998–99 124.9 110.3 128.5 115.6 116.7 119.3 1999–2000 133.5 111.6 132.1 120.3 119.5 124.8 2000–01 142.7 111.2 139.7 123.6 122.2 129.9 2001–02 154.5 111.3 148.8 126.2 125.3 136.1 2002–03 162.3 112.8 155.4 130.1 129.5 140.8 2003–04 174.2 113.9 149.3 136.1 133.2 147.5
Table 3.2.4(b) NHSINFLATION WEIGHTS
Year HCHS HCHS HCHS FHS Other NHS Pay Prices Capital total 1992–93 49% 21% 6% 21% 3% 100% 1993–94 49% 21% 5% 22% 3% 100% 1994–95 49% 21% 6% 22% 3% 100% 1995–96 49% 21% 5% 22% 3% 100% 1996–97 50% 21% 4% 23% 2% 100% 1997–98 47% 25% 3% 23% 2% 100% 1998–99 47% 25% 3% 22% 2% 100% 1999–2000 46% 24% 3% 24% 2% 100% 2000–01 46% 22% 4% 26% 2% 100% 2001–02 47% 21% 4% 26% 2% 100% 2002–03 48% 32% 4% 14% 2% 100% 2003–04 45% 30% 4% 18% 2% 100%
3.3 Hospital and Community Health Services Allocations and Distance from Targets 3.3.1 Could the Department please update the information provided in table 3.3.1 in response to last year’s questionnaire on expenditure covering HCHS and FHS for each SHA area together with estimates of distances from target needs based expenditure? [ 3.3.1] Answer 1. The information requested is provided in Table 3.3.1. 2. Table 3.3.1 has been updated to show the 2006–07 and 2007–08 revenue allocations to PCTs and distances from target at SHA level. The 2003–06 and 2006–08 revenue allocations cover hospital and community health services (HCHS), prescribing (the drugs bill), general medical services discretionary (general practice infrastructure) and HIV/AIDS. As a result of implementing the new GMScontract, the 2006–07 and 2007–08 revenue allocations also cover primary medical services. 3. The 2006–07 and 2007–08 revenue allocations represent £135 billion investment in the NHS, £64 billion to primary care trusts (PCTs) in 2006–07 and £70 billion in 2007–08. Over the two years covered by this allocation PCTs will receive an average increase of 19.5%. 3178271056 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 150 Health Committee: Evidence 0.02 1.02 1.85 1.13 1.17 0.99 0.25 2.98 1.98 1.66 2.50 1.73 0.72 1.66 1.14 0.25 1.38 1.90 0.25 0.47 " " " " " " " " " " " " " " " " " " " " 593 5,466 5,859 6,424 " 21,420 64,698 20,155 23,193 21,599 59,130 58,532 61,079 52,026 37,606 26,262 37,573 18,796 54,982 49,113 13,129 " " " " " " " " " " " " " " " " " " " 08 Distance from target " 1.35 1,959,612 1.23 2,079,041 2.45 3,435,003 1.76 1,764,200 1.43 2,164,348 3.88 1,927,548 2.76 2,903,296 2.05 3,621,767 3.20 2,027,377 2.13 2,136,438 0.06 2,314,056 1.83 2,529,130 0.90 3,633,535 1.75 2,223,559 1.29 1,630,168 1.64 3,940,609 0.34 2,600,534 0.27 2,766,036 " " " " " " " " " " " " " " " " " " 1,261 8,148 6,789 24,532 23,545 78,737 28,786 69,036 42,192 28,560 70,215 74,427 60,813 43,184 30,111 36,082 19,418 59,880 " " " " " " " " " " " " " " " " " " 07 Distance from target 2007 " ns cannot be made. es discretionary (general practice infrastructure and HIV/AIDS. 1.75 1,788,248 0.10 1,892,779 3.37 3,131,112 3.07 1,606,461 1.71 3,292,047 1.77 1,838,087 1.31 1,773,589 2,443 0.14 1,937,489 4,800 0.25 2.58 1,938,718 0.61 1,981,662 6,939 0.35 2,156,463 4,905 0.23 0.87 1,962,275 1.60 1,739,242 0.63 2,620,305 1.68 3,602,273 4.00 2,313,183 2.65 3,324,266 0.42 1,484,905 0.26 2,791,748 32,311 1.17 3,038,445 24,797 0.82 0.93 2,535,446 " " " " " " " " " " " " " " " " " 12 1.29 2,371,782 1,681 5,628 8,155 4.09 2,243,470 136,899 6.50 2,426,366 129,807 5.65 28,361 98,176 45,062 50,780 29,395 21,154 45,417 10,853 15,262 25,256 14,710 54,938 85,219 80,518 21,630 " " " " " " " " " " " " " " " " " 0 170,416 7.72 2,621,558 183,926 7.55 2,834,865 165,965 6.22 9 102,428 3.69 3,206,254 119,026 3.86 3,479,845 104,396 3.09 8 109,050 7.69 1,699,414 129,072 8.22 1,837,897 121,668 7.09 06 Distance from target 2006 31 15,439 0.86 2,023,280 92 67,839 4.30 1,829,509 91,792 5.28 1,982,811 81,298 4.28 " 0,397 30,976 1.76 1,987,872 1,781 0.09 2,167,126 151,254 10,038 0.44 2,593,069 1,529 0.06 2,837,133 774,693 15,936 0.85 2,117,042 Table 3.3.1 1.90 1,491,793 0.74 1,640,446 0.03 1,587,168 3.82 2,622,886 3.22 1,336,875 1.80 2,727,928 1.74 1,517,652 1.39 1,495,863 3.04 1,612,617 0.51 1,672,682 1.60 1,440,317 0.63 2,157,512 3.24 2,802,103 0.28 1,237,940 1.76 3,032,321 4.87 1,946,486 0.93 2,152,300 " " " " " " " " " " " " " " " " " 521 8,410 3,379 " 28,334 11,968 43,344 49,164 26,552 20,564 48,988 23,107 13,336 90,168 52,448 95,031 19,751 101,746 " " " " " " " " " " " " " " " " heir distances from target at SHA level. 05 Distance from target 2005 ty services (HCHS), prescribing (the drugs bill), General Medical Servic " herefore, comparisons between the 2003–06 and 2006–08 revenue allocatio STRATEGIC HEALTH AUTHORITY ALLOCATIONS 1.96 1,364,476 0.67 1,501,484 0.05 1,451,691 4.17 2,391,372 3.45 1,222,828 1.93 2,496,772 1.83 1,390,899 1.46 1,369,372 3.30 1,465,825 0.48 1,534,096 1.62 1,318,517 0.63 1,976,745 3.78 2,552,541 0.17 1,136,014 1.81 2,777,869 5.54 1,754,155 0.91 1,972,068 " " " " " " " " " " " " " " " " " 777 9,923 1,912 7,115 " 26,649 42,395 47,981 25,462 19,679 48,570 21,350 12,287 96,070 49,375 98,878 17,667 " 101,519 " " " " " " " " " " " " " " " 04 Distance from target 2004 total total total total total " £000s £000s % £000s £000s % £000s £000s % £000s £000s % £000s £000s % allocation allocation allocation allocation allocation ordshire 1,245,649 V olk and 1,806,841 V 3. The 2006–08 revenue allocations also cover Primary Medical Services. T Wiltshire Bedfordshire and 1,325,496 2. The 2003–06 and 2006–08 revenue allocations cover hospital and communi Hertfordshire Birmingham and The Black 2,175,882 Strategic Health Authorities 2003 Avon, Gloucestershire and 1,804,844 13,405 0.70 1,972,269 12,477 0.59 2, Notes 1. The table shows the 2003–06 and 2006–08 revenue allocations to PCTs and t Country Cheshire and Merseyside 2,319,596 Trent 2,277,668 County Durham and Tees 1,114,222 Thames Valley 1,659,291 27,060 1.53 1,814,281 27,699 1.43 1,981,395 27,3 Valley Cumbria and Lancashire 1,801,810 West Midlands South 1,269,343 England total 45,027,181 49,328,244 53,924,975 64,309,595 70,354,697 South YorkshireSurrey and Sussex 1,249,993 2,269,214 100,500 4.33 2,476,324 102,569 4.04 2,698,62 South West Peninsula 1,425,546 20,018 1.33 1,555,843 18,226 1.11 1,692,6 Dorset and Somerset 1,038,896 West Yorkshire 1,947,810 9,235 0.44 2,129,079 6,881 0.30 2,322,682 6,453 Essex 1,334,192 South West London 1,200,252 100,780 8.49 1,315,069 105,409 8.12 1,438,22 Wear Shropshire and Sta Greater Manchester 2,537,784 Kent and Medway 1,372,381 South East London 1,576,425 80,158 5.01 1,730,005 79,943 4.56 1,895,135 7 Northumberland, Tyne and 1,401,925 Leicestershire, 1,204,190 Hampshire and Isle of Wight 1,489,983 19,378 1.23 1,627,112 18,306 1.06 1, North East London 1,582,024 North West London 1,887,023 158,275 8.57 2,067,064 165,306 8.17 2,259,85 and Northern Lincolnshire North Central London 1,302,450 64,465 4.88 1,429,122 66,730 4.61 1,565,1 Northamptonshire and Rutland Norfolk, Su Cambridgeshire North and East Yorkshire 1,406,451 34,333 2.33 1,535,353 33,268 2.06 1,67 3178271058 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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3.4 Care of Mental Health and Learning Disability Patients 3.4.1 Could the Department update the information given in Tables 3.5.1, on patients under the care of a learning disability or mental illness consultant, discharges by length of stay, ages and destination, and residential and other places available? Could the Department identify the number of individuals concerned, and hence the number of repeat discharges? [3.5.1] Answer 1. The estimated number of in-patients under the care of the learning disability specialty, at the end of each year, fell to 4,100 in 2003–04 from 13,900 in 1993–94—Table 3.4.1(a). This is mainly due to the fall in the number of very long stay patients, from 7,400 to 1,800 over the period. This is matched by a decrease in the number of in-patients under the care of the mental illness specialty, at the end of the year, to 28,700 in 2003–04 from 36,400 in 1993–94—Table 3.4.1(b). This reflects a reduction in dependence on long stay hospital beds and growth in provision of alternative forms of supported residential and home based services and community teams. 2. There has been an increase in the proportion of patients with learning disability discharged from hospital after a short stay. Table 3.4.1(c) shows that 77% of patients in 2003–04 had been in hospital for less than a week. This compares with 73% of those in 1993–94. 3. Table 3.4.1(d) shows a decrease in the number of in-patient episodes of mental illness care lasting less than one month. There were 103,700 discharges in 2003–04 after short stay episodes (60% of all discharges) compared with 141,700 in 1993–94 (67% of all discharges). 4. Table 3.4.1(e) shows that most learning disability patients under 65 discharged after a length of stay of less than a year return to their usual place of residence (98% in 2003"04). This compares with an estimated 86% for mental illness patients in the same year, Table 3.4.1(f). 5. In the case of learning disability, patients aged 65 or over, 72% returned to their usual place of residence in 2003–04, with a further 23% transferred to other NHSproviders. This com pares to 66% and 16% respectively for mental illness patients. 6. Of the learning disability patients under 65 discharged after a stay of a year or more (an estimated 470 in 2003–04), 30% returned to their usual place of residence, 36% transferred to another NHSprovider and 4% to local authority homes or other non-NHSinstitutions. For discharged mental illness patients under 65 (an estimated 2,400 in 2003–04), 53% returned to their usual place of residence, 17% transferred to another NHSprovider and 6% to local authority homes or other non-NHSinsti tutions. 7. Only an estimated 50 learning disability patients aged 65 or over were discharged after a stay of a year or more in 2003–04, compared with 950 for mental illness patients; the estimates of destination on discharge are based on small numbers and are unlikely to be reliable. 8. Table 3.4.1(g) shows that, in NHSfacilities, the average daily number of beds on wards for patients with learning disabilities has fallen to 8,100 in 2003–04 from 16,300 in 1993–94. There has been a fall in the average daily number of beds available for mentally ill patients in NHSfac ilities to 34,400 in 2003–04 from 43,500 in 1993–94—Table 3.4.1(h). The number of long stay adult beds in learning disability wards has fallen to 3,200 in 2003–04 from 14,300 in 1993–94 with little change in the number of short stay beds. Similarly, the number of long stay adult beds in mental illness wards has fallen to around 45% of the number in 1993–94 with only a slight drop in the number of short stay beds. 9. Data on private hospitals and clinics is not available in a comparable form, due to service definitional issues. Data on places in care homes from 2002–03 is not comparable to data for earlier years. Figures from 2002–03 relate to the number of places registered. A place can be registered for more than one client group, therefore the figures for 2002–03 onwards represent the maximum number of places for people with mental illness and learning disabilities. Prior to 2002–03 a place was only recorded against one primary client group. There was some vagary around the definitions used to provide the historic information collected, further work will be conducted between CSCI and Health and Social Care Information Centre to ensure that the correct definitions are being used. 10. Local authority registered homes—Learning disability and Mental health. The fluctuation of registered Local authority registered homes between 2002–03 and 2003–04 was due to the delay in registering these homes. All outstanding local authority were registered by the 31 March 2004.
Number of Repeat Discharges in Tables 3.4.1 11. Data on the number of times individual patients are discharged over a period of time after completing their spell in hospital is not yet reliable because coverage of patients in receipt of this care is patchy across the NHS. 12. The Department does however have available two indicators, compiled by the Healthcare Commission, reflecting the number of emergency psychiatric re-admissions. One, “psychiatric re-admissions (adults)”, for patients aged 17–64 re-admitted as an emergency to the care of a psychiatric specialist within 28 days of discharge, relates to Mental Health National Service Framework standard 4. The other, “psychiatric re-admissions (older people)”, is for people aged over 65. The “psychiatric re-admissions 3178271058 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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(adults)” indicator covers patients under a consultant whose specialty is Mental Illness or Old Age Psychiatry and is based on HESdata. However, it excludes any patients with a primary diagnosis of substance abuse or eating disorder (ICD 10 codes: F10 to F19, F50, Z50.2 and Z50.3). For these excluded conditions, re-admission is often considered a necessary part of the care. It should also be noted that any planned re-admissions are excluded from the count of re-admissions. 13. It is very important to note that the definition and coverage of this indicator diVers from that applied to psychiatric discharges in Tables 3.4.1(c) and 3.4.1(d). 14. The Healthcare Commission has recently released England readmission rates for the calendar years 2003 and 2004. There have been changes to the definition so it is not comparable with information available for previous years. The changes have made the indicator more relevant by excluding readmissions that are not related to psychiatric conditions.
15. 10.32% of adult patients were re-admitted in 2004, compared with 10.70% in 2003. For older people, the 2004 figure was 5.33%, compared with a 2003 figure of 5.65%. Each of these values is estimated to an accuracy of &0.25%.
Table 3.4.1(a) PATIENTS UNDER THE CARE OF A LEARNING DISABILITIES CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1994, 1998 TO 2004(1) England Estimated numbers and rates per 100,000 population Duration of stay 1994 1998 1999 2000 2001 2002 2003 2004 Number of patients
All Durations 13,900 8,400 7,100 6,050 6,500 5,350 6,000 4,100 Under 1 year 2,400 1,900 1,950 1,350 1,500 1,450 2,750 1,050 1 to 2 years 1,600 800 650 700 600 550 450 300 2 to 3 years 1,200 650 500 550 600 400 450 400 3 to 5 years 1,300 700 900 750 750 600 450 550 5 years and over 7,400 4,400 3,100 2,700 3,100 2,400 1,800 1,800 Rates per 100,000 population All Durations 29 17 15 12 13 11 12 8 Under 1 year 5 4 4 3 3 3 6 2 1 to 2 years 3 2 1 1 1 1 1 1 2 to 3 years 2 1 1 1 1 1 1 1 3 to 5 years 3 1 2 2 2 1 1 1 5 years and over 15 9 6 6 6 5 4 4
Notes 1. Figures for 1998 to 2004 have been estimated from the number of unfinished consultant episodes at 31 March. They are estimates based on returns to the Department from Trusts. These are not directly comparable with figures for earlier years, as the data from Hospital Episode Statistics is incomplete. 2. 2004 rates are based on 2003-based population projection figures.
Table 3.4.1(b) PATIENTS UNDER THE CARE OF A MENTAL ILLNESS CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1994, 1998 TO 2004(1) England Estimated numbers and rates per 100,000 population Duration of stay 1994 1998 1999 2000 2001 2002 2003 2004 Number of patients All Durations 36,400 31,750 30,800 29,900 31,550 32,350 29,050 28,650 Under 1 year 22,400 23,500 22,900 21,200 22,750 22,200 21,600 21,200 1 to 2 years 4,200 2,700 2,750 3,400 2,750 2,900 2,700 2,450 2 to 3 years 2,100 1,450 1,500 1,600 1,850 1,300 1,900 1,650 3 to 5 years 2,400 1,750 1,600 1,550 2,150 1,800 1,300 1,800 5 years and over 5,400 2,350 2,050 2,150 2,000 2,150 1,500 1,550 3178271060 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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England Estimated numbers and rates per 100,000 population Duration of stay 1994 1998 1999 2000 2001 2002 2003 2004 Rates per 100,000 population All Durations 76 65 63 61 64 63 59 57 Under 1 year 47 48 47 43 46 47 44 42 1 to 2 years 9 6 6 7 6 6 5 5 2 to 3 years 4 3 3 3 4 3 4 3 3 to 5 years 5 4 3 3 4 4 3 4 5 years and over 11 5 4 4 4 4 3 3 Notes 1. Figures for 1998 to 2004 have been estimated from the number of unfinished consultant episodes at 31 March. They are estimates based on returns to the Department from Trusts. These are not directly comparable with figures for earlier years, as the data from Hospital Episode Statistics is incomplete. 2. 2004 rates are based on 2003-based population projection figures.
Table 3.4.1(c) ESTIMATED DISCHARGES OF LEARNING DISABILITIES PATIENTS FROM NHS FACILITIESBY DURATION OF STAY1993–94 AND 1997–98 TO 2003–04 (1) England Estimated numbers and rates per 100,000 population Duration of stay 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04(2) All durations 53,400 56,390 49,710 38,550 36,000 38,200 32,880 28,600 Under 1 week 38,730 42,100 33,590 28,670 26,850 29,400 25,310 21,950 1 week 10,600 10,570 9,150 7,530 6,680 6,530 5,530 4,990 1 month 1,080 1,180 890 790 660 680 520 560 3 months 460 440 740 620 630 610 270 270 1 year 390 400 280 230 270 210 260 220 2 years 370 390 360 230 370 250 280 170 5 years 380 400 200 190 250 200 280 200 10 years! 1,370 760 510 250 290 320 410 150 Duration Unknown — 160 3,990 40 10 — 20 90 Percentages(3) All durations 100 100 100 100 100 100 100 100 Under 1 week 73 74 75 68 75 77 78 77 1 week 20 18 19 18 19 17 16 17 1 month 2 2 2 2 2 2 2 2 3 months 1 2 1 1 2 2 2 1 1 year 1 1 1 1 1 1 1 1 2 years 1 1 1 1 1 1 1 1 5 years 1 0 1 0 1 1 0 1 10 years! 321 11111 Duration Unknown 0 0 0 8 0 0 0 0
Source: HES Notes 1. Figures include transfers to other NHSproviders. All durations includ e age unknown data. 2. Estimates for 2003–04 are provisional as no adjustments have been made for the shortfalls in data. 3. Percentages have been calculated using unrounded figures.
Table 3.4.1(d) ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY DURATION OF STAY 1993–94 AND 1997–98 TO 2003–04(1) England Numbers and percentages Duration of stay 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04(2)
All durations 212,670 218,900 209,580 200,900 190,460 184,090 183,220 171,650 Under 1 week 46,030 47,500 47,250 45,640 42,740 41,860 42,200 38,260 1 week 95,700 92,040 86,810 82,230 75,240 71,540 70,690 65,410 1 month 51,860 54,500 51,250 50,500 47,970 47,060 46,510 43,750 3 months 12,050 14,860 20,060 19,400 20,400 20,710 14,260 14,290 1 year 4,070 5,490 1,820 1,770 2,210 1,730 5,540 5,540 2 years 1,430 1,830 1,000 940 1,300 830 2,020 1,970 3178271062 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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England Numbers and percentages Duration of stay 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04(2) 5 years 770 830 260 240 370 230 840 1,030 10 years! 770 430 170 110 120 120 310 370 Duration Unknown — 1,430 960 170 110 30 870 1,020 Percentages(3) All durations 100 100 100 100 100 100 100 100 Under 1 week 22 22 22 23 22 23 23 22 1 week 45 43 42 41 40 39 39 38 1 month 24 24 25 24 25 26 25 25 3 months 6 9 7 10 11 11 8 8 1 year 2 1 3 1 1 1 3 3 2 years 1 0 3 0 1 0 1 1 5 years 0 0 0 0 0 0 0 1 10 years! 000 00000 Duration Unknown 0 0 1 0 0 0 0 1
Source: HES Notes 1. Figures include transfers to other NHSproviders. All durations includ e age unknown data. 2. Estimates for 2003–04 are provisional as no adjustments have been made for the shortfalls in data. 3. Percentages have been calculated using unrounded figures.
Table 3.4.1(e) ESTIMATED DISCHARGES OF LEARNING DISABILITY PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1997–98 AND 2003–04
England Number and percentages Intended discharge destination 1997–98 2003–04(1) length of stay length of stay length of stay length of stay less than one of one year or less than one of one year or year more year more
Aged under 65 NUMBER OF DISCHARGES(2) 54,320 1,260 27,840 470 Percentage(3) Usual Residence(4) 97 25 98 30 Temporary Residence 0 2 0 4 Other NHSprovider (5) 1 37 1 36 LA residential 0 3 0 2 Non NHSinstitution (6) 0302 Other and not known(7) 130126 Aged 65 or over NUMBER OF DISCHARGES(2) 340 290 150 50 Percentage(3) Usual Residence(4) 71 17 72 8 Temporary Residence 1 0 0 0 Other NHSprovider (5) 18 34 23 67 LA residential 1 3 0 2 Non NHSinstitution (6) 1310 Other and not known(7) 941422
Source: HES Notes: 1. Estimates for 2003-04 are provisional as no adjustments have been made for shortfalls in data. 2. Age unknowns data are not included. 3. Percentages relate to intended discharge of patients as recorded inpatients’ notes and are based on unrounded data. 4. Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with no fixed abode. 3178271063 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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5. Other NHStrust hospitals or NHSrun nursing homes. 6. Independent residential or nursing care homes and private hospitals. 7. Prison, high security psychiatric hospitals, not known.
Table 3.4.1(f) ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1997–98 AND 2003–04 England Number and percentages 1997–98 2003–04(1) length of length of length of length of stay less stay of stay less stay of than one one year than one one year Intended discharge destination year or more year or more Aged under 65 NUMBER OF DISCHARGES(2) 147,540 2,260 120,630 2,420 Percentage(3) Usual Residence(4) 88 48 86 53 Temporary Residence 3 9 3 9 Other NHSprovider (5) 625617 LA residential 0 3 0 1 Non NHSinstitution (6) 0305 Other and not known(7) 212416 Aged 65 or over NUMBER OF DISCHARGES(2) 66,200 810 46,580 950 Percentage(3) Usual Residence(4) 74 31 66 24 Temporary Residence 3 4 2 3 Other NHSprovider (5) 9371636 LA residential 1 2 0 0 Non NHSinstitution (6) 3214 Other and not known(7) 10 23 15 32
Source: HES Notes 1. Estimates for 2003–04 are provisional as no adjustments have been made for shortfalls in data. 2. Age unknowns data are not included. 3. Percentages relate to intended discharge of patients as recorded inpatients’ notes and are based on unrounded data. 4. Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with no fixed abode. 5. Other NHSTrust hospitals or NHSrun nursing homes. 6. Independent residential or nursing care homes and private hospitals. 7. Prison, high security psychiatric hospitals, not known.
Table 3.4.1(g) HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH LEARNING DISABILITIES, ENGLAND: 1993–94, 1997–98 TO 2003–04 Numbers 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 Total available beds/places (excluding unstaVed)(1) 62,020 67,540 68,420 69,440 68,650 . . .
Average daily number of available beds in NHS facilities 16,270 12,280 11,530 10,600 10,020 9,090 8,050 8,090
For children short stay 250 280 270 290 280 210 270 230 long stay 170 100 100 90 100 70 140 60
For other ages secure units 290 440 420 400 430 410 510 510 short stay 1,320 1,440 1,420 1,340 1,320 1,370 1,120 1,210 long stay 14,250 5,940 5,280 4,720 4,190 3,640 3,000 3,200 3178271065 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Numbers 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04
Residential Facilities(1) . 4,080 4,040 3,760 3,700 3,390 3,010 2,880
Beds in private nursing homes, hospitals and clinics(2) 3,100 3,580 3,850 3,840 3,770 ......
Children 110 70 100 50 60 ...... Other ages 2,990 3,510 3,750 3,790 3,710 ......
Places in staVed residential homes for adults(2) (3) 35,010 41,580 42,610 44,130 43,580 ......
Local authority 10,120 8,200 7,380 7,100 6,630 ...... Voluntary 13,000 16,710 17,220 17,640 18,100 ...... Private 11,890 16,670 18,010 19,390 18,850 ......
Places in staVed residential homes for children(2) (3) 2,000 1,720 1,590 1,430 1,540 ......
Local authority 1,490 1,070 1,040 800 890 ...... Voluntary 360 290 260 310 330 ...... Private 140 350 290 320 320 ......
Places in small registered residential homes ('4 places)(2) 3,080 8,390 8,840 9,440 9,740 ......
Voluntary 700 ...... Private 2,380 ......
Places in local authority unstaVed (group) homes(2) 2,560 ...... Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA (Form A) Footnotes: 1. NHSresidential facilities were recorded for the first time in 1996–97. S ome of these beds may previously have been recorded under other headings. 2. Data relate to 31 March. 3. Excludes nursing care places in dual registered homes. . % not applicable, .. % not available.
Table 3.4.1(h) HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH MENTAL ILLNESS, ENGLAND: 1992–93, 1996–97 TO 2003–04 Numbers 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–036 2003–04
Total available beds/places (excluding unstaVed)(1) 89,090 104,910 104,240 104,230 104,370 . . .
Average daily number of available beds in NHS facilities 43,530 37,880 37,060 35,470 35,490 33,980 34,390 34,440
For children short stay 530 400 420 390 410 400 410 460 long stay 80 120 120 100 120 90 100 60
For elderly short stay 6,240 7,380 7,290 7,350 7,620 7,550 7,480 7,510 long stay 12,110 7,410 6,990 6,040 5,540 5,250 5,080 4,610
For other ages secure units 1,030 1,920 1,750 1,880 1,950 1,850 2,060 2,560 short stay 14,680 14,460 14,420 14,120 14,380 13,800 13,740 13,260 long stay 8,870 4,910 4,710 4,310 4,200 3,850 3,890 3,960
Residential Facilities(2) . 1,280 1,360 1,300 1,280 1,190 1,630 2,040
Beds in private nursing homes, hospitals and clinics(3) (4) 21,080 28,280 28,940 28,710 28,780 .. 33,159 32,972
Children 130 100 50 10 70 ...... Elderly 16,330 19,130 20,770 21,830 21,490 .. 18,331 18,635 Other ages 4,620 9,050 8,120 6,870 7,210 .. 14,828 14,337
Places in staVed residential homes for adults(1) (3) (5) 21,650 36,160 35,780 37,790 37,780 .. 48,510 51,427
Local authority7 2,140 4,530 3,480 4,120 3,910 .. 1,325 6,046 Voluntary 4,340 7,070 6,280 6,770 6,720 .. 10,047 9,487 Private 6,260 24,560 26,030 26,900 27,150 .. 36,898 35,686 Other 240 208 3178271066 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Numbers 1993–94 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–036 2003–04
Places in small registered residential homes ('4 places)(3) 1,130 2,590 2,460 2,260 2,320 .. 1,090 736
Voluntary 170 ...... 55 43 Private 960 ...... 1,035 693
Places in local authority unstaVed (group) homes(3) 1,700 ...... Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA (Form A) Footnotes: 1. Discontinuity in data due to reclasification of some Elderly homes as homes for Elderly Mentally Ill patients. 2. NHSresidential facilities were recorded for the first time in 1996–97. S ome of these beds may previously have been recorded under other headings. 3. Data relate to 31 March. 4. The method of data collection was changed in 1997–98 so the figures for 1997–98 are not strictly comparable with those for earlier years. 5. Excludes nursing care places in dual registered homes. 6. Data on places in care homes from 2002–03 onwards is not comparable to data from earlier years. Figures from 2002–03 relate to the number of places registered from the CSCI registration and inspection database. A place can be registered for more than one client group, therefore the figures for 2002–03 onwards represent the maximum number of places for people with mental illness. Prior to 2002–03 a place was only recorded once against the primary client group. 7. Figures for 2002–03 exclude places in Local Authority care homes which were open but not registered. 8. For 2002–03 onwards, the following client groups have been used to provide this information from the R!I database. Mentally ill—Care homes providing services for all adults aged 18–64 suVering from mental disorder Elderly mentally infirm—Care homes providing services for all adults aged over 65 suVering from mental disorder 9. Please note, for the years 2002–03 and 2003–04 for places in small registered residential care homes excludes those providing adult placements. 10. Please note, for the years 2002–03 and 2003–04 beds in private nursing homes, hospitals and clinics, the figures relate to the maximum capacity in private care homes providing nursing care, not hospitals or clinics, this information is not available. 11. The ownership clasification “Other” covers those care homes owned by religious organisations which CSCI inspectors do not believe can be classed under the voluntary type. . % not applicable, .. % not available.
3.4.2 Could the Department please update tables 3.5.2, showing: (i) number of people sectioned, by trust and by type of section? (ii) number of people sectioned in proportion to HA population? If the data are not available, will the Department consider obtaining it from the HES? (iii) number of people sectioned in proportion to number of admissions? (iv) proportion of people who appeal against being sectioned and the outcomes of the appeals? [3.5.2] Answer
Number of People Sectioned by Trust and the Type of Section
1. Table 3.4.2(a) presents information on the number of admissions to NHSfacilities (trust s, care trusts and primary care trusts) where the patient was detained under the Mental Health Act 1983 at admission, and on the number of occasions a patient already in hospital as an informal patient was placed under detention. Table 3.4.2(b) shows similar information for independent hospitals, as defined by the Care Standards Act 2000, in each SHA area (these data were forwarded to the Department directly from the independent hospitals). There were a total of 24,800 formal admissions to NHSfacilities in 2003–04 with a further 1,400 formal admissions to independent hospitals. Another 19,500 changes from informal to formal detentions were recorded (19,100 in the NHSand 400 in independent hospita ls). There may be double counting of patients where a patient has been detained more than once in the year.
Number of people sectioned in proportion to SHA population
2. It is not possible to produce reliable figures on the numbers of people sectioned by SHA area of residence. The data provided on the aggregate return is provider based and does not include geographic information on the area of residence. The Hospital Episode Statistics (HES) system does have some information on patients treated by area of residence, but the quality of data is poor on admissions of formally detained patients. 3. It is possible to look at the variation in the rate of psychiatric activity by Strategic Health Authority area of residence. Table 3.4.2(c) shows 2003–04 rate of consultant episodes varied from 2.81 to 5.93 per 1000 population, with an average of 4.38 per 1,000 population. This does not imply similar variations in the rates for those sectioned. 3178271067 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Number of People Sectioned in Proportion to Admissions 4. In England, in 2003–04, there were 26,200 formal admissions to hospital (including high security hospitals and independent hospitals) under the Act and a further 19,500 changes from informal status to detention where patients were already in hospital. A patient subject to more than one period of detention under the Act during the year will be counted in these figures each time they are admitted to hospital under detention or have a change from informal status while in hospital. It is therefore not possible to determine the number of people sectioned. Around 15.3% of all admissions (estimated as 162,000) under psychiatric specialities in NHShospitals in 2003–04 were formal admissions (24,800) .
Appeals 5. The Mental Health Review Tribunal is an independent judicial body which hears applications and references by and on behalf of patients detained under the Mental Health Act 1983 as amended by the Mental Health (Patients in the Community) Act 1995. This includes patients admitted for assessment and/ or treatment, hospital orders, guardianship, after-care under supervision, and restricted patients who have come through the courts or transferred to hospital from prison. In some cases the nearest relative can also apply for the patient’s detention to be reviewed. Most hearings are a result of applications by the patient or the patient’s legal representative. 6. The act places a duty on Hospital Managers to refer a case to the tribunal at the end of specified periods where a patient has not had a hearing during that time. The Home Secretary in restricted cases is also obliged to refer cases to the Tribunal periodically and has a discretion to refer a patient’s case at any time. 7. In the calendar year 2004, there were 21,390 applications and references for appeals. During the same period 8,107 cases were aborted mostly because the patient was discharged by the hospital or the application was withdrawn before the hearing. There were 12,119 decided cases resulting in 1,333 discharges (absolute, conditional, deferred or delayed).
Table 3.4.2(a) ADMISSIONS TO NHS FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 2003–04(1)(2) Numbers Admitted to hospital Subject to Section after Total detentions in under Section admission(1) hospital
England 24,832 [25,100] 19,057 [19,583] 43,889 [44,683] North East 1,170 [1,196] 940 [898] 2,110 [2,094] County Durham and Darlington Priority Services 229 125 354 Gateshead Health 53 28 81 Newcastle Upon Tyne Hospitals 2 — 2 Newcastle, North Tyneside and Northumberland Mental Health 339 235 574 Northgate and Prudhoe 59 45 104 Northumbria Health Care 11 18 29 South of Tyne and Wearside Mental Health 202 268 470 Tees and North East Yorkshire 275 221 496 North West 3,299 [3,168] 3,155 [3,101] 6,454 [6,269] 5 Boroughs Partnership 285 343 628 Bolton, Salford and TraVord Mental Health 464 377 841 Calderstones 18 10 28 Cheshire and Wirral Partnership 329 378 707 Lancashire Care 616 605 1,221 Manchester Mental Health and Social Care 488 252 740 Mersey Care 366 448 814 Morecambe Bay PCT 155 158 313 North Cumbria Acute Hospitals 4 4 8 North Cumbria Mental Health and Learning Disabilities 113 106 219 Pennine Care 461 466 927 Southport and Ormskirk Hospital — 8 8
Yorkshire and The Humber 1,857 [2,108] 1,783 [1,871] 3,640 [3,979] Barnsley PCT 69 80 149 Bradford District Care 266 225 491 Craven, Harrogate and Rural District PCT 37 40 77 Doncaster and South Humber Healthcare 196 310 506 Hambleton and Richmondshire PCT 36 51 87 Harrogate Health Care 2 1 3 Hull and East Riding Community Health 209 147 356 Leeds Mental Health Teaching 348 318 666 Leeds Teaching Hospitals — 32 32 Rotherham PCT — 1 1 Selby and York PCT 89 95 184 SheYeld Care Trust 231 153 384 SheYeld Childrens 3 1 4 3178271068 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Numbers Admitted to hospital Subject to Section after Total detentions in under Section admission(1) hospital
South West Yorkshire Mental Health 371 327 698 York Hospitals — 2 2 East Midlands 1,705 [1,647] 1,443 [1,573] 3,148 [3,220] Chesterfield PCT 33 6 39 Derbyshire Mental Health Services 357 379 736 High Peak and Dales PCT 13 12 25 Leicestershire Partnership 368 351 719 Lincolnshire Partnership 183 180 363 North Eastern Derbyshire PCT 5 — 5 Northampton General Hospital — 3 3 Northamptonshire Healthcare 268 135 403 Nottinghamshire Healthcare 478 377 855 West Midlands 2,697 [2,660] 1,651 [1,797] 4,348 [4,457] Birmingham and Solihull Mental Health 765 487 1,252 Birmingham Children’s Hospital 10 — 10 Coventry PCT 211 147 358 Dudley Beacon and Castle PCT 95 73 168 Dudley South PCT 2 — 2 Herefordshire PCT 65 48 113 North StaVordshire Combined Healthcare 216 119 335 North Warwickshire PCT 92 71 163 Royal Shrewsbury Hospitals 4 2 6 Sandwell Mental Health and Social Care 137 67 204 Shrewsbury and Telford Hospitals 4 2 6 Shropshire County PCT 313 150 463 South Birmingham PCT 10 1 11 South StaVordshire Healthcare 183 169 352 South Warwickshire PCT 82 49 131 Walsall Hospitals 12 8 20 Walsall PCT 168 79 247 Wolverhampton City PCT 120 77 197 Worcestershire Mental Health Partnership 208 102 310 East of England 2,275 [2,184] 1,524 [1,622] 3,799 [3,806] Bedfordshire and Luton Community 329 133 462 Cambridge and Peterborough Mental Health Partnership 245 289 534 Colchester PCT 7 — 7 Hertfordshire Partnership 428 130 558 James Paget Healthcare 1 1 2 Local Health Partnerships 237 186 423 Norfolk and Norwich University Hospital — 21 21 Norfolk Mental Health Care 388 219 607 North Essex Mental Health Partnership 337 321 658 Norwich PCT 9 3 12 South Essex Partnership 234 143 377 West Norfolk PCT 60 78 138 London 5,695 [6,305] 4,638 [4,313] 10,333 [10,618] Barnet, Enfield and Haringey Mental Health 696 497 1,193 Barts and The London 2 20 22 Brent PCT 3 6 9 Camden and Islington Mental Health and Social Care 548 146 694 Central and North West London Mental Health 595 1,212 1,807 East London and The City Mental Health 629 534 1,163 King’s College Hospital 7 7 14 Kingston Hospital — 18 18 North East London Mental Health 368 289 657 Oxleas 314 231 545 South London and Maudsley 1160 720 1,880 South West London and St George’s Mental Health 539 396 935 The Hillingdon Hospital 106 151 257 University College London Hospital — 5 5 West London Mental Health 728 406 1,134
South East 3,737 [3,538] 2,477 [2,642] 6,214 [6,180] Berkshire Healthcare 411 166 577 Buckinghamshire Hospitals — 4 4 Buckinghamshire Mental Health 196 73 269 East Hampshire PCT 51 17 68 East Kent and Social Care Partnership 224 289 513 East Sussex County Healthcare 252 183 435 Isle of Wight Healthcare 135 19 154 Milton Keynes PCT 84 81 165 North West Surrey Mental Health Partnership 74 117 191 Oxford Learning Disability 4 1 5 Oxford RadcliVe Hospitals 2 — 2 Oxfordshire Mental Healthcare 356 218 574 Portsmouth City PCT 97 60 157 3178271068 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Numbers Admitted to hospital Subject to Section after Total detentions in under Section admission(1) hospital
South Downs Health 277 104 381 Southampton University Hospitals 2 8 10 Stoke Mandeville Hospital — — — Surrey Hampshire Borders 170 144 314 Surrey Oaklands 157 131 288 West Hampshire 398 265 663 West Kent and Social Care Trust 436 289 725 West Sussex Health and Social Care 409 308 717 Winchester and Eastleigh Healthcare NHSCare 2 — 2
South West 2,397 [2,294] 1,446 [1,766] 3,843 [4,060]
Avon and Wiltshire Mental Health Partnership 731 314 1,045 Bath and North East Somerset PCT 4 4 8 Cornwall Partnership 238 170 408 Devon Partnership 413 312 725 Dorset Health Care 247 93 340 Gloucestershire Partnership 230 192 422 North Bristol 3 5 8 North Dorset PCT 77 75 152 Plymouth Hospitals 5 23 28 Plymouth PCT 175 114 289 Royal Cornwall Hospitals 9 9 18 Salisbury Healthcare 4 3 7 Somerset Partnership NHS and Social Care 261 127 388 Swindon and Marlborough — 5 5 Source: KP90
Notes
1. Includes all changes from informal status to detention under the Act, and detentions where the patient was initially brought to hospital under Section 136 (Place of Safety Order).
2. The figures in brackets are the totals for 2002–03.
3. The high security psychiatric hospitals are now the responsibility of NHStrusts.
Table 3.4.2(b)
ADMISSIONS TO INDEPENDENT HOSPITALS UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 2003–04(1) (2)
Numbers Admitted to Subject to Total hospital Section after detentions in under Section admission (2) hospital Independent Hospitals by GOR and SHA area
England 1,403 [1,303] 426 [503] 1,829 [1,806]
North East 14 [56] 7 [15] 21 [71]
County Durham and Tees Valley 13 3 16 Northumberland, Tyne and Wear 1 4 5
North West 210 [190] 42 [44] 252 [234]
Cheshire and Merseyside 32 1 33 Cumbria and Lancashire 45 5 50 Greater Manchester 133 36 169
Yorkshire and The Humber 108 [115] 28 [25] 136 [140]
North and East Yorkshire and North Lincolnshire 64 22 86 South Yorkshire 1 — 1 West Yorkshire 43 6 49 3178271069 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Numbers Admitted to Subject to Total hospital Section after detentions in under Section admission (2) hospital East Midlands 61 [76] 16 [32] 77 [108] Leicestershire, Northamptonshire and Rutland 35 14 49 Trent 26 2 28 West Midlands 76 [33] 8 [9] 84 [42] Birmingham and The Black Country 20 2 22 Shropshire and StaVordshire 53 3 56 West Midlands South 3 3 6 East of England 97 [89] 25 [45] 122 [134] Bedfordshire and Hertfordshire 15 2 17 Essex 27 18 45 Norfolk, SuVolk and Cambridgeshire 55 5 60 London 550 [450] 177 [129] 727 [579] North Central London 24 35 59 North East London 188 32 220 North West London 213 47 260 South East London 80 43 123 South West London 45 20 65 South East 265 [265] 101 [184] 366 [449] Hampshire and Isle of Wight 29 22 51 Kent and Medway 15 5 20 Surrey and Sussex 130 68 198 Thames Valley 91 6 97 South West 22 [29] 22 [20] 44 [49] Avon, Gloucestershire and Wiltshire 12 19 31 Dorset and Somerset 1 1 2 South West Peninsula 9 2 11 Source: KP90 Notes 1. Includes all changes from informal status to detention under the Act, and detentions where the patient was initially brought to hospital under Section 136 (Place of Safety Order). 2. The figures in brackets are the totals for 2002–03.
Table 3.4.2(c.) ALL CONSULTANT EPISODES(1) OF PATIENTSWITH MENTAL ILLNESS BY STRATEGIC HEALTH AUTHORITY(2) OF RESIDENCE, 2003–04(3)
Rate per 1,000 Episodes(3) population(4) England 218,313 4.38 Avon, Gloucestershire and Wiltshire 7,755 3.54 Bedfordshire and Hertfordshire 6,296 3.90 Birmingham and the Black Country 8,761 3.85 Cheshire and Merseyside 10,340 4.39 County Durham and Tees Valley 4,991 4.35 Coventry, Warwickshire, Herefordshire and Worcestershire 8,438 4.40 Cumbria and Lancashire 6,123 5.07 Dorset and Somerset 8,610 5.28 Essex 11,379 4.50 Greater Manchester 8,996 5.01 Hampshire and Isle of Wight 4,490 2.81 Kent and Medway 9,378 5.93 Leicestershire, Northamptonshire and Rutland 8,884 4.00 Norfolk, SuVolk and Cambridgeshire 6,672 5.47 North and East Yorkshire and North Lincolnshire 8,300 5.42 North Central London 5,526 3.37 North East London 6,416 4.61 North West London 7,600 4.19 Northumberland, Tyne and Wear 6,387 4.27 Shropshire and StaVordshire 8,118 5.37 South East London 6,925 5.28 South West London 6,524 4.07 South West Peninsula 6,143 4.83 3178271070 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Rate per 1,000 Episodes(3) population(4) South Yorkshire 10,775 4.19 Surrey and Sussex 7,514 3.56 Thames Valley 10,395 3.89 Trent 5,828 3.76 West Yorkshire 10,749 5.13
Notes 1. Hospital in-patient are assigned to a Consultant who is responsible for their treatment, and their period of care under a Consultant is termed a “Consultant Episode”. 2. Strategic Health Authority of residence is the Strategic Health Authority in which the patient lived in before admission. This however may not be the same area where the treatment took place. The Strategic Health Authority codes were introduced in 2002–03, previously Health Authority codes were used. 3. The figures are provisional as no adjustments have been made for the shortfalls in data. 4. The population rates use the 2003 population estimate based on the 2001 census, and have been rounded to the nearest two decimal places.
3.4.3 Could the Department please update the information provided in response to last year’s questionnaire showing, over the last four years, the numbers of people with mental health problems and with learning disabilities who have been in special hospitals, prisons and regional secure units? [3.5.3] Answer
High Security Hospitals, Medium Secure Units and Prisons 1. Table 3.4.3 shows the total number of patients in the high security hospitals at 31 December in each of the last four years and the number of patients who were classified as having a learning disability (coming within the Mental Health Act 1983 categories of mental impairment or severe mental impairment) for the same period. 2. The NHSPlan commitment to move up to 400 inappropriately placed patient s out of the high security hospitals to more appropriate accommodation (through what became known as the Accelerated Discharge Programme (ADP)) by the end of 2004 was achieved (just over 400 actually moved). It is expected that the number of patients moving out of high security will continue to exceed the number being admitted, at least for the immediate future. 3. A high degree of priority within the ADP was given to the movement of women patients, many of whom did not require the levels of physical security provided by the high security hospitals. As mentioned last year, this led to a decision that a high security women’s service would only be required on one of the three hospital sites (Rampton Hospital) in the longer term. The women’s service at Ashworth Hospital was thus closed with all the women patients moving either to Rampton Hospital, if still needing to be in a high security environment, or to lower levels of security where that was appropriate. This contributed to the significant reduction in the Ashworth Hospital patient population as at 31 December 2003 (reflected in Table 3.4.3). There are currently 42 patients in the women’s service at Broadmoor Hospital and the target is for all women to have moved out of the hospital by April/May 2007. 4. The future impact of mental health prison in-reach teams on high security hospital admissions remains uncertain. While these teams may be preventing some hospital admissions by improving the standard of community-type care available in prison, they are also improving the identification of prisoners who require transfer to hospital for treatment of mental health problems. Some of these individuals require a high security setting, although the eVect on hospital facilities providing medium and other levels of security is more significant. The potential need for hospital places for mentally disordered prisoners will be considered in the course of the review of high and medium secure services capacity from 2005–10, to which reference is made below. 5. Broadmoor and Rampton Hospitals are involved in pilot projects for the assessment and treatment of people with dangerous and severe personality disorder (DSPD). As at 31 December 2004, Broadmoor Hospital was accommodating ten DSPD patients while Rampton Hospital had 20 patients in their DSPD service. When both pilots are fully up and running Broadmoor and Rampton Hospitals will each provide 70 beds for DSPD patients. The impact on high security hospital patient numbers in the longer term arising from the development of the policy for dealing with this client group will become clearer as the pilot projects are evaluated. 6. Each of the high security hospitals is the responsibility of an NHSTrust —Ashworth: Mersey Care NHSTrust, Broadmoor: West London Mental Health NHSTrust, Rampton: Notti nghamshire Healthcare NHSTrust. It is possible that one or more of the Trusts might seek Foundatio n Trust status at some stage in the future and the arrangements that need to be made for high security psychiatric services to be provided by a Foundation Trust are currently under consideration. 3178271071 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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7. The three trusts with responsibility for the high security hospitals are performance managed by the relevant Strategic Health Authorities.
Table 3.4.3 TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH SECURE HOSPITALS
As at Ashworth Broadmoor Rampton Total
31.12.01 405 382 392 1,179 31.12.02 367 331 375 1,073 31.12.03 289 314 372 975 31.12.04 280 286 357 923
TOTAL NUMBER OF PATIENTSWITH LEARNING DISABILITIESIN HIGH SECURE HOSPITALS
As at Ashworth Broadmoor Rampton Total
31.12.01 3 0 87 90 31.12.02 4 1 75 80 31.12.03 2 0 63 65 31.12.04 0 0 55 55
Source: High Security Hospitals 8. The table indicates a continuing downward trend in the total number of high security hospital patients and in the number of patients with a classification of mental impairment/severe mental impairment at 31 December 2004. All figures exclude patients on trial leave of absence.
Number of People with Mental Health problems in Medium Secure Units 9. The position remains, as in previous years, that we are unable to supply data over the last four years for the number of people with mental health problems and with learning disabilities who have been in medium secure units. We know, however, that there has historically been pressure on medium secure and other secure beds. Therefore, steps have been taken to increase the number of secure psychiatric beds, for example through the achievement of the following targets set out in the NHS Plan: — The creation of almost 500 extra secure beds by April 2001. — The development of 200 long-term secure beds. — The creation of 140 DSPD hospital beds (to which is linked the development of medium secure beds, hostel places and community teams for this group of people). 10. The increase in bed numbers has significantly improved the prospects of patients requiring care and treatment in secure conditions being placed in the most appropriate settings to meet their needs. 11. More generally, the development and modernisation of mental health services, which is one of the Government’s core national priorities, has placed a focus on the local development of services to meet the needs of the local population. This has provided a more focused mechanism for identifying the needs of local populations and the development of integrated local services. 12. In the spirit of Shifting the Balance of Power, high and medium secure psychiatric services are commissioned by primary care trusts (PCTs) but in a collaborative manner around “Cluster Group” arrangements. The Cluster Groups are charged with taking forward the development of appropriate secure psychiatric services. 13. A review of high and medium secure services capacity from 2005–10 has been commissioned by the High Security Psychiatric Services National Oversight Group, which has responsibility for co-ordinating the planning and delivery of high security psychiatric services and for ensuring that the Secretary of State’s specific duties under Section 4 of the National Health Service Act 1977 to provide high security psychiatric care are properly discharged.
Prevalence of Mental Health problems in the Prison Population 14. It is not possible to state with any precision how many prisoners have mental health problems at any one time. That is not a question of the application of objective criteria but is essentially a matter for the clinical judgement of the psychiatrists responsible for each person’s care and treatment. However, a survey of mental ill health in the prison population undertaken in 1997 by the OYce for National Statistics 3178271071 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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estimated that around 90% of prisoners had at least one of the five disorders (personality disorder, psychosis, neurosis, alcohol misuse, and drug dependence) considered in the survey. Co-morbidity levels are also high. [Psychiatric Morbidity among Prisoners in England and Wales ONS1998]. 15. The NHSPlan included firm commitments that, by 2004, 300 additional sta V would be involved in providing mental health services to prisoners and 5,000 prisoners at any one time would be receiving more comprehensive mental health services in prison. All prisoners with severe mental illness would be in receipt of treatment, and no prisoner with serious mental illness would leave prison without a care plan and a care co-ordinator. 16. These commitments have been met through the prison mental health in-reach project, under which the NHShas funded the introduction into prisons of multi-disciplinary me ntal health in-reach teams. The project began at 18 establishments in England and the four in Wales in 2001–02, and was extended to another 26 during 2002–03 and a further 46 in 2003–04. Mental health in-reach teams are now operating at 102 establishments and should, by April 2006, become available within all prison establishments where the need for them has been identified. The commitment in the NHSplan that 300 add itional staV would be in post by the end of 2004 has been exceeded. 17. In December 2001, the then Prison Health Policy Unit and Task Force published, Changing the Outlook, a Strategy for Developing and Modernising Mental Health Services in Prisons. This set out the vision of where prison mental health services should be by 2006 and identified the steps that would have to be taken if it were to be realised. Every prison was expected to look critically, with its local NHSpartner (PCT) at its existing provision to establish whether it met the needs identified in the establishment’s joint health needs assessment and conformed to the principles and standards set out in both the Department of Health’s National Service Framework for Mental Health and Changing the Outlook. 18. The basic principle underpinning the Strategy is that mental health services for prisoners should, as far as possible, be provided in the same way as they would be in the wider community. Prisoners who, were they not in prison, would be treated in their own homes under the care of Community Mental Health Teams (CMHTs), should be treated on the wings, their prison “home”. Those needing more specialist care should be able to receive it in the prison health care centre, and there should be quick and eVective mechanisms to transfer prisoners who need in-patient treatment for mental disorder to hospital. 19. Prisoners who are already receiving treatment for mental disorder in the community under, for example, the Care Programme Approach should continue to have access to that level of service while they are in prison and, if appropriate, on release. A more eVective screening tool has been introduced at establishments that receive prisoners directly from court to identify those who have immediate and/or significant health needs, particularly mental health needs. 20. At the end of 2003 the National Institute for Mental Health in England (NIMHE) was commissioned to implement a national prison mental health programme to form part of a wider range of innovative NIMHE projects and work-streams. This “mainstreaming” of prison mental health within NIMHE is designed to ensure that front-line clinical staV and service users in prison are linked into a range of new developments, learning is shared and good practice disseminated. A nationally developed care pathway for prison mental health was published in January 2005 that provides detailed guidance to staV and service commissioners alike. By following the prisoner from arrest through custody and on to release, it underpins the concept of end to end oVender management. 21. The number of prisoners transferred to hospital as restricted patients under sections 47 (sentenced) and 48 (unsentenced) of the Mental Health Act 1983 rose by 76% between 1991 and 1994 but thereafter remained relatively stable at an average of 745 each year until 1999. In 2003, the last year for which statistics have been published, 721 prisoners were transferred as restricted patients under those sections, a rise of 12 per cent on the revised 2002 figure of 644. 22. Many prisoners, particularly those in the acute stage of a mental illness, are transferred to hospital within a reasonable timescale but problems of apparently excessive delay can still occur in some individual cases. Although considerable eVorts have been made to reduce such delays, at any one time around 40 or so prisoners will have been waiting longer than three months for a hospital place following acceptance by the NHS. Tighter regular monitoring has already been introduced to identify any prisoners who have been waiting unacceptably long periods for transfer to hospital. A protocol issued in 2003 set out what must be done when a prisoner has been waiting for a hospital place for more than three months following acceptance by the NHS. As indicated by the rise in the number of transfers in 2003, both appear to have brought about an improvement. 23. However, there remains some lack of clarity around the arrangements for transferring prisoners with mental health problems to hospital. The Prison Service, Prison Health, the National Institute for Mental Health in England (NIMHE), and the commissioners and providers of NHShosp ital services are now working collaboratively on a two year project that began in April 2005. Its principal objective is to establish a national waiting time limit for transfers between custodial settings and hospitals that is equivalent to the waiting time for referrals between mainstream NHSproviders and hospital and which is maintained for all prisoners requiring transfer. It will also aim to develop referral guidelines and care pathways both to and from prison and hospital settings and to monitor national compliance. 3178271073 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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3.5 Expenditure on Prescribing 3.5.1 Could the Department please update the information provided in table 3.6.1 response to last year’s questionnaire regarding total NHS expenditure on pharmaceuticals for the past four years, including a breakdown by sector and by generic/branded drugs. [3.6.1] Answer 1. Total NHSnet expenditure on medicines and listed appliances in England in 2003–04 was £9,272 million. £6,961 million of this total relates to prescriptions dispensed in the community and £2,311 million relates to medicines supplied in a secondary care setting. In 2004–05 the total spent on prescriptions dispensed in the community was £7,374 million (please note this is a provisional figure and has yet to be finalised). 2. In cash terms, total NHSnet expenditure on medicines and listed applian ces relating to prescriptions dispensed in the community in England in 2004–05 was £7,344 million (please note this is a provisional figure and has yet to be finalised). Cash figures for HCHS2004–05 expenditure are no t available. 3. Historical NHSDrug Bill expenditure figures, broken down by sector, for the financial years 2000–01 to 2004–05 is provided in Table 3.5.1(a).
Table 3.5.1(a) NHS DRUG BILL EXPENDITURE 2000–01 TO 2004–05
Year Total NHS net expenditure Total NHS net expenditure Total NHS net relating to prescriptions relating to medicines supplied expenditure on medicines dispensed in the community in a secondary care setting and listed appliances (Cash) (£m) (£m) (£m) 2000–01 5,161 1,530 6,691 2001–02 5,552 1,740 7,292 2002–03 6,209 2,013 8,222 2003–04 6,799 2,308 9,107 2004–05 7,344 N/A N/A Year Total NHS net expenditure Total NHS net expenditure Total NHS net relating to prescriptions relating to medicines supplied in expenditure on medicines dispensed in the community a secondary care setting and listed appliances (Resource) (£m) (£m) (£m) 2001–02 5,707 1,740 7,447 2002–03 6,342 2,013 8,355 2003–04 6,961 2,311 9,272 2004–05 7,374 N/A N/A
4. For prescriptions dispensed in the community in England, a breakdown between branded medicines, generic medicines, dressings and listed appliances for the financial years 1994-95 to 2004–05 is provided in Table 3.5.1(b). The table shows both the cost (expressed in terms of net ingredient cost) and the volume (number of prescription items) for each category. In 2004–05, branded drugs dispensed represent about 70% per cent of the total net ingredient cost (inc. the cost of dressings and appliances). In 2004–05, the share of prescription items written generically was 79%, and the share of prescription items dispensed generically was 57%.
Table 3.5.1(b) NUMBER AND NET INGREDIENT COST OF GENERIC AND PROPRIETARY PRESCRIPTION ITEMS DISPENSED IN THE COMMUNITY 1994–95 TO 2004–05
England Drugs dispensed generically Drugs dispensed as Dressings and Appliance proprietary NIC Prescription NIC Prescription NIC Prescription items items items Financial Year (£m) (m) (£m) (m) (£m) (m) 1994–95 402 186 2,881 262 205 14 1995–96 457 201 3,066 259 216 15 1996–97 516 214 3,328 258 228 15 1997–98 651 230 3,574 260 240 15 1998–99 703 240 3,845 261 251 15 1999–2000 1,049 254 4,116 265 270 15 2000–01 1,077 284 4,283 261 291 16 2001–02 1,079 300 4,886 275 316 17 3178271073 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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England Drugs dispensed generically Drugs dispensed as Dressings and Appliance proprietary NIC Prescription NIC Prescription NIC Prescription items items items Financial Year (£m) (m) (£m) (m) (£m) (m) 2002–03 1,397 325 5,275 282 346 17 2003–04 1,799 359 5,488 282 378 18 2004–05 2,054 392 5,633 281 407 19
Notes: 1. Source: PCA, PPA, England. Figures are for prescription items dispensed by chemists and appliance contractors and dispensing doctors including items personally administered in England, for financial years April to March. Note that in addition to prescriptions written by GPs in England, this includes those written by nurses, dentists, hospital doctors, (and, up to March 1994, armed services doctors and dentists) provided they were dispensed in the community. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospital or private prescriptions. Please note data for 2001–2002 in the previous HSC was incorrect due to errors in Prescription Cost Analysis (PCA). The data has now been revised. 2. The net ingredient cost (NIC) is the basic cost of a drug. This cost does not take account of discounts, dispensing costs, fees or prescription charge income. All figures are expressed at outturn prices. 3. Generic dispensing covers drugs that are prescribed and available generically and the dispenser is reimbursed at the Drug TariV or generic price. It is possible in some circumstances for a branded drug or parallel import to be dispensed against the prescription. 4. The Department collects data on secondary care prescribing through NHS Trust and Health Authority financial returns. On an annual basis, these high level aggregate returns enable it to monitor the pressure faced by local NHSorganisations and the aggregate cost to the NHS as a whole. More detailed information is available to Trusts at a local level from hospital pharmacy IT systems. This is primarily used to monitor local spending on pharmaceuticals together with adherence to local policies aimed at ensuring the cost eVective use of medicines. 5. ”Pharmacy in the Future”, the modernisation programme for pharmacy services in England made a commitment to implement a self-assessment tool for medicines management in NHShospitals. The tool was developed by the OYce of the Chief Pharmacist, at the Department of Health, with the support of the Regional Directors of Performance Management and Public Health and Regional Pharmaceutical Advisers. It was introduced to NHSTrust hospitals in England through a rol l-out programme managed by the Regional OYce (RO) network. 6. The self-assessment tool recognised that achieving clinical and cost-eVective medicines use is an organisation-wide issue on which managers, prescribers and pharmacists need to work together. The self- assessment tool provided an opportunity for hospitals to examine their arrangements ahead of the Audit Commission’s review of medicines management in Spring 2001. 7. Regional OYces organised meetings with Trusts in Autumn 2001 to ensure action plans were in place to improve performance. 8. The Audit Commission published their report “A Spoonful of Sugar” in December 2001. The report complements the Department’s medicines management performance framework. 9. Work is in hand to develop the next stage of the framework. The next wave will focus on implementation of action plans and the greater use of automation and IT. The central aim is to ensure that clinicians, pharmacists and financial planners work more closely together across local health economies.
3.5.2 Could the Department please update the information provided in response to last year’s questionnaire in Table 3.6.4 regarding the likely costs of NICE recommendations for the current financial year? [3.6.2] Answer 1. The information requested is shown in Table 3.5.2. It is as at July 2005. 2. The estimated full-year costs of all NICE appraisal guidance issued so far amount to some £836.4 million for England and Wales. 3. In some cases the financial impact on the NHSmay build up gradually over a n umber of years, for instance where infrastructure changes are needed to put the recommendations into full eVect. 4. In addition, there will be some costs arising out of appraisals due to be completed during the current year. 5. There are a number of TAs for which there are a range of costs. For the purpose of the revised schedule a mid point has been taken, hence the change to the overall total estimated cost. 3178271076 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 167 stimates of the year 1 set of £15–20 million to V imate was 14.5, but this was in ect superseded by the later estimate for the V the prevalent cases, then reducingmillion to pa. £5 drug and associated running costs,cost and of of initial the assessment ofeligible potentially patients. gross costs of £45 million appraisal. two glitzones together in the pioglitazone e 0 This assumes an o .0 7.3 £55 million spread over three years to clear 5.0 8.0 45.0 " " " (England,£m) (3) selective/ year costs research Table 3.5.2 (As at July 2005) ESTIMATED COSTS OF NICE GUIDANCE Joints 16 Autologous Cartilage transplantation in Knee December 2000 Research 0 15 Zanamivir for Influenza November 2000 Selective 6.6 14 Ribavirin and Interferon Alpha for Hepatitis C October 2000 Selective 1 1213 Glycoprotein IIb/IIIa inhibitors Methylphenidate for ADHD September 2000 October 2000 Routine Routine 30.2 44.0 NICE made separate e 11 Implantable cardioverter defibrillators September 2000 Selective 30. 10 Inhaler systems for under 5s August 2000 Routine 0.0 9 Rosiglitazone for Type 2 Diabetes August 2000 Selective 0.0 Original est 8 Hearing Aids July 2000 Selective 0.0 7 Proton Pump Inhibitors July 2000 Selective 6 Taxanes for Breast Cancer June 2000 Selective 16.0 5 Liquid Based Cytology—cervical screening June 2000 Research 0.0 4 Coronary Artery Stents May 2000 Selective 0.0 3 Taxanes for Ovarian Cancer May 2000 Selective 7.0 No. Title of guidance1 Wisdom Teeth Date of Issue Routine/ March 2000 Estimated full- Comment Selective 2 Hip Replacement April 2000 Selective 3178271076 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 168 Health Committee: Evidence or 1st line and nd £3–4 million for ICE comment that . guidance unchanged. costs in 2nd line uselower”, could but be do “consideraly not give a lower bound. £20 million for 2nd line use. they indicate that detailed costings given. Estimated to be broadly cost neutral no take-up may increase in the longer term. overheads. a slow build-up over several years .0 This is a long-run annual cost NICE expected 11.3 See comment on rosiglitazone above. " (England,£m) (3) selective/ year costs research (continued) (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE cult to heal surgical wounds April 2001 Routine 0.9 Y leukaemia Arthritis Alzheimer’s 34 Tratuzumab breast cancer March 2002 Selective 17.0 3233 Beta interferon & glatiramer Colorectal Cancer January 2002 Research March 2002 Selective 0.0 41.0 NICE estimate £21 million f 31 Sibutramine for Obesity in adults October 2001 Routine 19.2 Year 3 figure 30 Taxanes for Breast Cancer ı review September 2001 Selective 0.0 Earlier 29 Fludarabine for B-cell chronic lymphocytic September 2001 Routine 0.0 28 Topetecan for advanced Ovarian Cancer August 2001 Selective 7.0 27 Cox II for Osteoarthritis and Rheumatoid July 2001 Selective 25.0 26 Non-small cell lung cancer June 2001 Routine 9.0 These a short run costs N 25 Gemcitabine for Pancreatic cancer May 2001 Selective 1.8 24 Di 23 Temozolomide for Brain Cancer April 2001 Selective 1.0 22 Orlistat for Obesity March 2001 Selective 9.0 £6 million for drug costs a 21 Pioglitazone for Type 2 Diabetes March 2001 Selective 20 Riluzole for Motor Neurone Disease January 2001 Routine 5.0 19 Donepezil, Rivastigmine and Galantamine for January 2001 Selective 42 18 Laparoscopic surgery for Inguinal Hernia December 2000 Selective 0.0 No. Title of guidance17 Laparoscopic surgery for Colorectal Cancer January 2001 Research Date of Issue Routine/ 0.0 Estimated full- Comment 3178271076 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 169 t lower tive estimate, llion for the first year eptember 2000 guidance e lower, but will build as with this revised guidance isincrease not costs expected to to the NHS. service provision increases. end of range. subsequent years but did not quantify. costs. They expected lower costs in but information in the guidancefigure suggests of a around £1.2 million 0.9 200,000 procedures x “less than £10” (England,£m) (3) selective/ year costs research (continued) (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE venous lines 49 Ultrasonic locating devices for pacing central September 2002 Routine 48 Home vs hospital haemodialysis September 2002 Selective 0.0 47 Glycoproteins (review) September 2002 Routine 0.0 Replacement of the S 46 Surgery for morbid obesity July 2002 Selective 21.0 Initial costs will b 45 PLDH (Caelyx) for ovarian cancer July 2002 Selective 3.1 4142 Routine anti43 D rhesus negative Human women growth44 hormone children Atypical antipsychotics Metal on Metal May 2002 May 2002 Routine June 2002 Routine June 2002 Routine 4.0 34.7 Selective 104.8 1.9 NICE says cost is more likely to be a 3839 Inhalers 5-40 15 Zyban & NRT Infliximab Crohn’s disease May 2002 March 2002 March 2002 Selective Routine Routine 2.5 NICE estimates £2.5 mi 0.9 2.5 3637 Enteracept & infliximab rheumatoid arthritis Rituximab lymphoma March 2002 Selective March 2002 59.0 Selective 1.2 NICE do not attempt a quanti No. Title of guidance35 Enteracept juvenile arthritis Date March of 2002 Issue Selective Routine/ Estimated full- Comment 3.0 3178271076 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 170 Health Committee: Evidence year is between 10.3 million. commended. % tional costs to the NHS or England each with running treatment options. tegafur uracil in preference to existing costs of £64,500 pa in certain restricted circumstances. three drugs. savings/pressure balance out between the of the range. will result from this review. Estimate on the high side—basedpotentially on eligible all patients switching totreatment—actual this costs will be proportionately less depending on uptake. Further research recommended. and Wales. £11.8 million and £15.8 million for England 11.2 Assumes 3,500 each use capecitabine or " (England,£m) e 5.3 NICE suggest costs will be at the bottom end (3) nd no— 0.0 Cost impact depends on the severity of an selective increase over previous estimated figures—as selective/ year costs research (continued) (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE metastatic colorectal cancer flu hence tabled as outbreak in any given year. No anticipated 61 Capecitabine and tegafur with uracil for May 2003 Routine 60 Patient education models diabetes April 2003 Routine 10.3 160 centres f 59 ECT April 2003 Selective 0.0 Guidance recommends the use of ECT only 58 Zanamivir oseltamivir amantidine treatment of February 2003 Routine a 57 Subcutaneous insulin infusion (insulin pumps) February 2003 Selectiv 56 Tension free vaginal tape February 2003 Routine 0.0 Further research re 55 Paclitaxel—ovarian cancer January 2003 Routine 0.0 Unlikely that addi 54 Vinorelbine for breast cancer December 2002 Selective 6.5 5253 Thrombolysis Long acting insulin analogues (glargine) December 2002 Selective October 2002 16.0 Routine 33.5 51 Computerised Cognitive behavioural therapy October 2002 Research 0.0 No. Title of guidance50 Imatinib for CML Date of Issue October 2002 Routine/ Estimated full- Routine Comment 13.8 Estimated increse in the first 3178271076 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 171 setting saving from V t no figures estimated ost of using drug-eluting ning costs are likely to be similar with ikely to be costs or savings. ICE say incidence is rising by 4% pa and reducing the restenosis rate. stents vs bare metal stents.possible NICE £4 estimate million a o similar to the start-up costs. some possible (unquantified) time savingsdiagnosis. in Running costs are likely to be quote upper limit of £27.3is for not 2007 clear. but basis about 30% the previous estimated£12 saving million of pa. docetaxel relative to docetaxel monotherapy. 0 Steady-state (year 5) costs. 4.0 0.1 1.2 Saving is for combination capecitabine/ 16.0 Revision on previous guidance reduces by " " " " (England,£m) (3) nd no— 10.0 Costs will vary with severity of influenza selective selective/ year costs research (continued) (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE screening flu hence tabled as outbreak. bipolar 1 disorder lymphoma 72 Rheumatoid arthritis—anakinra November 2003 Research 71 Use of coronary artery stents October 2003 Selective 6.6 This is the net c 70 Use of imatanib for chronic myeloid leukaemia October 2003 Selective 5. 69 Use of liquid-based cytology for cervical October 2003 Routine 10.2 Run 68 PDT for macular degeneration September 2003 Selective 8.3 67 Oseltamivir and amantidine for prophylaxis of September 2003 Routine a 66 Olanzapine and valporate semisodium for September 2003 Routine 0.0 Unl 65 Rituximab for aggressive non Hodgkin’s September 2003 Selective 13.2 N 64 Human Growth Hormone in adults August 2003 Selective 0.0 Cost saving—bu 63 Glitazones for type 2 diabetes (review) August 2003 Selective No. Title of guidance62 Capecitabine for locally advance breast cancer May 2003 Routine Date of Issue Routine/ Estimated full- Comment 3178271076 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 172 Health Committee: Evidence £32 " £29 to " ange of . is likely that costs willlower trend end. towards the a NICE’s recommendation was not positive it million. However it is unlikelysavings that would such be realised. 0 9 Possible range of cost extremely variable, but 0 0.0 14.2 10.5 31.5 Cost saving. " " (England,£m) (3) selective/ year costs research (continued) (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE imatinib regimens (adults) tacrolimus menstrual bleeding endometrial ablation techniques for heavy and alfa interferon therapy in trauma diagnosis and management of anginamyocardial and infarction 86 Gastro-intestinal stromal tumours (GIST)— October 2004 Selective 4.7 85 Renal transplantation—immuno-suppressive September 2004 Selective 84 Sepsis (severe)—drotrecogin September 2004 Routine 15.0 83 Hernia—laparoscopic surgery (review) September 2004 Selective 1.0 82 Atopic dermatitis (eczema)—pimecrolimus and August 2004 Selective 2. 81 Atopic dermatitis (eczema)—topical steroids August 2004 Selective 80 Acute coronary syndromes—clopidogrel July 2004 Routine £26.5. 79 Newer drugs for epilepsy in children April 2004 Selective 0.0 78 Fluid-filled thermal balloon and microwave April 2004 Selective 77 Newer hypnotic drugs for insomnia April 2004 Selective 0.0 Cost neutral 76 Newer drugs for epilepsy in adults March 2004 Selective 0.0 NICE quote a r 75 Hepatitis C—pegylated interferons, ribavarin January 2004 Selective 74 Pre-hospital initiation of fluid replacement January 2004 Selective 0. No. Title of guidance73 Myocardial perfusion scintigraphy for the November 2003 Selective Date of Issue 27. Routine/ Estimated full- Comment 3178271076 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 173 % esearch mall expenditure to fund research .0 (England,£m) Total Cost (3) ectiveness is needed. selective/ year costs V research Routine 28 (continued) on e se of this table, we have taken the mid point where appropriate. NICE has approved technology, but only for use under specific conditions, R e. % (As at July 2005) Table 3.5.2— ESTIMATED COSTS OF NICE GUIDANCE NICE has approved the use of a technology, Selective % topotecan (review) pegylated liposomal doxorubicin hydrochloride and dipyridamole implantation (ACI) (review) (No. 89) symptomatic bradycardia Total no of researchable topics Research 8 NICE has not approved the technology and recommends that further research 92 Tooth Decay—Healozone July 2005 Research Cost neutral 91 Ovarian cancer (advanced)—paclitaxel, May 2005 Selective 2.3 90 Vascular disease—clopidogrel and May 2005 Selective 27.4 4. There are a number of TA’s for which there are range of costs. For the purpo 3. Recommended 89 Cartilage injury—autologous chondrocyte May 2005 Research 0.0 May be s 2. NICE estimates are given on an England and Wales basis. No. Title of guidance8788 Secondary osteoporosis Dual-chamber pacemakers for the treatment of February 2005 Selective Date of Issue January 2005Totals Total number of appraisals Routine/ 9 SelectiveNotes: Estimated1. full- All estimates are based Comment on figures published in NICE’s appraisal guidanc 36.5 Selective 56 £758.63 3178271078 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 174 Health Committee: Evidence
3.6 National Specialist Services 3.6.1 Could the Department please update the information provided in Table 3.7.1 in response to last year’s questionnaire? [3.7.1] Answer 1. Table 3.6.1 shows the expenditure on each of the national specialist services in 2003–04 and 2004–05. It also shows the service values for 2005–06. 3178271078 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 175 70 144 155 ,922 304 677 5,755 04–05 AND 2005–06 87 92 ing Service Funding Provider Funding Service Funding 972 1,025 284 249 250 264 327 981 539 12,638 2,596 17,251 142 479 149 505 3,1921,656 3,500 1,984 1,897 1,920 91 1,579 1,579 1,841 1,841 (1) (1) (1) (1) 1 £’000 £’000 £’000 2003–04 2004–05 2005–06 Total Expenditure Total Expenditure Service Agreement Table 3.6.1 d Hospital, 1,511 1,511 2,449 2,449 3,703 3,703 eld 1,600 1,171 1,210 Y eld 640 649 697 Y e Hospital, Oxford 1,759 1,811 1,984 V Great Ormond Street Hospital, London 1,480 Great Ormond Street Hospital, London 1,460 Charing Cross Hospital, London 1,361 2,001 1,420 2,069 1,493 2,190 Dudley, Beacon & Castle PCT Middlesex, and Freeman Hospital, Newcastle Papworth Hospital, CambridgeWythenshawe Hospital, ManchesterFreeman Hospital, Newcastle upon TyneQueen Elizabeth Hospital, Birmingham 4,336 3,250 6,410 2,459 31,317 2,814 4,579 3,714 6,863 33,753 3,035 5,152 3,966 7,353 36, South London & Maudsley NHS Trust Gardener Unit, ManchesterWells Unit, West London West Hampshire PCT 3,867 11,682 4,234 3,366 Northern General Hospital, She Manchester Children’s Hospital 362 1,292 400 1,372 424 1,449 Royal Brompton & Harefield, LondonBirmingham Children’s HospitalAlder Hey Children’s 10,541 Hospital, LiverpoolGlenfield Hospital, Leicester 1,042 1,513 11,420 5,774 1,202 2,145 11,928 1,697 6,366 4,300 1,382 2,298 7, 1,892 4,921 2,511 5,108 SUPRA REGIONAL SERVICES AND CENTRALLY COMMISSIONED SERVICES 2003–04, 20 ECMO (Neonates and Infants) Freeman Hospital, Newcastle upon Tyne 675 639 ECMO (Adult) Glenfield Hospital, Leicester 2,813 2,813 3,491 3,491 3,922 3 Bladder Exstrophy Great Ormond Street Hospital, London 930 Craniofacial Surgery John Radcli Amyloidosis Royal Free Hospital, London 1,518 1,518 1,770 1,770 1,970 1,9 Heart and Lung Transplantation Great Ormond Street Hospital, London 2,72 Choriocarcinoma Weston Park Hospital, She Deaf Telemental Health Springfield Hospital, London Service NHS Provider Unit Provider Funding Service Funding Provider Fund Deaf Children and Adolescents Selby & York PCT Adult Ventricular Assist Devices Papworth Hospital, Cambridge, Harefiel Inpatient Psychiatric Service for Springfield Hospital, London 1,791 1,7 Service for Adolescents Roycroft Unit, Newcastle upon Tyne 3,513 3,817 4, Mental Health Forensic Secure Ardenleigh Unit, Birmingham 4,302 3,437 3178271078 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 176 Health Committee: Evidence 3 667 322 340 340 04–05 AND 2005–06 ing Service Funding Provider Funding Service Funding 950 5,350 167 3,348 3,330 (1) £’000 £’000 £’000 2003–04 2004–05 2005–06 —continued Total Expenditure Total Expenditure Service Agreement Table 3.6.1 n 616 682 754 eld 1,172 2,541 1,339 2,942 1,294 3,012 Y e Hospital, Oxford 148 181 230 V St. Bartholomew’s Hospital, LondonRoyal Hallamshire Hospital, She 433 505 547 University College Hospital, London 164 1,192 294 1,538 325 1,673 Royal Victoria Infirmary, Newcastle uponJohn Tyne Radcli 544 602 636 Kings College Hospital, LondonSt James’s University Hospital, Leeds 2,367 3,181 8,542 2,973 3,387 9,708 3,604 3,749 10,68 Great Ormond Street Hospital, London 152 King’s College Hospital, LondonQueen Elizabeth Hospital, BirminghamSt James’s University Hospital, LeedsRoyal Free Hospital, LondonFreeman Hospital, Newcastle upon Tyne 8,665 8,185 4,918 2,897 3,049 32,551 9,226 3,232 8,718 5,352 34,696 3,218 3,499 10,007 9,349 5,783 37, 3,679 Birmingham Heartlands Hospital 163 633 271 763 300 874 Birmingham Children’s Hospital 316 932 423 1,105 402 1,156 St Mark’s Hospital, London 3,966 10,086 4,128 10,767 5,150 12,207 Royal National Orthopaedic Hospital, StanmoreRoyal Orthopaedic Hospital, Birmingham 3,243 3,678 9,124 3,778 3,937 9,785 Royal Free Hospital, London 320 1,081 371 1,183 Manchester Children’s Hospital 80 93 SUPRA REGIONAL SERVICES AND CENTRALLY COMMISSIONED SERVICES 2003–04, 20 Ocular Oncology Royal Liverpool University Hospital 936 1,098 1,171 Neuromuscular Hammersmith Hospital, London 336 461 482 Paediatric Liver Transplantation Birmingham Children’s Hospital 2,994 Gauchers (4) Addenbrooke’s Hospital, Cambridge 529 552 Adult Liver Transplantation Addenbrooke’s Hospital, Cambridge 4,837 4, Epidermolysis Bullosa (Adult) St Thomas’ Hospital, London 470 492 574 Tract Intestinal Failure Hope Hospital, Salford 6,120 6,639 7,057 Epidermolysis Bullosa (Paediatric) Great Ormond Street Hospital, Londo Malformation of the Female Genital Adolescents for Congenital Service NHS Provider Unit Provider Funding Service Funding Provider Fund ENDO (3) University College Hospital, London 2,203 2,070 HTLV (6)Reconstructive Surgery in Queen Charlotte’s Hospital, London St Mary’s Hospital, London 268 268 365 322 365 588 588 3178271078 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 177 42 2,604 ,385 2,385 6,346 2,224 818 2,185 10,755 04–05 AND 2005–06 8 1,608 1,694 1,694 02 4,041 ing Service Funding Provider Funding Service Funding 3,250 3,250 4,186 4,186 7,688 3,560 7,349 5,176 9,865 (1) £’000 £’000 £’000 56 1,113 600 1,201 635 1,269 171 171 3,306 3,306 4,186 4,186 2003–04 2004–05 2005–06 —continued 164,866 164,866 181,856 181,856 191,796 191,796 165,037 165,037 185,162185,162195,982195,982 Total Expenditure Total Expenditure Service Agreement Table 3.6.1 don 557 601 634 Great Ormond Street Hospital, London 4,189 The Christie Hospital, Manchester 1,409 4,405 2,144 5,546 2,472 6,513 Infirmary/ Addenbrooke’s Hospital, Cambridge/ St Mary’s Hospital, London/ Churchill Hospital, Oxford/ Guy’s Hospital, London Liverpool University Hospital/ Manchester Royal Great Ormond Street Hospital, London 51 171 56 56 Main House, BirminghamWebb House, Salford 1,891 2,019 6,211 2,104 2,409 7,112 2,558 2,445 7,861 SUPRA REGIONAL SERVICES AND CENTRALLY COMMISSIONED SERVICES 2003–04, 20 SCIDS Freeman Hospital, Newcastle upon Tyne 3,499 3,789 4,689 EndarterectomyRetinoblastoma St Bartholomew’s Hospital, London Birmingham Children’s Hospital 1,254 963 2,217 1,493 1,073 2,566 1,0 1,562 Pulmonary Thrombo Papworth Hospital, Cambridge 1,573 1,573 1,807 1,807 2 Pseudomyxoma Peritonei North Hampshire Hospital, Basingstoke 2,996 3,4 Sub Total Other Total Existing Service Hepatobiliary St James’s University Hospital, Leeds 1,923 8,904 2,075 9, Paediatric Liver and Complex Birmingham Children’s Hospital 1,939 2,112 Pancreas Transplants (2) Freeman Hospital, Newcastle upon Tyne/ Royal or ECMO) King’s College Hospital, London 5,042 5,631 OTHER Paediatric RheumatologyTransplants (2) (5) Freeman Hospital, Newcastle upon Tyne 120 0 Sub Total Service Agreements (Bridge to Transplantation—VADSFreeman Hospital, Newcastle upon Tyne 5 Service NHS Provider Unit Provider Funding Service Funding Provider Fund Total Anorectal Reconstruction (6) Royal London Hospital 477 477 565 565 Paediatric Ventricular Assist Devices Great Ormond Street Hospital, Lon Small Bowel Transplantation Birmingham Children’s Hospital 964 964 1,60 Personality Disorder Henderson Hospital, London 2,301 2,599 2,858 3178271078 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 178 Health Committee: Evidence 525 956 910 167 185 332 770 15,155 706 523 5,582 632 705 995 377 6,322 1,261 1,079 1,369 2,059 3,706 1,494 2,503 57,782 57,782 04–05 AND 2005–06 ing Service Funding Provider Funding Service Funding 0 0 0 0 10,188 15,155 £’000 £’000 £’000 2003–04 2004–05 2005–06 —continued 165,037 165,037 185,162185,162277,960277,960 Total Expenditure Total Expenditure Service Agreement Table 3.6.1 Tumour Service. rder Service. eld Y eld Orthopaedic Centre, Oxford Y Nu Robert Jones & Agnes Hunt Hospital, Oswestry Royal Orthopaedic Hospital, Birmingham Freeman Hospital, Newcastle upon Tyne Southmead Hospital, Bristol Royal National Orthopaedic Hospital, Stanmore Institute of Ophthalmology, London Royal Hallamshire Hospital, She Hospital Royal Liverpool University Hospital79 Manchester Children’s Hospital Royal Free Hospital, London Hope Hospital, Salford University College Hospital, London Great Ormond Street Hospital, London Glenfield Hospital, Leicester Great Ormond Street Hospital, London SUPRA REGIONAL SERVICES AND CENTRALLY COMMISSIONED SERVICES 2003–04, 20 6. This service has been returned to PCT commissioning from April 2005. 5. From 2005–06 this service is funded as part of the SCID Service. 4. From 2005–06 this service is funded as part of the Lysosomal Storage Diso 3. From 2005–06 this service is funded as part of the Primary Malignant Bone Notes: 1. Remapping between commissioners has taken2. place. This service is funded on a cost per case basis. Sub Total New Serices TOTAL Primary Malignant Bone Tumours University College Hospital, London Drugs Ophthalmic Pathology Central Manchester & Manchester Children’s Lysosomal Storage Disorders ERT All LSD centres Lysosomal Storage Disorders Service Addenbrooke’s Hospital, Cambridge Service NHS Provider Unit Provider Funding Service Funding Provider Fund NEW SERVICES ECMO (Paediatrics) Freeman Hospital, Newcastle upon Tyne 3178271080 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 179
3.7 Management and Administration Costs 3.7.1 Could the Department please update the information provided in Table 3.8.1 in response to last year’s questionnaire? [3.8.1] Answer 1. The information requested in given in Table 3.7.1.
Table 3.7.1 MANAGEMENT COSTS 1997–98 to 2003–04 (ENGLAND) £ million 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 Actual Actual Actual Actual Actual Actual Actual HA/SHA 432 414 497 536 463 97 115 PCT — — — 24 224 723 847 NHStrust 1,296 1,290 1,287 1,307 1,306 1,311 1,425 GP Fundholding(1) —— — ———— Total 1,728 1,704 1,784 1,867 1,993 2,131 2,387 Total NHSExpenditure 34,664 36,608 40,201 43,932 49,021 54,042 63,001 Management costs as % of NHS Spend 5.0% 4.7% 4.4% 4.2% 4.1% 3.9% 3.8%
Notes: 1. Figures not available. 2. The large rise in expenditure between 2002–03 and 2003–04 is due to a change in accounting basis from stage 1 resource based budgeting in 2002–03 to stage 2 resource based budgeting in 2003–04. This involved a transfer of non cash items into the DEL. On a stage 2 basis, the value for the total expenditure in 2002–03 is £56,503 million. Source: Audited health authority annual accounts 1997–98 to 1998–99. Audited health authority summarisation forms 1999–2000 to 2001–02. Audited strategic health authority summarisation forms 2002–03 to 2003–04. Audited NHStrust summarisation schedules 1997–98 to 2003–04. Audited primary care trust summarisation schedules 2000–01 to 2003–04. Total Net NHSExpenditure (England).
3.7.2 What was the expenditure and staYng (WTE) of each of the Department of Health’s arm’s length bodies in 2004–05? Answer 1. The information requested is given in Table 3.7.2.
Table 3.7.2 EXPENDITURE AND STAFFING OF ARM’S LENGTH BODIES IN 2004–05
Gross Operating Department of Health: arm’s length Costs (5) bodies £000 Headcount Information Source
Healthcare Commission (HC) 61,960 609 Figures from 2004–05 Annual Accounts Commission for Patient and Public 30,457 176 Figures from 2004–05 Annual Accounts Involvement in Health (CPPIH) Human Fertilisation and Embryology 8,296 120 Figures from 2004–05 Annual Accounts Authority (HFEA) Mental Health Act Commission 5,312 44 Figures from 2004–05 Annual Accounts (MHAC) Commission for Social Care 141,009 2,548 Figures from 2004–05 Annual Accounts Inspection (CSCI) Health Protection Agency (HPA) 195,403 2,611 Figures from 2004–05 Annual Accounts National Biological Standards Board 17,616 301 Figures from 2004–05 Annual Accounts (NBSB) Dental Practice Board (DPB) 26,084 299 Figures from 2004–05 Annual Accounts NHSPensions Agency (NHSPA) 22,786 357 Figures from 2004–05 Annual Accoun ts Prescription Pricing Authority (PPA) 72,551 2,747 Figures from 2004–05 Annual Accounts NHSLogistics 65,915 1,385 Figures from 2004–05 Annual Accounts NHSPurchasing and SupplyAgency 22,183 332 Figures from 2004–05 Annual Ac counts (NHSPASA) Health Development Agency (HDA) 13,712 131 Figures from 2004–05 Annual Accounts 3178271083 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 180 Health Committee: Evidence
Gross Operating Department of Health: arm’s length Costs (5) bodies £000 Headcount Information Source
National Institute for Clinical 19,487 111 Figures from 2004–05 Annual Accounts Excellence (NICE) Dental Vocational Training Authority 290 3 Figures from 2004–05 Annual Accounts (DVTA) National Blood Service (NBS) 385,219 6,035 Figures from 2004–05 Annual Accounts UK Transplant (UKT) 14,019 128 Figures from 2004–05 Annual Accounts Council for Healthcare Regulatory 2,687 10 Figures from 2004–05 Annual Accounts Excellence (CHRE) General Social Care Council (GSCC) 12,744 252 Figures from 2004–05 Annual Accounts Medicines and Healthcare products 66,441 781 Draft and unaudited accounts for 2004–05 Regulatory Agency (MHRA) MHRA Risk and Audit Committee in June 2005 NHSAppointments Commission 4,881 52 Figures from 2004–05 Annual Account s (NHSAC) NHSInformation Authority 219,372 1,047 Figures from 2004–05 Annual Acco unts (NHSIA) NHSLitigation Authority (NHSLA) 12,246 183 Figures from 2004–05 Annual A ccounts National Patient Safety Agency 16,569 156 Figures from 2004–05 Annual Accounts (NPSA) National Clinical Assessment Service 8,906 97 Figures from 2004–05 Annual Accounts (NCAS) NHSCounter Fraud and Security 20,653 312 Figures from 2004–05 Annual Acco unts Management Service (NHS CFSMS) NHSModernisation Agency 204,892 640 Figures from ALB (NHSMA) NHSDirect (NHSD) 143,552 2,961 Gross operating cost fig from ALB (Feb 2005) and staV fig from DH sources NHSEstates (NHSE) 26,496 368 Figures from 2004–05 Annual Accounts NHSProfessionals (NHSP) 36,958 798 Gross operating cost fig from ALB (Feb 2 005) and staV fig from DH sources NHSU 39,226 313 Figures from 2004–05 Annual Accounts National Treatment Agency (NTA) 10,518 146 Figures from DH sources Independent Regulator of NHS14,810 37 Figures from 2004–05 Annual Accoun ts Foundation Trusts (Monitor) Postgraduate Medical Education and 3,437 11 Gross operating cost fig from ALB (Feb 2005) Training Board (PMETB) and staV fig from DH sources
TOTAL 1,946,687 26,101
Notes: 1. The following ALBs were dissolved on 1 April 2004 National Care Standards Commission (NCSC), Commission for Health Improvement (CHI) and Retained Organs Commission (ROC) and hence are not on this years’ list. 2. National Clinical Assessment Authority (NCAA) has changed its name in the 2004–05 Annual Accounts to National Clinical Assessment Service (NCAS). 3. National Radiological Protection Board (NRPB) and Public Health Laboratory Service (PHLS) have both been transferred to HPA and are included within the HPA figures. 4. Family Health Services Appeal Authority (FHSAA (SHA)) merged with NHS Litigation Authority (NHSLA) and the Gross Operating Cost is included in the NHSLA figure. 5. Gross operating costs exclude: Depreciation and Amortisation Capital Charges Profit/Loss on Disposal of Fixed Assets Impairments 6. Where possible all figures are taken from the 2004–05 Annual Accounts, where this has not been possible for what ever reason the figures used have been supplied by the ALB earlier in the year and are shown in italic. 7. The Postgraduate Medical Education and Training Board (PMETB) are not required to produce Statutory Annual Accounts as it has been operating in shadow form during 2004–05.
3.7.3 How many extra staV does the Department estimate will need to be employed by individual practices in order to implement practice-based commissioning? Answer
1. Agreements on appropriate levels of management costs will be left to decisions between a PCT and practice. Management costs include the necessary resources and management support needed to implement practice-based commissioning, as well as payment for clinical time involved in planning and implementing practice-based commissioning. Management costs will vary depending on local circumstances, such as the scope of budget that is involved. 3178271084 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 181
3.8 Activity and waiting times 3.8.1 Could the Department update the information given in Tables 3.9.1 showing activity data by region, including: total activity, with trends; activity by Inpatient, Day-Case and Outpatient; maternity and simple access data? Could the Department provide figures for the ratio of Finished Consultant Episodes (FCEs) to hospital spells by Region for the same period? To what extent do a relatively small number of providers depart from the overall pattern? Could the Department report on the progress made by the NHS Information Authority in reviewing clinical information, including the use of the FCE as a measure of activity? [3.9.1] Answer 1. The activity information requested is given in Tables 3.8.1(a) to 3.8.1(e). 2. The data in Table 3.8.1(b) to 3.8.1(e) are shown for 2002–03 and 2003–04 by Strategic Health Authority of residence. The tables use SHA of residence of the patient since this provides a consistent measure per 10,000 population. As a result, they do not show total activity since around 4% of FCEs are for non-English residents or patients where the home address was missing or invalid. This is consistent with the data that was supplied last year. 3. The figures for 2002–03 have changed since last year because we have performed some rectification cleans on the data (which primarily remove duplicate records), these diVerences should be small.
Inpatient/Day Cases 4. Tables 3.8.1(b) presents the number of hospital inpatient finished consultant episodes (FCEs), for ordinary admissions and day cases, as number of cases and rate per 10,000 resident population, compiled into a single table. The data show an overall increase in both day cases and ordinary admissions in 2003–04 compared with 2002–03. Table 3.8.1(c) shows FCEs by method of admission, in particular showing an increase in the number of planned elective admissions in 2003–04 compared with 2002–03 and a lesser increase in booked admissions, with a slight decrease in waiting list admissions. Data for 2004–05 are expected to be published in early December, with provisional data available for analysis in October.
Ratio of FCEs to spells 5. Tables 3.8.1(d) and (e) show the ratio of FCEs to hospital spells. A hospital spell may comprise more than one FCE if responsibility for the patient is passed from one consultant to another. Overall, the ratio has continued to increase very slightly in 2003–04. Table 3.8.1(e) shows the 15 providers who depart most from the average ratio of 1.142 in 2003–04. The variation in ratio from provider to provider may be quite legitimate and may be due to a number of factors, including service provision, complexity of clinical care, clinical policy, and data quality.
Source of data/Level of accuracy 6. FCE data are processed via the Hospital Episode Statistics (HES) system. We have now started processing Outpatient data as part of a pilot for the HESdata warehouse, bu t this is not yet available publicly. Data have not yet been adjusted for shortfalls in coverage or known invalid/missing clinical data. 7. HESdata continues to improve in quality and reliability, in particular due to a number of data quality initiatives, such as the Data Quality Indicator, the requirement on Chief Executives to sign oV their HES data, increased data quality feedback on the HESOnline website (www.heso nline.nhs.uk) and increased usage of the data for high profile purposes.
Review of clinical information update 8. Existing HRGs (Version 3.5) are FCE-based, and a goal of HRG Version 4 has been to convert to SPELL-based HRGs. 9. To establish a baseline for future developmental comparison, an NHS-wide analysis of 2002–03’s NWCSpatient records (approximately 12 million) was done in December 2003 by FCE, length of stay, procedure and HRG. This was analysed by the NHSIA’s Case mix team. A second global analysis of the same data was done in February 2004 using modified HRG boundaries chosen from the results of the baseline analysis to try and improve their LoSvariance and RIV distributi on. 10. Analysis of clinical activity by FCE and length-of-stay was then done in many specific clinical areas, sometimes repeatedly, to try and explain areas of poor HRG variance and to test the grouping eYcacy of increasingly modified draft HRGs. As a result of this and the guidance from the project’s 22 clinical Expert Working Groups that were convened, diagnosis was upheld in about 30% of draft HRGs as a more eVective basis of grouping than procedure. 11. Starting in September 2004, analysis of costed patient activity records by FCE was added to the work mix. The data came from the financial systems (B-plan, SAPPS etc) of 8 of the 9 English trusts known to record costs at individual patient-level, comprising 225,000 episodes. Two rounds of analysis on this data 3178271084 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 182 Health Committee: Evidence
were conducted ending in February 2005. The data had been requested submitted by SPELL rather than FCE, but this proved impractical for suppliers so it was received and analysed by FCE. Chapters of HRGs where the percentage of cost not represented in length-of-stay then become distinguishable, and further HRG modifications made. 12. No further NHS-wide analysis by FCE has been performed in 2005 so far. 13. FCE data for 2004 converted to SPELL is expected received before the end of the project, as some of the eight trusts have now found a way to provide FCE-linkage identifiers.
Table 3.8.1(a) NEW OUTPATIENT ATTENDANCESPER 10,000 RESIDENTPOPULATION 2004–05 GENERAL AND ACUTE SECTOR
Attendances per New outpatient 10,000 Code Name attendances population Y00 England 12,609,511 2,519
Q01 Norfolk, SuVolk and Cambridgeshire 555,468 2,483 Q02 Bedfordshire and Hertfordshire 339,429 2,090 Q03 Essex 367,115 2,241 Q04 North West London 501,264 2,740 Q05 North Central London 499,090 4,061 Q06 North East London 442,436 2,875 Q07 South East London 477,892 3,157 Q08 South West London 365,638 2,770 Q09 Northumberland, Tyne and Wear 429,799 3,092 Q10 County Durham & Tees Valley 292,798 2,556 Q11 North and East Yorkshire and Northern Lincolnshire 335,446 2,038 Q12 West Yorkshire 455,450 2,166 Q13 Cumbria & Lancashire 429,501 2,233 Q14 Greater Manchester 745,922 2,943 Q15 Cheshire & Merseyside 708,384 3,009 Q16 Thames Valley 515,591 2,430 Q17 Hampshire and Isle of Wight 387,998 2,150 Q18 Kent and Medway 341,580 2,120 Q19 Surrey and Sussex 590,951 2,287 Q20 Avon, Gloucestershire & Wiltshire 525,675 2,386 Q21 South West Peninsula 372,855 2,312 Q22 Somerset & Dorset 306,934 2,527 Q23 South Yorkshire 450,354 3,535 Q24 Trent 527,214 1,964 Q25 Leicestershire, Northamptonshire & Rutland 323,237 2,032 Q26 Shropshire and StaVordshire 336,278 2,245 Q27 Birmingham and the Black Country 649,819 2,855 Q28 West Midlands South 335,393 2,154
Source: Department of Health form QMOP 3178271085 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 183 1.2 5 9.7 1 7.2 02 2.9 45 2.1 14 7.2 338 6.8 325 5.6 506 2.2 Day cases ,475 5.0 ! 8 233 7.1 08 549 8.1 03 420 4.2 86 531 9.4 426 448 5.1 5 308 311 1.1 5 620 677 9.2 3.7 585 610 4.4 -1.7 499 513 2.7 hange FCEs (’000) % change 14 1.1 371 387 4.3 22 0.4 293 298 1.8 24 1,050 2.5 379 398 4.8 2002-03 2003-04 2003-04 2002-03 2003-04 2003-04 0 736 772 4.9 12 530 3.6 4 637 655 3.0 308 326 6.0 DAY CASES COMBINED, GENERAL & ACUTE ! RY Table 3.8.1(b) Per 10,000 Per 10,000 s exclude non-England residents and those with address unknown. Ordinary Admissions Day Cases Ordinary 2002-03 to 2002-03 to 2002-03 to 2002-03 to 2002-03 to FCEs (’000) % change population % change FCEs (’000) % change population % c 2002-03 2003-04 2003-04 2002-03 2003-04 2003-04 2002-03 2003-04 2003-04 ordshire HA 197 207 4.6 1,322 1,38 4.4 138 145 5.1 922 967 4.9 335 351 4.8 V olk and HA Cambridgeshire 338 369 9.3 1,542 1,665 8.0 170 180 5.7 776 811 4.5 5 V Hospital Episode Statistics and Worcestershire HA 193 200 3.5 1,257 1,292 2.8 100 102 1.5 651 656 0.8 294 3 Rutland HA 212 223 5.2 1,348 1,410 4.6 115 120 4.6 731 760 4.0 327 343 5.0 HA 288 316 9.5 1,325 1,442 8.8 161 166 3.0 739 757 2.4 449 482 7.2 Northern Lincolnshire HA 263 278 5.5 1,612 1,691 4.9 139 142 1.8 854 865 1.3 4 Q28 Coventry, Warwickshire, Herefordshire Q27 Birmingham and the Black Country HA 345 355 2.9 1,517 1,561 2.9 167 176 5. Q26 Shropshire and Sta Q25 Leicestershire, Northamptonshire and Q24 Trent HA 459 450 -2.0 1,731 1,683 -2.7 218 224 2.9 821 839 2.1 677 674 -0.4 Q23 South Yorkshire HA 219 224 2.2 1,729 1,754 1.4 119 121 2.0 934 950 1.7 338 3 Q22 Dorset and Somerset HA 192 197 2.9 1,598 1,634 2.3 116 114 -1.9 970 945 -2. Q21 South West Peninsula HA 299 319 6.7 1,877 1,989 6.0 128 130 1.4 803 809 0.8 Q20 Avon, Gloucestershire and Wiltshire Q19 Surrey and Sussex HA 313 351 12.2 1,223 1,365 11.6 172 179 4.2 671 697 3.8 4 Q18 Kent and Medway HA 214 217 1.5 1,344 1,355 0.9 93 93 0.5 582 581 -0.1 306 310 Q17 Hampshire and Isle of Wight HA 262 277 5.4 1,468 1,536 4.7 109 110 1.6 608 6 Q16 Thames Valley HA 228 252 10.4 1,086 1,185 9.2 104 112 8.2 494 532 7.7 332 36 Q15 Cheshire & Merseyside HA 422 453 7.4 1,796 1,926 7.2 163 157 -3.5 692 666 - Q14 Greater Manchester HA 424 480 13.0 1,683 1,895 12.6 195 197 0.9 775 779 0. Q13 Cumbria and Lancashire HA 338 354 4.5 1,772 1,843 4.0 161 159 -1.2 842 828 Q12 West Yorkshire HA 338 350 3.7 1,616 1,671 3.4 157 155 -0.9 750 741 -1.1 495 Q11 North and East Yorkshire and Q10 County Durham and Tees Valley HA 199 204 2.5 1,735 1,776 2.4 94 94 0.5 819 8 Q09 Northumberland, Tyne & Wear HA 237 252 6.2 1,701 1,806 6.2 143 146 2.5 1,0 Q08 South West London HA 142 154 8.2 1,085 1,172 8.0 74 78 5.4 562 592 5.2 216 23 Q07 South East London HA 195 210 8.1 1,285 1,392 8.3 98 104 5.5 649 686 5.7 293 3 Q06 North East London HA 213 231 8.4 1,396 1,510 8.2 103 106 3.6 672 695 3.4 316 Q05 North Central London HA 149 161 8.5 1,225 1,322 7.9 69 72 4.0 571 591 3.5 21 Q04 North West London HA 205 217 5.9 1,132 1,194 5.4 103 109 4.9 573 598 4.4 308 Q03 Essex HA 218 236 8.3 1,344 1,448 7.8 110 121 10.4 678 745 10.0 328 358 9.0 Q02 Bedfordshire and Hertfordshire HA 205 220 7.2 1,277 1,364 6.7 102 106 3. Q01 Norfolk, Su 2. Finished Consultant Episodes (FCEs) by SHA of residence. England figure England 7,309 7,757 6.1 1,472 1,555 5.6 3,620Source : 3,718 2.7 729 746 2.3 10,929 11 Notes 1. All calculations are based on data which are unadjusted for shortfalls. FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS, DAY CASES AND ORDINA 3178271085 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 184 Health Committee: Evidence 2 30 Maternity antepartum 44 59 6 387 38 44 ergency Total total in total) 2002–03 Maternity antepartum Emergency (not Emergency (not Table 3.8.1(c) 2003–04 e non-England residents and those with address unknown. List Booked Planned Emergency Total total in total) List Booked Planned Em 2,209 1,987 1,441 4,080 9,717 42 1,085 2,268 1,902 1,320 3,818 9,309 41 1,04 Waiting as % of included Waiting as % of included TOTAL ADMISSIONS, BY METHOD OF ADMISSION AND STRATEGIC HEALTH AUTHORITY ordshire HA 64 68 67 122 322 38 34 66 61 63 117 308 38 32 V olk and Cambridgeshire HA 106 92 65 171 434 39 40 102 86 67 159 414 38 38 V Hospital Episode Statistics Worcestershire HA 54 58 43 112 267 42 33 71 48 38 108 265 41 33 Rutland HA 73 55 46 123 298 41 55 68 56 43 118 285 41 50 Lincolnshire HA 99 86 24 147 356 41 33 97 88 21 141 347 41 31 Q28 Coventry, Warwickshire, Herefordshire & Q27 Birmingham and The Black Country HA 81 115 59 208 463 45 59 105 94 48 196 442 Q26 Shropshire and Sta Q25 Leicestershire, Northamptonshire and Q24 Trent HA 121 100 104 229 553 41 48 126 93 98 229 546 42 48 Q23 South Yorkshire HA 61 50 66 126 302 42 28 63 54 58 125 301 41 28 Q22 Dorset and Somerset HA 50 49 69 100 267 38 25 48 56 66 97 267 36 24 Q21 South West Peninsula HA 104 37 71 146 359 41 27 102 40 66 135 343 39 25 Q20 Avon, Gloucestershire and Wiltshire HA 107 63 79 160 410 39 48 103 64 73 14 Q19 Surrey and Sussex HA 115 105 62 187 468 40 40 99 113 54 168 433 39 37 Q18 Kent and Medway HA 81 37 27 121 267 46 27 76 42 29 116 262 44 27 Q17 Hampshire and Isle of Wight HA 91 47 48 141 326 43 29 90 52 42 133 317 42 28 Q16 Thames Valley HA 62 75 45 136 318 43 53 61 74 39 121 295 41 50 Q15 Cheshire & Merseyside HA 115 89 49 240 494 49 54 128 83 46 218 475 46 53 Q14 Greater Manchester HA 138 105 92 237 571 41 62 139 98 68 218 522 42 59 Q13 Cumbria and Lancashire HA 116 71 58 179 425 42 46 125 66 56 173 419 41 46 Q12 West Yorkshire HA 112 97 31 199 440 45 51 118 92 33 188 432 44 49 Q11 North and East Yorkshire and Northern Q10 County Durham and Tees Valley HA 58 37 44 120 259 46 27 63 35 43 113 254 45 25 Q09 Northumberland, Tyne & Wear HA 63 107 34 145 349 42 29 74 89 36 136 336 41 30 Q08 South West London HA 33 55 29 81 198 41 31 32 55 26 75 188 40 30 Q07 South East London HA 49 77 28 108 262 41 37 52 70 25 100 247 40 39 Q06 North East London HA 37 63 50 117 267 44 35 46 52 46 107 251 43 34 Q05 North Central London HA 32 45 33 83 193 43 29 33 44 29 75 181 41 28 Q04 North West London HA 42 87 44 114 287 40 36 41 89 37 97 264 37 34 Q03 Essex HA 72 57 44 117 290 40 34 79 44 37 104 265 39 30 Q02 Bedfordshire and Hertfordshire HA 72 61 29 111 274 41 34 61 65 32 105 263 40 Q01 Norfolk, Su 2. Finished in-year admissions by SHA of residence. England figures exclud England Source: Notes: 1. All calculations are based on data which are unadjusted for shortfalls. 3178271088 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 185
Table 3.8.1(d) EPISODES/SPELLS RATIOS, GENERAL & ACUTE PATIENTS, BY STRATEGIC HEALTH AUTHORITY, NHS HOSPITALS, ENGLAND, 2002–03 AND 2003–04
2002–03 2003–04 Q01 Norfolk, SuVolk and Cambridgeshire HA 1.215 1.243 Q02 Bedfordshire and Hertfordshire HA 1.107 1.116 Q03 Essex HA 1.126 1.130 Q04 North West London HA 1.133 1.114 Q05 North Central London HA 1.104 1.122 Q06 North East London HA 1.118 1.141 Q07 South East London HA 1.097 1.119 Q08 South West London HA 1.103 1.119 Q09 Northumberland, Tyne & Wear HA 1.099 1.111 Q10 County Durham and Tees Valley HA 1.128 1.125 Q11 North and East Yorkshire and Northern Lincolnshire HA 1.105 1.124 Q12 West Yorkshire HA 1.124 1.129 Q13 Cumbria and Lancashire HA 1.120 1.140 Q14 Greater Manchester HA 1.158 1.156 Q15 Cheshire & Merseyside HA 1.196 1.207 Q16 Thames Valley HA 1.095 1.104 Q17 Hampshire and Isle of Wight HA 1.168 1.188 Q18 Kent and Medway HA 1.104 1.117 Q19 Surrey and Sussex HA 1.073 1.082 Q20 Avon, Gloucestershire and Wiltshire HA 1.150 1.165 Q21 South West Peninsula HA 1.175 1.190 Q22 Dorset and Somerset HA 1.144 1.158 Q23 South Yorkshire HA 1.122 1.135 Q24 Trent HA 1.162 1.164 Q25 Leicestershire, Northamptonshire and Rutland HA 1.120 1.130 Q26 Shropshire and StaVordshire HA 1.091 1.091 Q27 Birmingham and The Black Country HA 1.158 1.142 Q28 Coventry, Warwickshire, Herefordshire & Worcestershire HA 1.119 1.128
England 1.134 1.143
Source: Hospital Episode Statistics Notes: 1. All calculations are based on data which are unadjusted for shortfalls. 2. SHA of residence. England figures exclude non-England residents and those with address unknown. 3178271088 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 186 Health Committee: Evidence 258) 2 (1.255) Position (ratio) .360 1 (1.330) .281 5 (1.284) 7 1.316 2 (1.306) 33,184 1.251 15 (1.238) 8,982 38,507 1.272 14 (1.239) MORE THAN 10,000 FCEs—GENERAL & ACUTE HA 73,193 58,027 1.261 8 (1.264) HA 102,692 82,032 1.252 28 (1.205) HA 46,741 36,585 1.278 9 (1.264) of Wight HA 38,702 30,043 1.288 13 (1.255) olk & Cambridgeshire HA 61,569 46,797 1.316 11 (1.256) olk & Cambridgeshire HA 72,513 57,990 1.250 25 (1.210) olk & Cambridgeshire HA 140,517 105,469 1.332 4 (1.287) V V V e & Merseyside HA 78,797 60,821 1.296 3 (1.294) Table 3.8.1(e) Strategic Health Authority FCEs Spells Ratio in 2002–03 olk Hospitals NHSTrust Q01 Norfolk, Su V (2) Hospital Episode Statistics THE 15 PROVIDER UNITS WITH THE HIGHEST FCEs/SPELLS RATIO 2003–04, AND WITH 15 RGQ Ipswich Hospital NHSTrust Q01 Norfolk, Su 14 RD8 Milton Keynes General Hospital NHSTrust Q16 Thames Valley HA 41,516 13 RH8 Royal Devon and Exeter Healthcare NHSTrust Q21 SouthWest Peninsula 12 RCSNottingham City Hospital NHSTrust Q24 Trent HA 80,563 63,995 1.259 1 11 RBN St Helens and Knowsley Hospitals NHS Trust Q15 Cheshire & Merseyside 10 RJ5 St Mary’s NHS Trust Q04 North West London HA 51,960 40,937 1.269 10 (1. 9 RFF Barnsley District General Hospital NHSTrust Q23 SouthYorkshire HA 4 8 RMP Tameside and Glossop Acute Services NHS Trust Q14 Greater Manchester 7 RBL Wirral Hospital NHSTrust Q15 Cheshire & Merseyside HA 88,133 68,774 1 6 RN1 Winchester and Eastleigh Healthcare NHSTrust Q17 Hampshire and Isle 5 RQ6 Royal Liverpool & Broadgreen Hospitals University Trust Q15 Cheshir 4 RGR West Su 3 REM Aintree Hospitals NHSTrust Q15 Cheshire & Merseyside HA 86,745 65,91 2 RM1 Norfolk and Norwich University Hospital NHSTrust Q01 Norfolk, Su 2. Provider of treatment. 1 RN7 Dartford and Gravesham NHSTrust Q18 KentSource: and Medway HA 39,849 29,305 1 Notes: 1. All calculations are based on data which are unadjusted for shortfalls. Position Provider 3178271090 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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3.8.2 Could the Department update the information given in Tables 3.9.2 in relation to the average daily number of available and occupied beds and throughput? [3.9.2] Answer 1. The information requested is given in Table 3.8.2.
Table 3.8.2 AVERAGE DAILY NUMBER OF AVAILABLE AND OCCUPIED BEDSAND THROUGHPUT BY SECTOR, ENGLAND, 1987–88 to 2003–04
All specialties General Mental Learning Year (exc day only) and acute Acute Geriatric illness disability Maternity Day only
Number of available beds 1990–91 255,479 162,691 116,788 45,902 55,239 23,379 14,170 3,068 1996–97 198,848 140,515 108,869 31,646 37,640 9,693 11,000 6,766 1997–98 193,625 138,047 107,807 30,240 36,601 8,197 10,781 7,125 1998–99 190,006 136,426 107,729 28,697 35,692 7,491 10,398 7,568 1999–2000 186,290 135,080 107,218 27,862 34,173 6,834 10,203 7,938 2000–01 186,091 135,794 107,956 27,838 34,214 6,316 9,767 8,155 2001–02 184,871 136,583 108,535 28,047 32,783 5,694 9,812 8,036 2002–03 183,826 136,679 108,706 27,973 32,753 5,038 9,356 8,544 2003–04 184,207 137,277 109,846 27,431 32,410 5,212 9,309 8,813 Average annual change "1.1% "0.3% 0.1% "2.0% "2.1% "8.5% "2.4% 3.8% Number of occupied beds 1997–98 156,549 111,112 85,038 26,074 31,647 7,221 6,568 n/a 1998–99 156,669 112,486 86,991 25,495 31,219 6,447 6,517 n/a 1999–2000 154,137 112,279 87,409 24,869 29,775 5,834 6,248 n/a 2000–01 156,290 114,982 89,730 25,252 29,918 5,504 5,886 n/a 2001–02 157,330 117,437 91,676 25,761 29,045 4,942 5,907 n/a 2002–03 156,933 118,278 92,712 25,565 28,654 4,315 5,686 n/a 2003–04 157,984 119,312 94,009 25,304 28,391 4,385 5,896 n/a Average annual change 0.2% 1.2% 1.7% –0.5% –1.8% –8.0% –1.8% Occupancy rate 1997–98 80.9% 80.5% 78.9% 86.2% 86.5% 88.1% 60.9% n/a 1998–99 82.5% 82.5% 80.8% 88.8% 87.5% 86.1% 62.7% n/a 1999–2000 82.7% 83.1% 81.5% 89.3% 87.1% 85.4% 61.2% n/a 2000–01 84.0% 84.7% 83.1% 90.7% 87.4% 87.1% 60.3% n/a 2001–02 85.1% 86.0% 84.5% 91.8% 88.6% 86.8% 60.2% n/a 2002–03 85.4% 86.5% 85.3% 91.4% 87.5% 85.6% 60.8% n/a 2003–04 85.8% 86.9% 85.6% 92.2% 87.6% 84.1% 63.3% n/a Throughput 1997–98 32 43 55 12 4 2 55 n/a 1998–99 41 50 60 17 6 5 75 n/a 1999–2000 43 52 61 18 6 5 78 n/a 2000–01 44 53 62 18 6 5 82 n/a 2001–02 45 54 63 19 6 6 81 n/a 2002–03 47 56 65 20 6 6 89 n/a 2003–04 50 58 67 21 6 6 100 n/a
Source: KH03, HES. Notes: 1. Number of finished consultant episodes for ordinary admissions per available bed. Figures exclude well babies. 2. General and acute is defined as acute plus geriatric (excluding well babies).
3.8.3 Could the Department provide figures for the number of delayed discharges of patients from acute settings in each of the four most recent quarters, broken down by region, reason for delay, age of patient and length of stay? Could these figures show absolute numbers and rates? [3.9.3] Answer 1. The information requested is given in Tables 3.8.3(a) and (b). 2. There has been a small reduction in the number of delayed discharges of patients occupying an acute hospital bed over the last 4 quarters: from 2,595 at Q1 to 2,521 at Q4, and a reduction in the rate from 2.5% to 2.4%. These reductions are smaller than those seen in 2003–04 as the reimbursement scheme, which was introduced in January 2004, has bedded in. 3178271092 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 188 Health Committee: Evidence ty occupied 9% 1.0% not .0% 2.7% 1.8% 2.3% 0.0% 2.9% covered Delayed patients Housing— % 0.0% 3.1% % 0.0% 0.8% utes Care Act bed) 0.0% 0.0% 2.6% % 19.0% 0.0% 0.9% 6% 2.5% 1.3% 5.1% 4% 0.0% 0.9% 2.2% 1.1% 2.2% 2.2% 1.4% 7.9% 10.3% 4.4% 2.0% 14.2% 1.9% 0.9% 3.0% % 12.3% 1.4% 0.0% 2.5% % 5.6% 0.0% 0.0% 5.5% % 12.8% 4.3% 0.0% 1.3% % 10.1% 3.4% 2.2% 1.4% % 9.6% 1.3% 1.3% 2.6% 2% 23.4% 2.6% 1.3% 2.9% 5% 11.6% 2.3% 0.0% 2.4% 9% 49.1% 0.0% 0.0% 1.6% .8% 17.7% 0.0% 2.5% 2.9% .0% 13.5% 0.0% 2.1% 3.1% .8% 5.5% 1.2% 1.2% 3.3% 1.0% 8.3% 3.1% 1.4% 6.1% 5.0% 21.7% 0.0% 0.0% 1.5% % 9.3% 22.7% 0.0% 4.0% 2.2% 1% 4.6% 38.2% 2.3% 0.0% 2.0% .6% 3.2% 16.1% 2.2% 1.1% 2.5% Percentage delays by reason Care Home Care Home Care Patient by NHS Discharge etion Further placement— placement— package Community or and Rate (per y of Public non acute Residential Nursing in own Equipment/ family Communi not Act Total assessment Funding NHS care Home Home home adaptions choice Disp covered patients Housing— Q1 2004–05 Table 3.8.3(a) DELAYED TRANSFERS OF PATIENTS OF ALL AGES Delays by reason Care Home Care Home Care Patient by NHS of Public non acute Residential Nursing in own Equipment/ family Communit assessment Funding NHS care Home Home home adaptions choice Disputes Care Completion Further placement— placement— package Community or and Compl olk V ordshire 23 3 29 2 2 3 2 13 2 0 79 29.1% 3.8% 36.7% 2.5% 2.5% 3.8% 2.5% 16.5% 2.5% 0 V Sitreps (trust based) Sta Tyne & Wear 3 0 11 0 2 2 3 13 0 1 35 8.6% 0.0% 31.4% 0.0% 5.7% 5.7% 8.6% 37.1% 0.0% 2. & Northern Lincolnshire 8 0 5 10 2 1 1 26 0 0 53 15.1% 0.0% 9.4% 18.9% 3.8% 1.9% 1. & Cambridgeshire 17 3 43 23 35 28 3 9 2 2 165 10.3% 1.8% 26.1% 13.9% 21.2% 17.0% 1 Northamptonshire & Rutland 24 1 18 3 8 3 4 11 1 0 73 32.9% 1.4% 24.7% 4.1% 11.0% 4.1% 5.5% 15.1% 1.4% Isle of Wight 56 5 27 15 26 3 5 17 4 2 160 35.0% 3.1% 16.9% 9.4% 16.3% 1.9% 3.1% 10. & Tees Valley 4 0 4 1 1 4 3 3 0 0 20 20.0% 0.0% 20.0% 5.0% 5.0% 20.0% 15.0% 15.0% 0.0 Black Country 22 6 29 17 27 31 5 15 2 2 156 14.1% 3.8% 18.6% 10.9% 17.3% 19.9% 3.2 Hertfordshire 6 2 23 4 9 1 3 10 0 0 58 10.3% 3.4% 39.7% 6.9% 15.5% 1.7% 5.2% 17.2% Gloucestershire & Wiltshire 16 0 31 10 19 17 3 15 0 1 112 14.3% 0.0% 27.7% 8.9% 17.0% 15.2% 2.7% 13. England 526 125 610 213 366 170 82 418 56 29 2,595 20.3% 4.8% 23.5% 8.2% 14.1% 6 Q12 West Yorkshire 5 2 9 3 7 0 0 8 8 0 42 11.9% 4.8% 21.4% 7.1% 16.7% 0.0% 0.0% 19.0 Q28 West Midlands South 24 2 15 7 8 4 3 14 0 2 79 30.4% 2.5% 19.0% 8.9% 10.1% 5.1% 3 Q24 Trent 29 0 27 4 4 6 4 29 5 2 110 26.4% 0.0% 24.5% 3.6% 3.6% 5.5% 3.6% 26.4% 4.5% Q16 Thames Valley 13 4 23 7 30 9 2 15 2 1 106 12.3% 3.8% 21.7% 6.6% 28.3% 8.5% 1.9% Q19 Surrey & Sussex 67 58 40 22 56 7 3 24 9 4 290 23.1% 20.0% 13.8% 7.6% 19.3% 2.4% Q23 South Yorkshire 21 0 1 5 1 10 0 5 1 1 45 46.7% 0.0% 2.2% 11.1% 2.2% 22.2% 0.0% 1 Q21 South West Peninsula 21 1 52 0 3 3 1 13 0 2 96 21.9% 1.0% 54.2% 0.0% 3.1% 3.1% 1 Q08 South West London 14 12 7 7 11 1 4 18 2 1 77 18.2% 15.6% 9.1% 9.1% 14.3% 1.3% 5. Q07 South East London 5 0 7 10 17 0 0 6 2 0 47 10.6% 0.0% 14.9% 21.3% 36.2% 0.0% 0.0 Q26 Shropshire & Q09 Northumberland, Q04 North West London 13 3 25 8 20 2 3 10 2 0 86 15.1% 3.5% 29.1% 9.3% 23.3% 2.3% 3. Q06 North East London 15 1 8 4 3 5 3 19 7 3 68 22.1% 1.5% 11.8% 5.9% 4.4% 7.4% 4.4% 2 Q05 North Central London 3 0 18 10 13 4 7 17 0 3 75 4.0% 0.0% 24.0% 13.3% 17.3% 5.3 Q11 North & East Yorkshire Q01 Norfolk, Su Q25 Leicestershire, Q18 Kent and Medway 20 2 12 11 16 1 1 9 1 0 73 27.4% 2.7% 16.4% 15.1% 21.9% 1.4% 1.4 Q17 Hampshire & the Q14 Greater Manchester 16 6 37 1 4 7 4 9 3 2 89 18.0% 6.7% 41.6% 1.1% 4.5% 7.9% 4.5 Q03 Essex 24 7 10 11 3 4 6 20 0 0 85 28.2% 8.2% 11.8% 12.9% 3.5% 4.7% 7.1% 23.5% 0.0 Q22 Dorset & Somerset 24 0 78 4 10 2 0 7 0 0 125 19.2% 0.0% 62.4% 3.2% 8.0% 1.6% 0.0 Q13 Cumbria & Lancashire 4 4 10 9 13 4 3 13 0 0 60 6.7% 6.7% 16.7% 15.0% 21.7% 6.7% Q10 County Durham Q15 Cheshire & Merseyside 29 3 11 5 16 8 6 50 3 0 131 22.1% 2.3% 8.4% 3.8% 12.2% 6. Q27 Birmingham & the Q02 Bedfordshire & Q20 Avon, Source: 3178271092 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 189 ty occupied not .0% 3.1% .0% 3.5% .0% 1.3% .0% 2.1% 0.0% 1.0% covered Delayed patients Housing— 7% 1.7% 1.6% .6% 3.1% 2.7% utes Care Act bed) % 1.4% 0.0% 3.2% % 4.0% 3.2% 2.6% 7% 0.5% 2.7% 6.3% .5% 7.8% 0.0% 1.1% .9% 7.4% 1.9% 1.7% 5.1% 0.0% 2.2% 2.8% 5.0% 2.5% 2.5% 1.1% 4.1% 0.0% 3.6% 3.3% 20.7% 2.4% 2.4% 2.9% 17.7% 1.6% 3.2% 1.8% 3% 11.3% 0.0% 1.3% 2.5% 0% 39.0% 0.0% 0.0% 1.3% .5% 12.7% 0.0% 0.6% 3.6% 0.0% 22.0% 2.2% 2.2% 3.5% 2.6% 18.8% 1.7% 1.7% 3.2% 3.8% 26.6% 0.0% 1.3% 2.3% 4.2% 28.4% 3.2% 3.2% 1.6% 1.8% 7.3% 0.0% 0.0% 5.0% % 2.1% 11.1% 8.9% 1.7% 5.1% 6% 3.3% 12.1% 0.0% 0.0% 3.3% 3% 3.0% 17.9% 2.2% 1.7% 2.7% 9.4% 2.9% 40.0% 0.0% 1.8% 2.7% Percentage delays by reason Care Home Care Home Care Patient by NHS Discharge etion Further placement— placement— package Community or and Rate (per y of Public non acute Residential Nursing in own Equipment/ family Communi (continued) not Act Total assessment Funding NHS care Home Home home adaptions choice Disp covered patients Housing— Q2 2004–05 Table 3.8.3(a) DELAYED TRANSFERS OF PATIENTS OF ALL AGES Delays by reason Care Home Care Home Care Patient by NHS of Public non acute Residential Nursing in own Equipment/ family Communit assessment Funding NHS care Home Home home adaptions choice Disputes Care Completion Further placement— placement— package Community or and Compl olk V ordshire 42 0 22 6 7 5 2 14 0 0 98 42.9% 0.0% 22.4% 6.1% 7.1% 5.1% 2.0% 14.3% 0.0% 0 V Sitreps (trust based) Sta Tyne & Wear 1 0 13 1 3 6 1 20 2 0 47 2.1% 0.0% 27.7% 2.1% 6.4% 12.8% 2.1% 42.6% 4.3% 0 & Northern Lincolnshire 5 0 8 6 4 2 0 16 0 0 41 12.2% 0.0% 19.5% 14.6% 9.8% 4.9% 0. & Cambridgeshire 37 3 17 23 32 32 6 22 0 1 173 21.4% 1.7% 9.8% 13.3% 18.5% 18.5% 3 Northamptonshire & Rutland 2 3 15 2 12 2 1 19 0 0 56 3.6% 5.4% 26.8% 3.6% 21.4% 3.6% 1.8% 33.9% 0.0% 0 Isle of Wight 63 5 36 11 34 7 5 20 1 5 187 33.7% 2.7% 19.3% 5.9% 18.2% 3.7% 2.7% 10. Lancashire 5 0 12 12 19 1 1 8 1 1 60 8.3% 0.0% 20.0% 20.0% 31.7% 1.7% 1.7% 13.3% 1. & Tees Valley 8 1 8 0 4 0 3 2 0 0 26 30.8% 3.8% 30.8% 0.0% 15.4% 0.0% 11.5% 7.7% 0.0% Black Country 14 13 45 25 30 45 7 8 0 7 194 7.2% 6.7% 23.2% 12.9% 15.5% 23.2% 3.6% Hertfordshire 3 1 23 8 13 6 5 10 1 0 70 4.3% 1.4% 32.9% 11.4% 18.6% 8.6% 7.1% 14.3 Gloucestershire & Wiltshire 17 2 33 14 25 11 2 12 5 4 125 13.6% 1.6% 26.4% 11.2% 20.0% 8.8% 1.6% 9.6 England 526 99 592 227 391 227 81 491 61 46 2,741 19.2% 3.6% 21.6% 8.3% 14.3% 8. Q12 West Yorkshire 6 0 10 3 8 5 1 14 4 0 51 11.8% 0.0% 19.6% 5.9% 15.7% 9.8% 2.0% 27 Q28 West Midlands South 23 2 16 12 18 6 3 11 0 0 91 25.3% 2.2% 17.6% 13.2% 19.8% 6. Q24 Trent 34 0 33 8 4 14 2 22 10 4 131 26.0% 0.0% 25.2% 6.1% 3.1% 10.7% 1.5% 16.8% 7 Q16 Thames Valley 17 4 25 8 15 4 4 14 0 2 93 18.3% 4.3% 26.9% 8.6% 16.1% 4.3% 4.3% 1 Q19 Surrey & Sussex 47 41 28 17 37 9 5 26 21 4 235 20.0% 17.4% 11.9% 7.2% 15.7% 3.8 Q23 South Yorkshire 21 2 3 0 0 9 0 14 4 1 54 38.9% 3.7% 5.6% 0.0% 0.0% 16.7% 0.0% 25 Q21 South West Peninsula 16 0 47 2 2 2 1 9 0 1 80 20.0% 0.0% 58.8% 2.5% 2.5% 2.5% 1. Q08 South West London 17 10 20 8 11 1 0 20 2 2 91 18.7% 11.0% 22.0% 8.8% 12.1% 1.1% Q07 South East London 5 1 4 1 7 0 2 18 1 1 40 12.5% 2.5% 10.0% 2.5% 17.5% 0.0% 5.0% 4 Q26 Shropshire & Q09 Northumberland, Q04 North West London 21 3 28 11 21 4 3 22 2 2 117 17.9% 2.6% 23.9% 9.4% 17.9% 3.4% Q06 North East London 23 1 13 4 6 0 1 11 1 2 62 37.1% 1.6% 21.0% 6.5% 9.7% 0.0% 1.6% Q05 North Central London 5 0 21 9 14 5 3 21 0 1 79 6.3% 0.0% 26.6% 11.4% 17.7% 6.3% Q11 North & East Yorkshire Q01 Norfolk, Su Q25 Leicestershire, Q18 Kent and Medway 20 1 5 10 14 6 5 17 2 2 82 24.4% 1.2% 6.1% 12.2% 17.1% 7.3% 6.1% Q17 Hampshire & the Q14 Greater Manchester 10 1 23 6 8 10 4 27 3 3 95 10.5% 1.1% 24.2% 6.3% 8.4% 10.5% Q03 Essex 25 4 15 1 4 8 7 18 1 0 83 30.1% 4.8% 18.1% 1.2% 4.8% 9.6% 8.4% 21.7% 1.2% 0 Q22 Dorset & Somerset 14 0 58 3 14 11 2 8 0 0 110 12.7% 0.0% 52.7% 2.7% 12.7% 10.0% Q13 Cumbria & Q10 County Durham Q15 Cheshire & Merseyside 25 1 11 16 25 16 5 68 0 3 170 14.7% 0.6% 6.5% 9.4% 14.7% Q27 Birmingham & the Q02 Bedfordshire & Q20 Avon, Source: 3178271092 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 190 Health Committee: Evidence ty occupied not .0% 0.9% .0% 2.3% 0.0% 2.2% 5.6% 3.6% 0.0% 1.7% covered Delayed patients Housing— % 0.0% 3.9% utes Care Act bed) 0% 12.0% 0.0% 1.0% 4% 1.5% 2.2% 6.1% 3% 0.0% 4.9% 2.8% .4% 2.2% 0.0% 1.3% .0% 2.0% 1.0% 2.0% 3.3% 3.5% 0.0% 1.7% 7.5% 0.0% 0.0% 1.7% 23.9% 5.6% 1.4% 2.7% % 14.0% 0.0% 0.9% 3.2% % 19.8% 0.0% 0.0% 2.9% % 7.7% 6.2% 0.0% 1.9% 5% 14.0% 0.0% 0.0% 2.0% .2% 41.9% 1.1% 0.0% 2.8% .0% 10.1% 0.7% 0.7% 6.1% .4% 7.8% 7.8% 5.0% 3.0% 2.1% 13.5% 0.0% 2.1% 2.7% 4.3% 14.3% 0.0% 0.6% 3.2% 0.0% 25.9% 5.6% 3.7% 1.4% % 1.4% 11.6% 14.5% 1.0% 4.4% % 3.9% 24.7% 0.0% 2.6% 2.2% 2% 3.3% 23.9% 2.2% 1.1% 1.5% .9% 2.0% 49.3% 2.0% 2.0% 2.4% .5% 3.2% 19.3% 3.2% 1.5% 2.5% Percentage delays by reason Care Home Care Home Care Patient by NHS Discharge etion Further placement— placement— package Community or and Rate (per (continued) y of Public non acute Residential Nursing in own Equipment/ family Communi not Act Total assessment Funding NHS care Home Home home adaptions choice Disp covered patients Housing— Q3 2004–05 Table 3.8.3(a) DELAYED TRANSFERS OF PATIENTS OF ALL AGES Delays by reason Care Home Care Home Care Patient by NHS of Public non acute Residential Nursing in own Equipment/ family Communit assessment Funding NHS care Home Home home adaptions choice Disputes Care Completion Further placement— placement— package Community or and Compl olk V ordshire 37 1 22 3 3 6 3 22 4 6 107 34.6% 0.9% 20.6% 2.8% 2.8% 5.6% 2.8% 20.6% 3.7% V Sitreps (trust based) Sta Tyne & Wear 6 0 8 0 4 3 0 14 1 0 36 16.7% 0.0% 22.2% 0.0% 11.1% 8.3% 0.0% 38.9% 2.8% 0 & Northern Lincolnshire 13 0 18 7 7 6 2 39 1 0 93 14.0% 0.0% 19.4% 7.5% 7.5% 6.5% 2 & Cambridgeshire 18 1 35 23 30 23 7 23 0 1 161 11.2% 0.6% 21.7% 14.3% 18.6% 14.3% Northamptonshire & Rutland 24 4 6 1 11 0 5 14 0 0 65 36.9% 6.2% 9.2% 1.5% 16.9% 0.0% 7.7% 21.5% 0.0% 0 Isle of Wight 18 5 36 7 28 11 1 25 2 3 136 13.2% 3.7% 26.5% 5.1% 20.6% 8.1% 0.7% 18. & Tees Valley 6 0 25 2 1 1 5 4 0 0 44 13.6% 0.0% 56.8% 4.5% 2.3% 2.3% 11.4% 9.1% 0.0% Black Country 31 17 19 20 26 23 6 14 14 9 179 17.3% 9.5% 10.6% 11.2% 14.5% 12.8% 3 Hertfordshire 10 1 16 6 10 2 0 13 0 3 61 16.4% 1.6% 26.2% 9.8% 16.4% 3.3% 0.0% 21. Gloucestershire & Wiltshire 12 1 23 14 10 19 2 16 2 1 100 12.0% 1.0% 23.0% 14.0% 10.0% 19.0% 2.0% 16 England 448 136 572 227 313 195 82 501 84 38 2,596 17.3% 5.2% 22.0% 8.7% 12.1% 7 Q12 West Yorkshire 3 4 7 0 3 6 7 14 6 0 50 6.0% 8.0% 14.0% 0.0% 6.0% 12.0% 14.0% 28. Q28 West Midlands South 18 0 9 5 9 6 2 8 0 0 57 31.6% 0.0% 15.8% 8.8% 15.8% 10.5% 3. Q24 Trent 21 1 48 3 8 6 3 18 4 0 112 18.8% 0.9% 42.9% 2.7% 7.1% 5.4% 2.7% 16.1% 3.6% Q16 Thames Valley 10 6 19 15 34 3 4 15 0 1 107 9.3% 5.6% 17.8% 14.0% 31.8% 2.8% 3.7 Q19 Surrey & Sussex 32 57 17 10 22 10 3 24 30 2 207 15.5% 27.5% 8.2% 4.8% 10.6% 4.8 Q23 South Yorkshire 11 14 2 0 3 5 1 19 2 0 57 19.3% 24.6% 3.5% 0.0% 5.3% 8.8% 1.8% 3 Q21 South West Peninsula 3 0 45 0 0 1 0 4 0 0 53 5.7% 0.0% 84.9% 0.0% 0.0% 1.9% 0.0% Q08 South West London 9 8 20 5 6 0 1 17 4 1 71 12.7% 11.3% 28.2% 7.0% 8.5% 0.0% 1.4% Q07 South East London 3 0 3 22 8 0 1 8 1 0 46 6.5% 0.0% 6.5% 47.8% 17.4% 0.0% 2.2% 17 Q26 Shropshire & Q09 Northumberland, Q04 North West London 20 5 29 10 11 4 2 13 0 2 96 20.8% 5.2% 30.2% 10.4% 11.5% 4.2% Q06 North East London 19 0 16 7 3 2 9 5 4 0 65 29.2% 0.0% 24.6% 10.8% 4.6% 3.1% 13.8 Q05 North Central London 6 0 14 16 17 0 3 19 0 2 77 7.8% 0.0% 18.2% 20.8% 22.1% 0.0 Q11 North & East Yorkshire Q01 Norfolk, Su Q25 Leicestershire, Q18 Kent and Medway 18 5 9 12 17 4 0 16 0 0 81 22.2% 6.2% 11.1% 14.8% 21.0% 4.9% 0.0 Q17 Hampshire & the Q14 Greater Manchester 12 1 22 5 10 14 3 22 2 1 92 13.0% 1.1% 23.9% 5.4% 10.9% 15. Q03 Essex 32 2 19 9 3 13 9 12 0 0 99 32.3% 2.0% 19.2% 9.1% 3.0% 13.1% 9.1% 12.1% 0.0 Q22 Dorset & Somerset 28 1 62 12 9 10 0 14 1 1 138 20.3% 0.7% 44.9% 8.7% 6.5% 7.2% 0 Q13 Cumbria & Lancashire 11 2 10 1 9 2 0 14 3 2 54 20.4% 3.7% 18.5% 1.9% 16.7% 3.7% Q10 County Durham Q15 Cheshire & Merseyside 17 0 13 12 11 15 3 75 3 3 152 11.2% 0.0% 8.6% 7.9% 7.2% 9 Q27 Birmingham & the Q02 Bedfordshire & Q20 Avon, Source: 3178271092 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 191 ty occupied 0% 4.1% not .0% 3.1% .0% 3.2% .0% 0.6% 0.8% 2.4% 0.0% 1.0% covered Delayed patients Housing— utes Care Act bed) 0.7% 3.3% 5.0% 0.0% 0.0% 2.3% 0.0% 1.0% 1.9% 4.3% 18.2% 0.0% 1.6% 2.6% 0.0% 1.9% 1.6% 9.1% 3.6% 3.6% 1.6% 5.9% 0.0% 0.0% 4.4% 11.9% 4.0% 1.0% 2.9% % 6.5% 0.0% 0.0% 1.5% % 6.4% 0.0% 4.3% 1.3% 2% 41.3% 8.7% 2.2% 1.3% 0% 24.7% 2.5% 0.0% 1.3% 9% 7.7% 0.6% 3.9% 2.6% .8% 11.3% 0.9% 1.9% 3.5% .0% 17.3% 2.7% 0.0% 2.5% 2.1% 13.8% 1.1% 5.3% 3.3% 2.7% 18.2% 0.9% 3.6% 3.1% 3.7% 25.9% 0.0% 3.7% 1.6% 1.9% 8.8% 0.0% 1.9% 3.1% 4.6% 23.1% 0.0% 1.5% 1.6% % 1.5% 14.6% 11.1% 1.5% 4.2% .7% 2.5% 15.1% 2.3% 1.7% 2.4% 13.9% 4.3% 34.8% 0.0% 1.7% 1.8% Percentage delays by reason Care Home Care Home Care Patient by NHS Discharge etion Further placement— placement— package Community or and Rate (per (continued) y of Public non acute Residential Nursing in own Equipment/ family Communi not Act Total assessment Funding NHS care Home Home home adaptions choice Disp covered patients Housing— Q4 2004–05 Table 3.8.3(a) DELAYED TRANSFERS OF PATIENTS OF ALL AGES Delays by reason Care Home Care Home Care Patient by NHS of Public non acute Residential Nursing in own Equipment/ family Communit assessment Funding NHS care Home Home home adaptions choice Disputes Care Completion Further placement— placement— package Community or and Compl olk V ordshire 38 0 29 0 6 2 3 19 0 2 99 38.4% 0.0% 29.3% 0.0% 6.1% 2.0% 3.0% 19.2% 0.0% 2 V Sitreps (trust based) Sta Tyne & Wear 3 0 5 0 4 11 2 14 0 0 39 7.7% 0.0% 12.8% 0.0% 10.3% 28.2% 5.1% 35.9% 0.0% & Northern Lincolnshire 7 0 5 4 5 0 1 19 4 1 46 15.2% 0.0% 10.9% 8.7% 10.9% 0.0% 2. & Cambridgeshire 27 6 38 23 19 26 3 14 0 3 159 17.0% 3.8% 23.9% 14.5% 11.9% 16.4% Northamptonshire & Rutland 29 7 50 6 4 7 6 7 0 0 116 25.0% 6.0% 43.1% 5.2% 3.4% 6.0% 5.2% 6.0% 0.0% 0. Isle of Wight 47 4 43 10 25 9 2 7 1 5 153 30.7% 2.6% 28.1% 6.5% 16.3% 5.9% 1.3% 4.6% & Tees Valley 3 0 12 0 0 0 1 0 0 0 16 18.8% 0.0% 75.0% 0.0% 0.0% 0.0% 6.3% 0.0% 0.0% 0 Black Country 26 17 23 14 24 29 3 12 1 6 155 16.8% 11.0% 14.8% 9.0% 15.5% 18.7% 1. Hertfordshire 3 2 8 11 7 3 0 19 0 0 53 5.7% 3.8% 15.1% 20.8% 13.2% 5.7% 0.0% 35.8% Gloucestershire & Wiltshire 19 8 20 11 13 16 1 9 0 1 98 19.4% 8.2% 20.4% 11.2% 13.3% 16.3% 1.0% 9.2% England 511 135 654 198 283 195 63 380 58 44 2,521 20.3% 5.4% 25.9% 7.9% 11.2% 7 Q12 West Yorkshire 14 3 13 6 7 6 3 11 14 0 77 18.2% 3.9% 16.9% 7.8% 9.1% 7.8% 3.9% 1 Q28 West Midlands South 26 1 13 2 8 7 3 13 2 0 75 34.7% 1.3% 17.3% 2.7% 10.7% 9.3% 4 Q24 Trent 21 3 60 4 5 7 2 18 3 1 124 16.9% 2.4% 48.4% 3.2% 4.0% 5.6% 1.6% 14.5% 2.4% Q16 Thames Valley 3 5 32 12 28 3 1 12 4 1 101 3.0% 5.0% 31.7% 11.9% 27.7% 3.0% 1.0% Q19 Surrey & Sussex 31 38 31 12 22 8 3 29 22 3 199 15.6% 19.1% 15.6% 6.0% 11.1% 4.0 Q23 South Yorkshire 16 1 17 0 0 5 1 12 0 1 53 30.2% 1.9% 32.1% 0.0% 0.0% 9.4% 1.9% 2 Q21 South West Peninsula 7 0 32 2 0 1 1 3 0 0 46 15.2% 0.0% 69.6% 4.3% 0.0% 2.2% 2.2 Q08 South West London 28 10 20 0 12 3 2 13 1 5 94 29.8% 10.6% 21.3% 0.0% 12.8% 3.2% Q07 South East London 1 0 13 14 12 1 1 3 0 2 47 2.1% 0.0% 27.7% 29.8% 25.5% 2.1% 2.1 Q26 Shropshire & Q09 Northumberland, Q04 North West London 24 10 24 8 14 2 3 20 1 4 110 21.8% 9.1% 21.8% 7.3% 12.7% 1.8% Q06 North East London 19 3 11 4 6 3 0 5 2 2 55 34.5% 5.5% 20.0% 7.3% 10.9% 5.5% 0.0% Q05 North Central London 1 1 12 10 9 3 2 14 0 2 54 1.9% 1.9% 22.2% 18.5% 16.7% 5.6% Q11 North & East Yorkshire Q01 Norfolk, Su Q25 Leicestershire, Q18 Kent and Medway 30 7 15 15 17 3 4 12 1 2 106 28.3% 6.6% 14.2% 14.2% 16.0% 2.8% 3 Q17 Hampshire & the Q14 Greater Manchester 13 0 27 5 6 8 0 20 2 0 81 16.0% 0.0% 33.3% 6.2% 7.4% 9.9% 0. Q03 Essex 32 4 9 9 4 5 7 14 0 0 84 38.1% 4.8% 10.7% 10.7% 4.8% 6.0% 8.3% 16.7% 0.0% 0 Q22 Dorset & Somerset 23 0 58 4 3 7 0 6 0 0 101 22.8% 0.0% 57.4% 4.0% 3.0% 6.9% 0.0% Q13 Cumbria & Lancashire 5 5 14 7 11 4 3 15 0 1 65 7.7% 7.7% 21.5% 10.8% 16.9% 6.2% Q10 County Durham Q15 Cheshire & Merseyside 15 0 20 5 12 16 5 40 0 2 115 13.0% 0.0% 17.4% 4.3% 10.4% Q27 Birmingham & the Q02 Bedfordshire & Q20 Avon, Source: 3178271092 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 192 Health Committee: Evidence 3% cy) 8 83.8% 85.1% 7 3,392 80.6% 82.1% Table 3.8.3(b) 9,339 6,343 7,886 5,445 84.4% 85.9% 4,755 3,494 4,182 3,064 88.0% 87.7% Total General and Acute Total General and Acute Total General and Acute 184,207 137,277 157,984 119,312 85.8% 86.9% (Available) (Available) (Occupied) (Occupied) (% Occupancy) (% Occupan STRATEGIC HEALTH AUTHORITIES ENGLAND, 2003–04 AVERAGE DAILY NUMBER OF AVAILABLE AND OCCUPIED BEDSBY SECTOR ordshire HA 4,923 3,743 4,287 3,336 87.1% 89.1% V olk and Cambridgeshire HA 8,503 6,522 7,289 5,666 85.7% 86.9% V England Department of Health form KH03 Q28 West Midlands HA 4,783 3,602 4,183 3,242 87.4% 90.0% Q27 Birmingham and the Black Country HA 9,205 7,056 8,144 6,402 88.5% 90.7% Q26 Shropshire and Sta Q25 Leicestershire, Northamptonshire & Rutland HA 5,371 3,662 4,503 3,11 Q24 Trent HA Q23 South Yorkshire HA 5,846 4,546 4,995 3,942 85.4% 86.7% Q22 Somerset & Dorset HA 4,785 3,661 4,075 3,156 85.2% 86.2% Q21 South West Peninsula HA 6,056 4,790 5,161 4,140 85.2% 86.4% Q20 Avon, Gloucestershire & Wiltshire HA 8,072 6,465 6,893 5,708 85.4% 88. Q19 Surrey and Sussex HA 8,909 6,508 7,791 5,704 87.5% 87.7% Q18 Kent and Medway HA 4,742 3,671 4,254 3,332 89.7% 90.8% Q17 Hampshire and Isle of Wight HA 5,777 4,426 4,963 3,908 85.9% 88.3% Q16 Thames Valley HA 6,129 4,708 5,286 4,144 86.2% 88.0% Q14Q15 Greater Manchester HA Cheshire & Merseyside HA 10,664 9,752 8,377 7,719 9,035 8,446 7,220 6,706 84.7% 86.6% 86.2% 86.9% Q13 Cumbria & Lancashire HA 7,519 5,505 6,289 4,641 83.6% 84.3% Q12 West Yorkshire HA 8,601 6,164 7,204 5,268 83.8% 85.5% Q11 North and East Yorkshire and Northern Lincolnshire HA 5,198 4,132 4,18 Q10 County Durham & Tees Valley HA 4,878 3,516 3,933 2,801 80.6% 79.7% Q09 Northumberland, Tyne and Wear HA 7,056 4,915 5,792 4,091 82.1% 83.2% Q08 South West London HA 4,790 3,421 4,129 3,029 86.2% 88.6% Q07 South East London HA 5,806 3,960 5,099 3,423 87.8% 86.4% Q06 North East London HA 6,050 4,380 5,410 3,934 89.4% 89.8% Q05 North Central London HA 5,821 4,315 5,141 3,825 88.3% 88.6% Q04 North West London HA 6,648 4,698 5,997 4,279 90.2% 91.1% Q03 Essex HA Q02 Bedfordshire and Hertfordshire HA 4,232 2,976 3,429 2,396 81.0% 80.5% Q01 Norfolk, Su OrgID Name Source: 3178271098 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 193
3.8.4 Could the Department please update the information provided last year in Tables 3.9.4 and Figures 3.9.4 on waiting lists/ time? [3.9.4] Answer 1. The information requested is given in Tables 3.8.4(a), 3.8.4(b) and Figure 3.8.4.
Table 3.8.4(a) INPATIENT WAITING LIST STATISTICS (ORDINARY ADMISSIONS AND DAY CASES) AT 31 MARCH 2005 (PROVIDER BASED): TIME ON WAITING LIST England by Strategic Health Authority Waiting Time (months) Total 0-2 3-5 6-8 9-11 12-14 15-17 18 months Strategic Health Authority Waiting months months months months months months plus Mean Median Norfolk, SuVolk and 45,534 30,100 11,689 3,742 0 1 0 0 2.6 2.0 Cambridgeshire Bedfordshire and Hertfordshire 23,171 15,213 6,395 1,563 0 0 0 0 2.5 2.0 Essex 26,895 18,821 7,396 678 0 0 0 0 2.3 1.9 North West London 27,136 17,728 8,481 927 0 0 0 0 2.5 2.1 North Central London 29,209 19,251 7,924 2,034 0 0 0 0 2.6 2.1 North East London 23,517 15,748 6,531 1,238 0 0 0 0 2.4 2.0 South East London 27,507 18,823 7,602 1,082 0 0 0 0 2.4 2.0 South West London 20,786 13,893 5,712 1,177 1 3 0 0 2.5 2.0 Northumberland,Tyneand21,62715,5735,31274200002.21.7 Wear County Durham & Tees Valley 15,866 10,624 4,351 891 0 0 0 0 2.5 2.0 North and East Yorkshire and 26,336 17,934 6,873 1,529 0 0 0 0 2.5 1.9 Northern Lincolnshire West Yorkshire 35,261 23,887 8,640 2,732 2 0 0 0 2.5 1.9 Cumbria & Lancashire 30,807 21,228 8,672 907 0 0 0 0 2.4 1.9 Greater Manchester 53,701 39,127 13,041 1,533 0 0 0 0 2.2 1.7 Cheshire & Merseyside 44,335 29,261 11,471 3,564 30 9 0 0 2.6 2.0 Thames Valley 26,748 19,909 6,477 362 0 0 0 0 2.1 1.7 Hampshire and Isle of Wight 29,943 18,849 8,737 2,357 0 0 0 0 2.7 2.2 Kent and Medway 23,974 14,766 7,785 1,422 0 1 0 0 2.7 2.3 Surrey and Sussex 42,309 27,490 12,655 2,161 3 0 0 0 2.6 2.2 Avon, Gloucestershire & 41,799 25,530 12,613 3,623 9 24 0 0 2.8 2.3 Wiltshire South West Peninsula 30,608 19,541 9,628 1,439 0 0 0 0 2.6 2.2 Somerset & Dorset 12,790 9,888 2,900 2 0 0 0 0 2.0 1.7 South Yorkshire 23,052 17,192 4,935 925 0 0 0 0 2.1 1.6 Trent 33,208 25,500 7,602 106 0 0 0 0 2.0 1.6 Leicestershire, Northamptonshire 26,760 17,880 6,967 1,913 0 0 0 0 2.5 1.9 & Rutland Shropshire and StaVordshire 22,854 14,513 6,403 1,687 251 0 0 0 2.7 2.2 Birmingham and the Black 32,613 25,353 7,235 25 0 0 0 0 1.9 1.6 Country West Midlands South 23,342 15,551 7,106 676 9 0 0 0 2.4 2.1 England 821,688 559,173 221,133 41,037 305 38 0 0 2.4 1.9
Source: KH07 1. These data includes Welsh patients who are waiting for treatment at English providers. These patients are not subject to NHSPlan access time targets.
Table 3.8.4(b) INPATIENT WAITING LIST STATISTICS (ORDINARY ADMISSIONS AND DAY CASE ADMISSIONS) AT 31 MARCH 2005 (COMMISSIONER BASED): TIME ON WAITING LIST England by Strategic Health Authority Waiting Time (months) Total 0-2 3-5 6-8 9-11 12-14 15-17 18 months Strategic Health Authority Waiting months months months months months months plus Mean Median Norfolk, SuVolk and 41,379 27,063 10,801 3,514 0 1 0 0 2.6 2.0 Cambridgeshire Bedfordshire and Hertfordshire 29,459 19,248 8,274 1,937 0 0 0 0 2.6 2.1 Essex 27,706 19,406 7,472 828 0 0 0 0 2.3 1.9 North West London 26,229 16,985 8,167 1,077 0 0 0 0 2.5 2.1 North Central London 17,725 11,579 4,955 1,191 0 0 0 0 2.6 2.1 North East London 23,801 15,977 6,506 1,318 0 0 0 0 2.5 2.0 South East London 24,193 16,502 6,776 915 0 0 0 0 2.4 2.0 South West London 18,370 12,303 5,067 997 1 2 0 0 2.5 2.0 Northumberland,Tyneand19,20213,8024,80159900002.21.7 Wear 3178271099 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 194 Health Committee: Evidence
England by Strategic Health Authority Waiting Time (months) Total 0-2 3-5 6-8 9-11 12-14 15-17 18 months Strategic Health Authority Waiting months months months months months months plus Mean Median County Durham & Tees Valley 15,973 10,825 4,265 883 0 0 0 0 2.4 1.9 North and East Yorkshire and 28,725 19,398 7,547 1,780 0 0 0 0 2.5 2.0 Northern Lincolnshire West Yorkshire 34,313 23,337 8,446 2,529 2 0 0 0 2.5 1.9 Cumbria & Lancashire 35,255 24,044 9,996 1,215 0 0 0 0 2.4 1.9 Greater Manchester 48,879 35,838 11,829 1,211 0 1 0 0 2.2 1.7 Cheshire & Merseyside 41,684 27,678 10,719 3,281 6 0 0 0 2.8 2.4 Thames Valley 26,273 19,513 6,388 372 0 0 0 0 2.1 1.7 Hampshire and Isle of Wight 32,847 21,039 9,545 2,263 0 0 0 0 2.6 2.2 Kent and Medway 26,936 16,864 8,526 1,545 0 1 0 0 2.7 2.3 Surrey and Sussex 42,064 26,782 12,626 2,652 3 1 0 0 2.6 2.2 Avon, Gloucestershire & 39,312 23,585 12,018 3,688 3 18 0 0 2.8 2.4 Wiltshire South West Peninsula 30,332 19,422 9,495 1,415 0 0 0 0 2.6 2.2 Somerset & Dorset 15,872 11,603 3,872 397 0 0 0 0 2.2 1.8 South Yorkshire 20,048 14,929 4,295 824 0 0 0 0 2.1 1.6 Trent 39,727 30,298 8,974 455 0 0 0 0 2.0 1.6 Leicestershire, Northamptonshire 26,826 17,755 7,135 1,936 0 0 0 0 2.5 2.0 & Rutland Shropshire and StaVordshire 22,710 15,087 6,340 1,281 2 0 0 0 2.5 2.1 Birmingham and the Black 28,646 22,345 6,285 16 0 0 0 0 1.9 1.6 Country West Midlands South 24,286 16,353 7,287 646 0 0 0 0 2.4 2.0 England 808,772 549,560 218,407 40,765 17 24 0 0 2.4 2.0
Source: QF01
Figure 3.8.4
Average Waiting Times
10 9 8 7 6 5 4 Months 3 2 1 0 Mar 88 Mar 89 Mar 90 Mar 91 Mar 92 Mar 93 Mar 94 Mar 95 Mar 96 Mar 97 Mar 98 Mar 99 Mar 00 Mar 01 Mar 02 Mar 03 Mar 04 Mar 05 Quarter ended
Mean Median
3.8.5 Could the Department please provide an update of Tables 3.9.5 on outpatient waiting times? [3.9.5] Answer 1. The information requested is given in Table 3.8.5(a) to Table 3.8.5(f). 3178271101 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 195
Table 3.8.5(a) PATIENTSNOT YET SEENFOLLOWING GP WRITTEN REFERRAL, TIME WAITING FROM REFERRAL TO QUARTER ENDED 31 MARCH 2005 (PROVIDER BASED)
GP written referrals not yet seen at end of quarter who have been waiting (weeks) Strategic Health Authority 13 to under 17 17 to under 21 21 ! Norfolk, SuVolk and Cambridgeshire 3,474 4 0 Bedfordshire and Hertfordshire 1,160 0 0 Essex 31 0 0 North West London 1,751 0 0 North Central London 2,677 0 0 North East London 1,271 0 0 South East London 193 0 0 South West London 581 3 2 Northumberland, Tyne and Wear 74 0 0 County Durham & Tees Valley 1,051 0 0 North and East Yorkshire and Northern Lincolnshire 1,057 2 0 West Yorkshire 1,856 0 0 Cumbria & Lancashire 614 0 0 Greater Manchester 515 0 0 Cheshire & Merseyside 2,603 84 609 Thames Valley 255 0 0 Hampshire and Isle of Wight 919 0 0 Kent and Medway 855 2 0 Surrey and Sussex 2,373 0 23 Avon, Gloucestershire & Wiltshire 1,257 1 0 South West Peninsula 571 0 0 Somerset & Dorset 0 0 0 South Yorkshire 978 0 0 Trent 224 0 0 Leicestershire, Northamptonshire & Rutland 917 0 0 Shropshire and StaVordshire 2,256 170 1,158 Birmingham and the Black Country 1 0 0 West Midlands South 504 0 0 England 30,018 266 1,792
Source: QM08. Provider based
Table 3.8.5(b) PATIENTSNOT YET SEENFOLLOWING GP WRITTEN REFERRAL, TIME WAITING FROM REFERRAL TO QUARTER ENDED 31 MARCH 2005 (COMMISSIONER BASED)
GP written referrals not yet seen at end of quarter who have been waiting (weeks) Strategic Health Authority 13 to under 17 17 to under 21 21 ! Norfolk, SuVolk and Cambridgeshire 3,126 4 0 Bedfordshire and Hertfordshire 1,392 0 0 Essex 119 0 0 North West London 2,952 0 0 North Central London 1,710 0 0 North East London 1,996 0 0 South East London 225 0 1 South West London 608 3 1 Northumberland, Tyne and Wear 96 0 0 County Durham & Tees Valley 798 0 0 North and East Yorkshire and Northern Lincolnshire 1,322 2 0 West Yorkshire 1,688 0 0 Cumbria & Lancashire 699 0 0 Greater Manchester 527 0 0 Cheshire & Merseyside 2,343 8 29 Thames Valley 262 0 0 Hampshire and Isle of Wight 979 0 0 Kent and Medway 826 2 0 Surrey and Sussex 1,785 0 23 3178271101 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 196 Health Committee: Evidence
GP written referrals not yet seen at end of quarter who have been waiting (weeks) Strategic Health Authority 13 to under 17 17 to under 21 21 ! Avon, Gloucestershire & Wiltshire 1,226 2 6 South West Peninsula 564 0 0 Somerset & Dorset 35 0 0 South Yorkshire 795 0 0 Trent 558 0 0 Leicestershire, Northamptonshire & Rutland 952 0 0 Shropshire and StaVordshire 1,982 15 52 Birmingham and the Black Country 8 0 0 West Midlands South 501 0 0 England 30,074 36 112
Source: QM08R. (Commisioner based)
Table 3.8.5(c) PATIENTSSEENFOLLOWING GP WRITTEN REFERRAL AND TIME WAITED FROM REFERRAL TO CONSULTATION, QUARTER ENDED 31 MARCH 2005 England by Strategic Health Authority
Number seen following GP Of those seen % who waited (in weeks) Strategic Health Authority written referral under 13 13 to under 17 17 and over
Norfolk, SuVolk and Cambridgeshire 90,125 78% 17% 5% Bedfordshire and Hertfordshire 54,971 80% 16% 3% Essex 63,508 84% 16% 0% North West London 71,093 78% 21% 1% North Central London 70,154 78% 19% 4% North East London 62,627 75% 25% 0% South East London 60,235 85% 13% 1% South West London 56,575 87% 13% 0% Northumberland, Tyne and Wear 64,168 94% 5% 1% County Durham & Tees Valley 48,487 84% 13% 3% North and East Yorkshire and Northern Lincolnshire 59,123 85% 14% 1% West Yorkshire 74,049 80% 17% 3% Cumbria & Lancashire 68,256 82% 18% 0% Greater Manchester 114,339 90% 10% 0% Cheshire & Merseyside 107,302 82% 17% 2% Thames Valley 78,004 92% 7% 0% Hampshire and Isle of Wight 60,940 87% 12% 1% Kent and Medway 52,837 83% 17% 0% Surrey and Sussex 99,410 81% 19% 0% Avon, Gloucestershire & Wiltshire 83,719 86% 13% 1% South West Peninsula 62,728 80% 19% 1% Somerset & Dorset 48,722 89% 11% 0% South Yorkshire 63,077 87% 13% 0% Trent 87,013 90% 9% 0% Leicestershire, Northamptonshire & Rutland 53,178 77% 23% 0% Shropshire and StaVordshire 52,757 73% 20% 7% Birmingham and the Black Country 110,225 94% 6% 0% West Midlands South 59,040 85% 14% 1% England 1,976,66284% 15% 1%
Source: QM08. Provider based 3178271102 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 197
Table 3.8.5(d)
PATIENTSSEENFOLLOWING GP WRITTEN REFERRAL AND TIME WAITED FROM REFERRAL TO CONSULTATION, QUARTER ENDED 31 MARCH 2005 England by specialty
Number seen following GP Of those seen % who waited (in weeks) Specialty written referral under 13 13 to under 17 17 and over
All specialties 1,976,66284% 15% 1% Of which: General surgery 261,259 90% 10% 1% Urology 83,844 84% 15% 1% Trauma and orthopaedics 199,204 73% 24% 3% Ear, Nose and Throat 170,133 80% 18% 1% Ophthalmology 176,911 78% 21% 1% Oral surgery 80,607 81% 18% 1% Plastic surgery 27,675 78% 19% 3% General medicine 113,888 87% 12% 1% Dermatology 154,691 82% 16% 1% Gynaecology 185,047 91% 9% 1%
Source: QM08. Provider based 3178271102 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 198 Health Committee: Evidence (1) SPECIALTY 87% 88% 77% DER 13 WEEKS England by Strategic Health Authority & Specialty ogy Surgery Surgery Medicine Dermatology Gynaecology Specialties Table 3.8.5(e) FOLLOWING GP WRITTEN REFERRAL General Trauma & Oral Plastic General All PERCENTAGE OF PATIENTSSEENIN THE QUARTER ENDED 31 MARCH 2005 WHO WAITED UN ordshire 85% 82% 57% 65% 63% 60% 50% 82% 58% 86% 73% V olk and Cambridgeshire 81% 83% 59% 80% 77% 84% 56% 81% 76% 83% 78% V QM08 Provider based West Midlands SouthEngland 90% 87% 90% 82% 84% 83% 73% 80% 80% 88% 78% 95% 81% 91% 78% 73% 87% 80% 82% 85% 91% 84% Birmingham and the Black Country 94% 94% 93% 92% 89% 96% 90% 93% 93% 97% 94% Shropshire and Sta South YorkshireTrentLeicestershire, Northamptonshire & Rutland 85% 65% 58% 93% 73% 91% 94% 68% 72% 87% 63% 84% 65% 75% 81% 93% 90% 74% 81% 69% 96% 90% 84% 93% 94% 99% 98% 87% 97% 90% Somerset & Dorset 92% 88% 86% 83% 78% 85% 89% 92% 90% 91% 89% South West Peninsula 87% 87% 70% 73% 74% 82% 78% 94% 70% 85% 80% Avon, Gloucestershire & Wiltshire 92% 88% 76% 83% 83% 86% 75% 87% 88% 91% 86% Surrey and Sussex 86% 82% 75% 75% 79% 75% 87% 87% 71% 91% 81% Kent and Medway 93% 84% 69% 73% 83% 84% n/a 82% 89% 92% 83% Hampshire and Isle of Wight 92% 87% 83% 77% 83% 72% 84% 87% 91% 91% 87% Thames Valley 97% 95% 77% 96% 89% 92% 95% 97% 93% 97% 92% Cheshire & Merseyside 89% 76% 65% 72% 79% 76% 79% 84% 85% 94% 82% Greater Manchester 87% 84% 82% 92% 92% 86% 90% 86% 85% 95% 90% Cumbria & Lancashire 87% 81% 74% 85% 72% 79% 75% 79% 79% 93% 82% LincolnshireWest Yorkshire 92% 88% 87% 71% 79% 74% 82% 67% 82% 71% 89% 81% 65% 68% 85% 81% 78% 82% 94% 78% 85% 80% North and East Yorkshire and Northern County Durham & Tees Valley 95% 89% 68% 92% 66% 62% 76% 93% 79% 96% 84% Northumberland, Tyne and Wear 99% 94% 78% 94% 99% 84% 70% 98% 100% 98% 94% South West London 92% 93% 75% 92% 75% 90% 82% 91% 88% 88% 87% South East London 94% 85% 84% 62% 69% 75% 70% 93% 85% 86% 85% North East London 82% 77% 60% 63% 57% 80% 64% 68% 67% 90% 75% North Central London 88% 77% 65% 81% 57% 93% 54% 79% 68% 82% 78% EssexNorth West London 84% 76% 90% 61% 92% 69% 68% 85% 64% 62% 76% 70% 75% 83% 96% 69% 77% 91% 88% 78% 94% 84% Bedfordshire and Hertfordshire 91% 81% 65% 67% 80% 76% 78% 83% 77% 91% 80% Strategic Health Authority Surgery Urology Orthopaedics ENT Ophthalmol Norfolk, Su Source: Notes: 1. Includes non-major specialties. 3178271102 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 199 (1) SPECIALTY ER 17 WEEKS England by Strategic Health Authority & Specialty ogy Surgery Surgery Medicine Dermatology Gynaecology Specialties Table 3.8.5(f) FOLLOWING GP WRITTEN REFERRAL General Trauma & Oral Plastic General All PERCENTAGE OF PATIENTSSEENIN THE QUARTER ENDED 31 MARCH 2005 WHO WAITED OV ordshire 4% 5% 13% 5% 11% 10% 16% 5% 9% 4% 7% V olk and Cambridgeshire 4% 4% 14% 5% 5% 3% 16% 4% 3% 1% 5% V QM08 Provider based Lincolnshire 0% 0% 4% 0% 1% 0% 4% 0% 2% 0% 1% England 1% 2% 3% 1% 1% 2% 4% 1% 1% 1% 1% West Midlands South 1% 3% 2% 2% 0% 0% 0% 0% 0% 1% 1% Birmingham and the Black Country 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Shropshire and Sta Leicestershire, Northamptonshire & Rutland 0% 1% 0% 0% 0% 0% 0% 1% 0% 0% 0% Trent 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% South Yorkshire 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Somerset & Dorset 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% South West Peninsula 0% 1% 2% 0% 1% 0% 0% 0% 1% 0% 1% Avon, Gloucestershire & Wiltshire 0% 0% 3% 3% 1% 2% 8% 0% 1% 0% 1% Surrey and Sussex 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Kent and Medway 0% 0% 0% 0% 0% 0% n/a 0% 0% 0% 0% Hampshire and Isle of Wight 1% 0% 3% 2% 1% 3% 0% 1% 0% 1% 1% Thames Valley 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% Cheshire & Merseyside 1% 3% 5% 1% 1% 2% 0% 0% 1% 0% 2% Greater Manchester 1% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% Cumbria & Lancashire 0% 0% 1% 0% 1% 1% 0% 1% 1% 0% 0% West Yorkshire 2% 5% 1% 3% 3% 0% 4% 5% 3% 7% 3% North and East Yorkshire and Northern County Durham & Tees Valley 0% 2% 4% 1% 5% 14% 7% 0% 3% 1% 3% Northumberland, Tyne and Wear 0% 1% 3% 0% 0% 2% 1% 0% 0% 0% 1% South West London 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% South East London 1% 4% 0% 0% 8% 0% 0% 1% 1% 0% 1% North East London 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% North Central London 2% 7% 7% 3% 1% 0% 20% 7% 8% 4% 4% North West London 0% 0% 4% 1% 0% 5% 3% 0% 3% 0% 1% Essex 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% Bedfordshire and Hertfordshire 1% 3% 6% 4% 6% 6% 1% 1% 1% 1% 3% Strategic Health Authority Surgery Urology Orthopaedics ENT Ophthalmol Norfolk, Su Source: Notes: 1. Includes non-major specialties. 3178271104 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 200 Health Committee: Evidence
3.8.6 Could the Department update the information given in Tables 3.9.6? [3.9.6] Answer 1. The information requested is given in Tables 3.8.6(a) and (b).
Table 3.8.6(a) NUMBERS OF ADMISSIONS AND REMOVALS England by admission type Ordinary Day Case 6 months to: Admitted Removed Admitted Removed Sep 88 941,363 72,131 359,213 18,419 Mar 89 938,864 86,256 392,645 23,871 Sep 89 959,516 92,715 420,536 26,784 Mar 90 934,164 109,963 454,266 31,041 Sep 90 910,557 101,572 465,603 36,409 Mar 91 888,291 125,408 496,554 43,510 Sep 91 918,376 115,338 534,998 47,616 Mar 92 938,842 157,759 601,316 67,267 Sep 92 901,687 124,675 638,905 67,044 Mar 93 879,834 139,707 691,201 80,873 Sep 93 829,580 131,708 712,016 85,040 Mar 94 800,632 137,604 768,249 97,207 Sep 94 796,780 136,907 849,379 111,295 Mar 95 804,411 143,757 925,446 129,361 Sep 95 763,117 128,408 943,405 131,830 Mar 96 767,412 139,901 1,026,419 147,724 Sep 96 761,967 132,833 1,056,084 154,879 Mar 97 683,421 117,203 1,047,602 147,084 Sep 97 * * * * Mar 98 * * * * Sep 98 687,330 134,836 1,189,074 194,417 Mar 99 682,511 136,383 1,267,592 206,796 Sep 99 662,461 120,560 1,175,154 175,132 Mar 00 628,114 130,814 1,216,451 196,281 Sep 00 632,607 119,418 1,112,734 172,900 Mar 01 608,008 133,715 1,113,989 187,898 Sep 01 598,444 122,255 1,008,152 164,812 Mar 02 612,537 128,485 1,025,052 165,982 Sep 02 615,575 119,585 1,017,050 162,831 Mar 03 624,559 134,841 1,073,797 184,096 Sep 03 626,734 125,352 1,029,740 171,141 Mar 04 638,826 136,551 1,096,344 188,301 Sep 04 622,530 127,683 1,078,635 175,447 Mar 05 603,509 129,753 1,086,020 179,121 Source: KH06 NHSTrust-based figures. * In the year 1997–98, information was collected annually only.
Table 3.8.6(b) NUMBER OF SELF DEFERRALS
England by admission type Number at: Ordinary Day Case Sep 88 40,753 8,433 Mar 89 37,098 8,769 Sep 89 38,224 9,905 Mar 90 36,441 9,735 Sep 90 39,274 11,865 Mar 91 36,115 11,998 Sep 91 33,868 12,469 Mar 92 30,965 13,151 Sep 92 35,992 18,134 Mar 93 35,800 19,095 Sep 93 41,550 24,142 Mar 94 39,189 25,185 3178271105 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 201
England by admission type Number at: Ordinary Day Case Sep 94 43,538 34,946 Mar 95 42,188 37,152 Sep 95 45,004 42,650 Mar 96 45,112 44,908 Sep 96 46,876 49,632 Mar 97 46,022 49,390 Sep 97 * * Mar 98 * * Sep 98 42,330 52,928 Mar 99 40,098 50,667 Sep 99 38,955 50,398 Mar 00 36,270 44,771 Sep 00 37,014 46,595 Mar 01 35,610 39,864 Sep 01 38,823 42,971 Mar 02 34,614 37,049 Sep 02 35,461 39,192 Mar 03 32,382 36,534 Sep 03 34,018 39,950 Mar 04 29,895 35,980 Sep 04 29,160 36,284 Mar 05 26,766 36,045 Source: KH07A NHSTrust-based figures. * In the year 1997–98, information was collected annually only.
3.8.7 Could the Department update the information provided in Tables 3.9.7? [3.9.7] Answer
1. The information requested is given in Table 3.8.7.
Table 3.8.7 TRENDSIN NON-EMERGENCY AND EMERGENCY ACTIVITY AND WAITING LISTS England Quarter ended:1 Non-Emergency Activity2,3 Emergency Activity Waiting Lists (’000) (’000) (’000)2 31 Mar 97 4,327 3,598 1,158 31 Mar 984 4,412 3,729 1,298 31 Mar 99 4,827 3,849 1,073 31 Mar 00 4,891 3,887 1,037 31 Mar 01 5,001 3,943 1,007 31 Mar 035 5,036 3,961 1,035 31 Mar 035 5,262 4,007 992 31 Mar 04 5,445 4,274 906 31 Mar 056,7 5,446 4,474 822
Source: KH07 NHStrust based figures, Health Authority Quarterly and Monthly monit oring returns 1. Figures for years prior to 2004–05 have been rebased to allow direct comparison. 2. Non-emergency and emergency activity are figures are for admissions purchased by the NHS(“commissioner-based”). These figures cover General & Acute specialties which do not include mental health, learning diYculties or maternity services. Waiting list figures relate to the number of patients waiting in NHStrusts (provide r based). 3. Non-emergency activity includes waiting list, booked and planned admissions. 4. From 30 June 1998, activity is on the basis of finished first consultant episodes. 5. Figures prior to 2001–02 are from Health Authorities. With the abolition of Health Authorities, figures for 2001–02 and 2002–03 are based on returns from NHSTrusts. 6. Figures are subject to revision when final outturn figures are received. 7. Data are presented for financial years and are not adjusted for the diVering number of working days per year. There were three fewer working days (251) in 2004–05 compared with 2003–04 (254) as a consequence of two Easters in the same financial year. 3178271108 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 202 Health Committee: Evidence
3.8.8 Could the Department update the information provided in Table 3.9.8? [3.9.8] Answer
1. The information requested is given in Table 3.8.8.
Table 3.8.8 AVERAGE WAITING TIMESAND NUMBERSFOR FIRST OUTPATIENT APPOINTMENTS England Median Outpatients Total first waiting time See after GP attendances Quarter (weeks) written referral seen Q3 1993–94 6.01 1,490,439 1,683,116 Q4 1993–94 5.47 1,809,117 2,118,240 Q1 1994–95 5.42 1,603,723 1,966,464 Q2 1994–95 5.69 2,026,726 2,411,193 Q3 1993–95 5.82 2,019,438 2,412,634 Q4 1994–95 5.72 2,003,009 2,569,639 Q1 1995–96 6.01 1,804,040 2,415,895 Q2 1995–96 6.31 1,847,549 2,524,893 Q3 1995–96 6.07 1,904,040 2,566,011 Q4 1995–96 6.02 2,010,249 2,715,403 Q1 1996–97 6.13 1,869,773 2,577,037 Q2 1996–97 6.18 1,893,706 2,635,007 Q3 1996–97 6.05 1,921,446 2,650,803 Q4 1996–97 6.05 1,880,217 2,642,116 Q1 1997–98 6.17 1,904,564 2,689,803 Q2 1997–98 6.37 1,896,977 2,675,056 Q3 1997–98 6.25 1,888,560 2,663,871 Q4 1997–98 6.27 1,919,032 2,732,305 Q1 1998–99 6.49 1,827,140 2,660,499 Q2 1998–99 6.80 1,881,607 2,739,913 Q3 1998–99 6.89 1,894,358 2,732,047 Q4 1998–99 6.99 1,929,607 2,803,960 Q1 1999–2000 7.09 1,837,726 2,714,179 Q2 1999–2000 7.31 1,907,904 2,798,366 Q3 1999–2000 7.32 1,935,766 2,791,712 Q4 1999–2000 7.58 2,028,664 2,953,779 Q1 2000–01 7.11 1,884,939 2,795,853 Q2 2000–01 7.45 1,949,273 2,863,533 Q3 2000–01 7.38 2,005,711 2,919,968 Q4 2000–01 7.38 2,098,170 3,050,816 Q1 2001–02 6.89 1,895,469 3,020,570 Q2 2001–02 7.21 1,961,853 3,099,821 Q3 2001–02 7.27 2,047,053 3,209,768 Q4 2001–02 7.57 2,111,633 3,282,456 Q1 2002–03 7.03 1,925,171 3,131,580 Q2 2002–03 7.15 2,017,304 3,183,497 Q3 2002–03 7.22 2,037,703 3,232,958 Q4 2002–03 7.34 2,092,696 3,330,764 Q1 2003–04 6.86 1,934,432 3,287,221 Q2 2003–04 7.05 2,015,385 3,345,338 Q3 2003–04 7.01 2,043,324 3,336,063 Q4 2003–04 7.08 2,093,093 3,461,908 Q1 2004–05 6.84 1,929,394 3,283,997 Q2 2004–05 7.08 2,030,623 3,395,417 Q3 2004–05 6.87 2,048,503 3,381,515 Q4 2004–05 6.96 1,976,662 3,301,587
Source: QM08 NHSTrust–based figures, KH09Q and QMOP (attendances 2001–02 onwards) 3178271110 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 203
3.8.9 Could the Department update the information provided in Tables 3.9.9? [3.9.9] Answer 1. The information requested is given in Tables 3.8.9(a), (b), (c) and (d).
Table 3.8.9(a) ESTIMATED TOTAL NUMBER OF NHS GP CONSULTATIONS IN ENGLAND PER YEAR
Year Total consultations (to the nearest 1,000,000) 1991 214,000,000 1992 232,000,000 1993 252,000,000 1994 224,000,000 1995 235,000,000 1996 254,000,000 1997 n/a 1998 217,000,000 1999 n/a 2000 221,000,000 2001 218,000,000 2002 243,000,000 2003 215,000,000 Source: the consultation estimates are prepared using General Household Survey (GHS) data and ONS mid year population estimates. Table 3.8.9(b) NUMBERSOF REFERRALSFOR FIRSTOUTPATIENT APPOINTMENTS England Referrals for first OP appointment Quarter GP Other Total Q3 1993–94 1,440,814 383,043 1,823,857 Q4 1993–94 1,777,656 344,218 2,121,874 Q1 1994–95 1,819,356 340,342 2,159,698 Q2 1994–95 2,058,342 432,163 2,490,505 Q3 1994–95 1,993,288 424,785 2,418,073 Q4 1994–95 2,125,033 483,637 2,608,670 Q1 1995–96 2,099,602 533,986 2,633,588 Q2 1995–96 2,106,125 612,669 2,718,794 Q3 1995–96 2,104,221 564,377 2,668,598 Q4 1995–96 2,237,690 611,431 2,849,121 Q1 1996–97 2,210,968 671,360 2,882,328 Q2 1996–97 2,186,116 716,100 2,902,216 Q3 1996–97 2,138,071 745,224 2,883,295 Q4 1996–97 2,157,003 744,835 2,901,838 Q1 1997–98 2,328,045 824,639 3,152,684 Q2 1997–98 2,224,842 818,295 3,043,137 Q3 1997–98 2,153,204 837,943 2,991,147 Q4 1997–98 2,285,631 847,327 3,132,958 Q1 1998–99 2,301,253 847,767 3,149,020 Q2 1998–99 2,282,527 861,021 3,143,548 Q3 1998–99 2,239,178 818,292 3,057,470 Q4 1998–99 2,316,827 834,171 3,150,998 Q1 1999–00 2,317,334 863,030 3,180,364 Q2 1999–00 2,270,191 872,706 3,142,897 Q3 1999–00 2,214,415 840,426 3,054,841 Q4 1999–00 2,339,485 884,742 3,224,227 Q1 2000–01 2,356,768 907,634 3,264,402 Q2 2000–01 2,318,477 931,285 3,249,762 Q3 2000–01 2,287,884 915,406 3,203,290 Q4 2000–01 2,399,641 963,146 3,362,787 Q1 2001–02 2,403,361 998,386 3,401,747 Q2 2001–02 2,358,005 1,004,419 3,362,424 Q3 2001–02 2,322,399 1,001,622 3,324,021 Q4 2001–02 2,386,577 1,012,131 3,398,708 3178271112 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 204 Health Committee: Evidence
England Referrals for first OP appointment Quarter GP Other Total Q1 2002–03 2,415,744 1,060,349 3,476,093 Q2 2002–03 2,453,148 1,080,701 3,533,849 Q3 2002–03 2,362,178 1,052,160 3,414,338 Q4 2002–03 2,424,804 1,106,192 3,530,996 Q1 2003–04 2,425,663 1,139,591 3,565,254 Q2 2003–04 2,448,980 1,162,821 3,611,801 Q3 2003–04 2,401,147 1,137,102 3,538,249 Q4 2003–04 2,526,447 1,204,148 3,730,595 Q1 2004–05 2,489,811 1,236,602 3,726,413 Q2 2004–05 2,483,388 1,259,532 3,742,920 Q3 2004–05 2,426,280 1,228,729 3,655,009 Q4 2004–05 2,383,046 1,239,734 3,622,780 Source: QM08 NHSTrust-based figures
Table 3.8.9(c) NUMBER OF PLACEMENTS ON WAITING LIST (DECISION TO ADMIT)
England Quarter Number of Decisions to admit Q1 1991–92 772,512 Q2 1991–92 793,501 Q3 1991–92 820,827 Q4 1991–92 870,775 Q1 1992–93 836,550 Q2 1992–93 858,452 Q3 1992–93 890,264 Q4 1992–93 895,002 Q1 1993–94 853,524 Q2 1993–94 869,617 Q3 1993–94 862,073 Q4 1993–94 916,501 Q1 1994–95 919,679 Q2 1994–95 924,721 Q3 1994–95 937,033 Q4 1994–95 983,974 Q1 1995–96 944,241 Q2 1995–96 967,048 Q3 1995–96 1,005,019 Q4 1995–96 1,052,517 Q1 1996–97 1,031,618 Q2 1996–97 1,034,147 Q3 1996–97 1,033,372 Q4 1996–97 1,012,374 Q1 1997–98 * Q2 1997–98 * Q3 1997–98 * Q4 1997–98 * Q1 1998–99 1,018,946 Q2 1998–99 1,063,473 Q3 1998–99 1,054,530 Q4 1998–99 1,052,374 Q1 1999–00 1,033,256 Q2 1999–00 1,042,575 Q3 1999–00 1,035,313 Q4 1999–00 1,047,934 Q1 2000–01 988,441 Q2 2000–01 982,086 Q3 2000–01 972,485 Q4 2000–01 992,918 Q1 2001–02 928,736 Q2 2001–02 934,025 Q3 2001–02 958,877 3178271113 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 205
England Quarter Number of Decisions to admit Q4 2001–02 959,799 Q1 2002–03 917,299 Q2 2002–03 941,534 Q3 2002–03 948,312 Q4 2002–03 971,245 Q1 2003–04 917,649 Q2 2003–04 943,457 Q3 2003–04 954,998 Q4 2003–04 986,640 Q1 2004–05 932,332 Q2 2004–05 955,373 Q3 2004–05 960,167 Q4 2004–05 939,841
Source: KH06 NHSTrust–based figures * In the year 1997–98, information was collected annually only.
Table 3.8.9(d) NUMBER OF ATTENDANCESAT FIRST OUTPATIENT APPOINTMENTS England Quarter Outpatients Total first Seen after GP attendance written referral seen Q3 1993–94 1,490,439 1,683,116 Q4 1993–94 1,809,117 2,118,240 Q1 1994–95 1,603,723 1,966,464 Q2 1994–95 2,026,726 2,411,193 Q3 1993–95 2,019,438 2,412,634 Q4 1994–95 2,003,009 2,569,639 Q1 1995–96 1,804,040 2,415,895 Q2 1995–96 1,847,549 2,524,893 Q3 1995–96 1,904,040 2,566,011 Q4 1995–96 2,010,249 2,715,403 Q1 1996–97 1,869,773 2,577,037 Q2 1996–97 1,893,706 2,635,007 Q3 1996–97 1,921,446 2,650,803 Q4 1996–97 1,880,217 2,642,116 Q1 1997–98 1,904,564 2,689,803 Q2 1997–98 1,896,977 2,675,056 Q3 1997–98 1,888,560 2,663,871 Q4 1997–98 1,919,032 2,732,305 Q1 1998–99 1,827,140 2,660,499 Q2 1998–99 1,881,607 2,739,913 Q3 1998–99 1,894,358 2,732,047 Q4 1998–99 1,929,607 2,803,960 Q1 1999–00 1,837,726 2,714,179 Q2 1999–00 1,907,904 2,798,366 Q3 1999–00 1,935,766 2,791,712 Q4 1999–00 2,028,664 2,953,779 Q1 2000–01 1,884,939 2,795,853 Q2 2000–01 1,949,273 2,863,533 Q3 2000–01 2,005,711 2,919,968 Q4 2000–01 2,098,170 3,050,816 Q1 2001–02 1,895,469 3,020,570 Q2 2001–02 1,961,853 3,099,821 Q3 2001–02 2,047,053 3,209,768 Q4 2001–02 2,111,633 3,282,456 Q1 2002–03 1,925,171 3,131,580 Q2 2002–03 2,017,304 3,183,497 Q3 2002–03 2,037,703 3,232,958 Q4 2002–03 2,092,696 3,330,764 3178271114 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 206 Health Committee: Evidence
England Quarter Outpatients Total first Seen after GP attendance written referral seen Q1 2003–04 1,934,432 3,287,221 Q2 2003–04 2,015,385 3,345,338 Q3 2003–04 2,043,324 3,336,063 Q4 2003–04 2,093,093 3,461,908 Q1 2004–05 1,929,394 3,283,997 Q2 2004–05 2,030,623 3,395,417 Q3 2004–05 2,048,503 3,381,515 Q4 2004–05 1,976,662 3,301,587 Source: QM08 NHSTrust-based figures, KH09Q & QMOP (attendances 2001–02 onwards).
3.8.10 What additional mechanisms have been put in place since last year’s response to deal with waiting lists/ time, and what has been the cost of these additional mechanisms? [3.9.10] Answer 1. The key national measures taken over the past year (2004-05) to support the NHSin reducing waiting lists and waiting times included: — Creating clear and challenging, but achievable national targets and standards In 2000, the Department published the NHS Plan, which set out clear targets for improving access to NHSservices. This publication set out how, by the end of 2005, maximum wa iting times for a first outpatient appointment with a consultant would be reduced to 13 weeks (from over 26 weeks) to 6 months for inpatient treatment (surgery) from 18 months. On 1 April 2004, the targets in were reduced to 17 weeks for first outpatient appointments (down from 21 weeks) and 9 months for inpatient treatment (down from 12 months). In addition to this, the Department has even shorter maximum waits in specific areas such as Cancer (two weeks for a first outpatient appointment and two months from urgent GP referral to treatment), Coronary Heart Disease (maximum three months for heart surgery) and cataracts (three months maximum wait by December 2004). More recently, in the NHSimprovement plan (2004) the Department has gone e ven further, and has set a target that, by the end of 2008, the maximum length of time any patient should have to wait will be just 18 weeks from General Practitioner referral to start of treatment. — The National Orthopaedic Project introduced tailored support to those Trusts facing the highest degree of challenge in reducing waiting times for orthopaedic patients. —“Choice at Six Months” framework was introduced to oVer faster treatment at alternative hospitals to those patients who would otherwise wait more than six months for inpatient treatment. The scheme reduced waiting times by oVering faster treatment to patients facing some of the longest waits, and providing a real incentive to hospitals to treat patients within the six month target. — Independent Sector was used selectively to bring on additional capacity more quickly. This included purchasing capacity for diagnostics as well as inpatient treatments. — Waiting list management was supported by a number of national tools, developed with the support of the Modernisation Agency, that include Primary Targetting Lists (PTLs), Clinical Prioritise and Treat (CpaT) and the NOP (see above). 2. These policies and programmes include a mix of national and local investment. See Table 3.8.10. Many of the programmes have a range of objectives and benefits and it is not possible to accurately attribute expenditure to the objective of reducing waiting times and lists. However, the most significant items of national investment in 2004–05 have been: — National Orthopaedic Project £3 million. — The General Supplementary Procurement (Gsup) budget of £75 million was used to purchase 25,000 procedures from two private providers. — The Independent Sector Treatment Centre Programme represents an investment of £400 million per year over five years (from 2003–04 to 2007–08 onwards). 3178271115 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 207
3. The success of these measures and those undertaken locally can be judged by the significant reductions in NHSwaiting times. Between March 2004 and March 2005: (i) the number of inpatients waiting over six months fell by half to 40,000 and the number waiting over 3 months by over 64,000 to less than 260,000, more than 50% less than March 1997; and (ii) the number of outpatients waiting over 13 weeks fell by over 10,000 to 30,000, more than 300,000 less than that inherited in June 1997. By March 2005, the number waiting over 17 weeks fell to less than 150, down from just under 100,000 in June 2002 (when the figures were first available). 3178271115 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 208 Health Committee: Evidence l nil t contracts—first expected r contracts—first expected Estimated future cost £20million Contract commenced 2003–04. expected to complete Oct 2011 Estimated future cost £1,605 million by the end of 2005–06 ITING TIMES (1) lion Complete by Dec 2005 illion 15 contracts each 5 years—last illion Complete by Mar 2008 2005–06 Expected Programme Duration and ion £24 million Completed in Jun 2005 million estimated approx The programme will complete 50 million–£200 million activity per year for three years up to 2008 s National Orthopaedics Project and the 18 week delivery programme. Table 3.8.10 £500 million pa Physiological Measurementdiagnostics £200 million pa to commence late 2006 range of specialities range of specialities Advertised as to commence early 2007 scheme Providers plus some locally procured SHA activity Providers range of specialities Trusts facing the greatest £2 million challenge in reducing waiting times; focused on orthopaedics NATIONAL MEASURES TAKEN TO SUPPORT THE NHS IN REDUCING WAITING LISTS AND WA ISTC—Wave 2 Diagnostics Imaging, Endoscopies and £1,000 million — — 5 Year ISTC—Wave 2 ECN Elective procedures across a Advertised as estimated at £1 ISTC—Wave 2 Electives Elective procedures across a £2,500 million — — 5 Yea BUPA Redwood Mainly general elective surgery £50 million £10 million £10 m procurement (2) orthopaedic delivered by three ISEstimated future cost— General supplementary Electives procedures, mainly £75 million — £75 mil procurement (1) orthopaedic delivered by two ISEstimated future cost—ni General supplementary Electives procedures, mainly £78 million £54 mill ISTC—Wave 1 Elective procedures across a £1,737 million £15 million £117 m Programme Description Total Cost 2004–05 Spend Spend Expected Future Cos National Orthopaedic project Tailored support direct to the £5 million £3 Notes: 1. Estimate based on approximate share of the £5 million budget which cover 3178271117 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 209
3.8.11 Could the Department provide figures and a graph (or graphs) showing the trend in removals, self- deferrals, decisions to admit, booked, planned and waiting list admissions, for each year since 1988? Where appropriate can this be broken down by inpatient and daycase activity? Would the Department provide a commentary on this series? Answer 1. The information requested is given in Table 3.8.11 and Figures 3.8.11(a), (b), (c) and (d). 2. The NHSis treating patients quicker, more appropriately and convenien tly. Fewer patients are required to stay in hospital and more patients are receiving the treatment they need in outpatients. 3. Self-deferrals have fallen steadily, by 35%, from their peak in September 1996. This reflects better management of waiting lists and more patient friendly practices adopted by the NHSin meeting waiting time targets.
Table 3.8.11
NUMBER OF DECISIONS TO ADMIT
Ordinary Quarter and daycase ending admissions Sep 88 683,000 Mar 89 712,934 Sep 89 715,655 Mar 90 770,943 Sep 90 726,187 Mar 91 750,334 Sep 91 793,501 Mar 92 870,775 Sep 92 858,452 Mar 93 895,002 Sep 93 869,617 Mar 94 916,501 Sep 94 924,721 Mar 95 983,974 Sep 95 967,048 Mar 96 1,052,517 Sep 96 1,034,147 Mar 97 1,012,374 Sep 97 * Mar 98 * Sep 98 1,063,473 Mar 99 1,052,374 Sep 99 1,042,575 Mar 00 1,047,934 Sep 00 982,086 Mar 01 992,918 Sep 01 934,025 Mar 02 959,799 Sep 02 941,561 Mar 03 971,245 Sep 03 943,457 Mar 04 986,640 Sep 04 955,373 Mar 05 939,841 3178271118 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 210 Health Committee: Evidence
Figure 3.8.11(a): Number of Patients Admitted - Provider based, England
1400000
1200000
1000000
800000
600000
400000
200000
0 Mar 89 Mar 90 Mar 91 Mar 92 Mar 93 Mar 94 Mar 95 Mar 96 Mar 97 Mar 98 Mar 99 Mar 00 Mar 01 Mar 02 Mar 03 Mar 04 Mar 05 Mar Sep 88 Sep 89 Sep 90 Sep 91 Sep 92 Sep 93 Sep 94 Sep 95 Sep 96 Sep 97 Sep 98 Sep 99 Sep 00 Sep 01 Sep 02 Sep 03 Sep 04 Sep
Ordinary Day case
Figure 3.8.11(b): Number of Patients Removed - Provider based, England
250000
200000
150000
100000
50000
0 Mar 89 Mar 90 Mar 91 Mar 92 Mar 93 Mar 94 Mar 95 Mar 96 Mar 97 Mar 98 Mar 99 Mar 00 Mar 01 Mar 02 Mar 03 Mar 04 Mar 05 Mar Sep 88 Sep 89 Sep 90 Sep 91 Sep 92 Sep 93 Sep 94 Sep 95 Sep 96 Sep 97 Sep 98 Sep 99 Sep 00 Sep 01 Sep 02 Sep 03 Sep 04
Ordinary Day case 3178271118 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 211
Figure 3.8.11(c): Number of Self Deferrals - Provider based, England
60000
50000
40000
30000
20000
10000
0 Mar 89 Mar 90 Mar 91 Mar 92 Mar 93 Mar 94 Mar 95 Mar 96 Mar 97 Mar 98 Mar 99 Mar 00 Mar 01 Mar 02 Mar 03 Mar 04 Mar 05 Mar Sep 88 Sep Sep 89 Sep 90 Sep 91 Sep 92 Sep 93 Sep 94 Sep 95 Sep 96 Sep 97 Sep 98 Sep 99 Sep 00 Sep 01 Sep 02 Sep 03 Sep 04 Sep
Ordinary Day case
Figure 3.8.11(d): Number of Decisions to admit - Provider based, England
1200000
1000000
800000
600000
400000
200000
0 Mar 89 Mar 90 Mar 91 Mar 92 Mar 93 Mar 94 Mar 95 Mar 96 Mar 97 Mar 98 Mar 99 Mar 00 Mar 01 Mar 02 Mar 03 Mar 04 Mar 05 Mar Sep 88 Sep 89 Sep 90 Sep 91 Sep 92 Sep 93 Sep 94 Sep 95 Sep 96 Sep 97 Sep 98 Sep 99 Sep 00 Sep 01 Sep 02 Sep 03 Sep 04
3.8.12Could the Department provide figures and a graph (or graphs) showing the trend in the number of GP outpatient referrals, other outpatient referrals, the number of first outpatient attendances, the number of follow- up outpatient attendances, and the number of DNAs, for each year since 1994? Would the Department provide a commentary on this series? Answer 1. The information requested is provided in Figures 3.8.12(a) to 3.8.12(c). 2. Over the last 10 years, the total number of GP referrals has risen by 22% to almost 10 million per year. 3. Did Not Attend (DNA) rates have fallen to less than 10% of appointments and are expected to continues to fall with patient-led initiatives such as Choose and Book. 3178271119 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 212 Health Committee: Evidence
Figure 3.8.12(a) GP and other referrals
16,000,000
14,000,000
12,000,000
10,000,000
Other referrals 8,000,000 GP referrals
6,000,000
4,000,000
2,000,000
0 1994-95 1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05
Figure 3.8.12(b) First outpatient attendances
16,000,000
14,000,000
12,000,000
10,000,000
Did not attend 8,000,000 seen
6,000,000
4,000,000
2,000,000
0 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 3178271119 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 213
Figure 3.8.12(c) Subsequent outpatient attendances
40,000,000
35,000,000
30,000,000
25,000,000
Did not attend 20,000,000 seen
15,000,000
10,000,000
5,000,000
0 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05
3.8.13 Could the Department provide figures and a graph (or graphs) showing the mean and median average waiting times for booked and waiting list admissions, by inpatient and daycase, for each quarter since 1988? Would the Department provide a commentary on this series? Answer 1. The information requested is given in Figure 3.8.4. 2. Waits have fallen steadily since March 1998 and are expected to continue to decline with the introduction of the six month maximum wait for inpatients from December 2005.
3.8.14 Could the Department provide figures and a graph (or graphs) for the number of people suspended from waiting lists, for each quarter since 1988? Would the Department provide a commentary on this series? Answer 1. The information requested is given in Table 3.8.14 and Figure 3.8.14. 2. Suspensions were highest in September 1999. Since then, they have fallen steadily and are now 10% less than their peak.
Table 3.8.14 NUMBER OF PATIENTS SUSPENDED England by admission type Number at: Ordinary Day Case Sep 95 29,576 14,062 Mar 96 35,065 17,479 Sep 96 38,291 21,080 Mar 97 41,534 25,298 Sep 97 * * Mar 98 * * Sep 98 44,794 31,226 Mar 99 47,442 33,644 Sep 99 46,915 31,461 Mar 00 44,425 30,568 Sep 00 46,967 31,202 Mar 01 46,558 30,176 Sep 01 44,504 28,542 Mar 02 43,580 27,450 Sep 02 43,752 26,463 Mar 03 43,991 28,832 Sep 03 41,934 26,904 3178271121 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 214 Health Committee: Evidence
England by admission type Number at: Ordinary Day Case Mar 04 47,191 31,622 Sep 04 44,486 31,116 Mar 05 42,686 30,673 Source: KH07A NHSTrust-based figures. * In the year 1997–98, information was collected annually only.
Figure 3.8.14: Number of Patients Suspended - Provider based, England
50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
- Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar Sep Mar 95 96 96 97 97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05
Ordinary Day Case
3.8.15 The Department has set a target of by the end of 2008 no one to wait more than 18 weeks from GP appointment to treatment. However it was not able to indicate what current performance is on this measure. Is the Department now able to estimate what the maximum wait from GP appointment to treatment currently is? If not, how does it propose to monitor this target? When will it be able to produce these figures? Answer 1. The Department set out the target of 18 weeks from GP referral to start of treatment in the NHS Improvement Plan (2004). 2. The Department does not currently collect information on the length of time from GP referral to start of treatment. However, as a step towards developing end-to-end monitoring arrangements, the Department is currently undertaking a pilot exercise with the NHSto develop a monthly data collection to monitor diagnostic waiting times and activity. 3. The format and content of the end-to-end monitoring and the supporting definitions and guidance required for the 18 week target will be refined in light of any lessons learnt during piloting before full roll- out across the NHS. It is the intention that, subject to successful piloting, the diagnostics data collection will be introduced across the whole NHSlater this year.
3.9 NHS productivity and value for money 3.9.1 What progress has the Department made in developing a better way of measuring NHS productivity and replacing the Cost Weighted Activity Index? How far will this take account of quality? [3.9.11] Answer 1. The Department has moved away from the Cost Weighted Activity Index (CWAI) as: — the index only included 12 activity types and places 60% of the expenditure weight on inpatients and a further 20% of the weight on outpatients which means: — the index gave no credit for more complex case-mix; and — shifting activity to more cost eVective settings, such as from inpatients to outpatients, reduced recorded output. 3178271122 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 215
2. In addition: — the CWAI had a secondary care focus and failed to include new types of NHSac tivity; and — quality of care was not considered. 3. To measure progress against our 2002 Spending Review value for money PSA target, DH has developed an interim value for money measure, the cost eYciency measure. In 2003–04, this measure suggests that value for money through cost eYciency increased by 2.1%. 4. The cost eYciency measure is calculated by comparing increases in NHSexpenditure ad justed for both input cost inflation and increases in expenditure on improving the quality of NHSservices, with increases in NHSOutputs as calculated by the NHSOutput Index. This index is derived m ainly using data published in the National Schedule of Reference Costs and in 2003–04 covered over 1,900 activity categories. The advantages of the new NHSOutputs Index include: — being better able to capture changes in case-mix as a result of using more detailed activity data; — the reduction in output resulting from shifting activity from inpatients to outpatients is reduced; — broadens coverage to include primary care; — new data included for activity of increasing importance—eg NHSDirect; a nd — the amount of activity included in the measure will grow as reference cost coverage expands. 5. Research we have commissioned from the University of York is looking specifically as how to adjust the new NHSOutputs Index so its captures the quality of NHScare in terms of r educed hospital mortality rates and shorter waiting times.
4. Personal Social Services Resources and Activity 4.1 General 4.1.1 Could the Department update tables 4.1.1, setting out the Formula Spending Share (FSS) for social service by local authority, and by FSS sub-block, in cash, per capita, per capita of relevant population and per client? [4.1.1] Answer 1. Formula Spending Share for social services in 2005–06 by local authority, by FSS sub-block, in cash (Table 4.1.1(a)), per capita of total population (Table 4.1.1(b)), per capita of relevant population (Table 4.1.1(c)) and per client (Table 4.1.1(d)) are provided in the tables attached. The FSS for children’s social services is excluded since responsibility for social care of children has moved to DfES. 2. PSS FSS allocations are calculated on the basis of need for services (adjusting for deprivation and diVering costs of service provision), so that authorities are essentially provided with equivalent levels of funding for equivalent levels of need (as measured by a series of socio-economic indicators) for each PSS client group. Individual local authorities’ PSS allocations will therefore not normally be directly comparable on a per capita basis as the formulae reflect relative levels of deprivation. Whilst one authority may receive a very low PSS allocation per capita relative to a neighbour, if that authority has less need for Personal Social Services (as measured by the indicators) compared to the neighbour then the authority has not necessarily received a disproportionately low share of funding. 3. FSS allocations per client have again been estimated. However given the potential diVerences in balance of services and intensity of service use between authorities, care needs to be taken when making comparisons. 4. For adults the Referral Assessment and Packages of Care return records client numbers for community based services. An aggregate measure of social services clients is not available but can be estimated by adding the number receiving community based services to permanent supported residents minus temporary admissions in care homes at 31 March 2003. It should be noted that this may be a slight undercount of the total number of clients receiving social services as clients receiving rehabilitation or intermediate care in care homes may be excluded. 3178271124 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 216 Health Committee: Evidence
Table 4.1.1(a) PERSONAL SOCIAL SERVICES FORMULA SPENDING SHARES FOR 2005–06—PER CAPITA
Adults Older People Total Adult FSS FSS FSS Local Authority £m £m £m Summary Table Principal Metropolitan Cities 292 473 765 Other Metropolitan Districts 551 999 1,550 Metropolitan Sub Total 843 1,471 2,314 Inner London 391 375 767 Outer London 407 533 940 London Sub total 798 909 1,707 Shire Counties 1,441 2,562 4,003 Shire Unitary Authorities 598 930 1,528 Shire sub total 2,039 3,492 5,531 England Total 3,680 5,8729,552 Principal Metropolitan Cities Birmingham 85 139 223 Leeds 54 84 138 Liverpool 43 74 116 Manchester 45 61 106 Newcastle upon Tyne 24 39 63 SheYeld 41 76 117 Sub-Total 292 473 765 Other Metropolitan Districts Barnsley 15 31 46 Bolton 19 33 52 Bradford 36 51 86 Bury 12 20 32 Calderdale 14 21 35 Coventry 23 36 60 Doncaster 19 37 56 Dudley 21 42 62 Gateshead 15 30 45 Kirklees 27 41 69 Knowsley 13 24 37 North Tyneside 14 27 42 Oldham 16 27 43 Rochdale 16 25 41 Rotherham 17 35 52 Salford 19 35 54 Sandwell 23 47 70 Sefton 20 39 59 Solihull 12 21 34 South Tyneside 12 25 37 St Helens 12 25 37 Stockport 19 32 51 Sunderland 22 41 63 Tameside 16 28 44 TraVord 15 25 39 Wakefield 22 42 64 Walsall 18 38 56 Wigan 21 39 60 Wirral 23 44 67 Wolverhampton 19 38 57 Sub-Total 551 999 1,550 Metropolitan Sub-total 843 1,471 2,314 Inner London City of London 1 1 3 Camden 33 30 63 Greenwich 27 34 62 Hackney 34 33 67 3178271124 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 217
Adults Older People Total Adult FSS FSS FSS Local Authority £m £m £m Hammersmith and Fulham 25 23 48 Islington 30 29 59 Kensington and Chelsea 23 21 45 Lambeth 42 33 75 Lewisham 31 34 66 Southwark 41 37 79 Tower Hamlets 36 32 68 Wandsworth 35 35 70 Westminster 33 31 64 Sub-total 391 375 767 Outer London Barking and Dagenham 15 26 40 Barnet 28 39 67 Bexley 15 24 39 Brent 28 32 60 Bromley 21 31 52 Croydon 27 31 58 Ealing 30 35 65 Enfield 23 32 55 Haringey 25 23 49 Harrow 16 27 43 Havering 15 27 42 Hillingdon 19 27 47 Hounslow 20 24 44 Kingston upon Thames 12 15 27 Merton 16 20 36 Newham 27 29 56 Redbridge 19 28 46 Richmond upon Thames 15 18 34 Sutton 14 20 34 Waltham Forest 21 26 47 Sub-total 407 533 940 London Sub-total 798 909 1,707 Shire Counties Bedfordshire 25 37 62 Buckinghamshire 29 46 76 Cambridgeshire 36 57 93 Cheshire 42 75 117 Cornwall 32 66 98 Cumbria 31 63 94 Derbyshire 46 94 140 Devon 43 86 129 Dorset 22 47 69 Durham 33 72 105 East Sussex 31 62 93 Essex 83 146 229 Gloucestershire 35 61 97 Hampshire 74 115 190 Hertfordshire 70 118 188 Kent 86 141 227 Lancashire 74 126 201 Leicestershire 35 58 93 Lincolnshire 40 75 114 Norfolk 51 97 147 North Yorkshire 33 60 93 Northamptonshire 40 62 102 Northumberland 20 40 60 Nottinghamshire 47 84 131 Oxfordshire 40 60 100 Shropshire 17 35 52 Somerset 30 59 88 StaVordshire 48 87 135 3178271124 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 218 Health Committee: Evidence
Adults Older People Total Adult FSS FSS FSS Local Authority £m £m £m SuVolk 40 78 118 Surrey 71 110 181 Warwickshire 32 57 89 West Sussex 47 85 131 Wiltshire 26 45 70 Worcestershire 33 58 91 Sub-total 1,441 2,562 4,003 Shire Unitary Authorities Bath & North East Somerset 11 19 31 Blackburn with Darwen 10 15 25 Blackpool 11 21 32 Bournemouth 12 22 34 Bracknell Forest 8 9 17 Brighton & Hove 22 28 50 Bristol 33 49 82 Darlington 7 11 18 Derby 17 27 44 East Riding of Yorkshire 19 36 54 Halton 9 15 24 Hartlepool 7 12 19 Herefordshire 10 21 32 Isle of Wight Council 9 18 27 Isles of Scilly 0 0 1 Kingston upon Hull 20 35 55 Leicester 23 34 57 Luton 14 17 31 Medway 16 20 36 Middlesbrough 11 17 29 Milton Keynes 15 19 34 North East Lincolnshire 11 18 29 North Lincolnshire 10 17 27 North Somerset 12 23 34 Nottingham 25 34 58 Peterborough 12 17 29 Plymouth 18 29 46 Poole 8 16 24 Portsmouth 16 20 35 Reading 12 13 25 Redcar and Cleveland 10 17 27 Rutland 2 3 5 Slough 10 13 22 South Gloucestershire 14 23 37 Southampton 19 24 43 Southend-on-Sea 11 21 32 Stockton-on-Tees 13 20 33 Stoke-on-Trent 17 33 51 Swindon 12 17 29 Telford and The Wrekin 11 17 27 Thurrock 10 15 26 Torbay 9 20 29 Warrington 13 21 33 West Berkshire 9 13 22 Windsor and Maidenhead 9 13 23 Wokingham 9 10 19 York 12 17 30 Sub-total 598 930 1,528 Shires Sub-total 2,039 3,492 5,531 3178271125 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 219
Table 4.1.1(b) FORMULA SPENDING SHARES PER CAPITA BASED ON TOTAL POPULATION FOR 2005–06
Younger Adults Older People Total Adults FSS FSS FSS per capita per capita per capita all ages all ages all ages Local Authority £m £m £m
Summary Table Principal Metropolitan Cities 113 182 295 Other Metropolitan Districts 95 172 267 Metropolitan Sub Total 100 175 276 Inner London 185 177 362 Outer London 111 146 257 London Sub total 138 158 296 Shire Counties 79 141 220 Shire Unitary Authorities 92 143 235 Shire sub total 83 142 224 England Total 95 151 246 Principal Metropolitan Cities Birmingham 115 188 303 Leeds 97 150 248 Liverpool 124 214 337 Manchester 132 182 315 Newcastle upon Tyne 115 184 298 SheYeld 102 188 290 Sub-Total 113 182295 Other Metropolitan Districts Barnsley 88 181 269 Bolton 95 165 260 Bradford 100 143 244 Bury 89 144 233 Calderdale 94 144 237 Coventry 99 155 254 Doncaster 87 165 252 Dudley 87 175 262 Gateshead 100 197 297 Kirklees 91 139 231 Knowsley 116 216 331 North Tyneside 96 181 277 Oldham 101 164 264 Rochdale 103 159 262 Rotherham 90 180 270 Salford 113 209 322 Sandwell 107 218 325 Sefton 90 180 269 Solihull 81 139 220 South Tyneside 103 210 313 St Helens 91 182 272 Stockport 86 146 231 Sunderland 98 188 286 Tameside 96 173 269 TraVord 89 151 240 Wakefield 89 172 261 Walsall 95 199 294 Wigan 89 166 255 Wirral 95 180 276 Wolverhampton 105 205 309 Sub-Total 95 172267 Metropolitan Sub-total 100 175 276 3178271125 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 220 Health Committee: Evidence
Younger Adults Older People Total Adults FSS FSS FSS per capita per capita per capita all ages all ages all ages Local Authority £m £m £m Inner London City of London 195 182 377 Camden 190 175 365 Greenwich 159 201 361 Hackney 220 213 433 Hammersmith and Fulham 174 162 336 Islington 207 197 404 Kensington and Chelsea 161 146 307 Lambeth 195 156 351 Lewisham 163 180 343 Southwark 208 189 396 Tower Hamlets 229 205 435 Wandsworth 154 153 307 Westminster 172 164 336 Sub-total 185 177 362 Outer London Barking and Dagenham 120 209 329 Barnet 109 156 265 Bexley 89 144 234 Brent 132 154 286 Bromley 91 132 223 Croydon 105 122 227 Ealing 126 144 270 Enfield 108 147 254 Haringey 145 134 280 Harrow 98 164 262 Havering 86 153 239 Hillingdon 101 144 246 Hounslow 123 144 267 Kingston upon Thames 104 123 227 Merton 108 130 238 Newham 147 161 308 Redbridge 99 148 248 Richmond upon Thames 108 128 236 Sutton 102 146 248 Waltham Forest 126 153 279 Sub-total 111 146 257 London Sub-total 138 158 296 Shire Counties Bedfordshire 83 124 207 Buckinghamshire 80 126 206 Cambridgeshire 81 127 208 Cheshire 79 142 221 Cornwall 78 163 241 Cumbria 80 162 243 Derbyshire 79 161 240 Devon 75 151 226 Dorset 69 148 217 Durham 85 184 270 East Sussex 79 160 238 Essex 81 142 222 Gloucestershire 80 138 218 Hampshire 77 119 195 Hertfordshire 87 148 235 Kent 82 136 218 Lancashire 84 142 226 Leicestershire 72 119 191 Lincolnshire 75 142 217 Norfolk 78 149 228 North Yorkshire 74 133 207 3178271125 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 221
Younger Adults Older People Total Adults FSS FSS FSS per capita per capita per capita all ages all ages all ages Local Authority £m £m £m Northamptonshire 82 125 208 Northumberland 82 162 244 Nottinghamshire 80 142 222 Oxfordshire 83 125 208 Shropshire 73 156 229 Somerset 75 148 223 StaVordshire 76 137 213 SuVolk 76 146 222 Surrey 85 133 218 Warwickshire 79 140 219 West Sussex 78 142 220 Wiltshire 75 131 206 Worcestershire 77 136 212 Sub-total 79 141 220 Shire Unitary Authorities Bath & North East Somerset 82 142 225 Blackburn with Darwen 103 150 253 Blackpool 96 186 282 Bournemouth 89 163 252 Bracknell Forest 92 111 203 Brighton & Hove 108 138 246 Bristol 106 156 263 Darlington 92 146 238 Derby 94 152 246 East Riding of Yorkshire 74 140 213 Halton 101 167 268 Hartlepool 99 177 276 Herefordshire 75 152 227 Isle of Wight Council 55 112 167 Isles of Scilly 99 215 314 Kingston upon Hull 107 183 290 Leicester 107 158 266 Luton 99 126 225 Medway 84 108 192 Middlesbrough 108 165 272 Milton Keynes 94 115 209 North East Lincolnshire 91 155 246 North Lincolnshire 81 142 223 North Somerset 77 151 228 Nottingham 114 155 269 Peterborough 96 144 241 Plymouth 93 152 245 Poole 77 143 220 Portsmouth 104 134 238 Reading 105 116 221 Redcar and Cleveland 92 162 254 Rutland 67 116 183 Slough 109 141 250 South Gloucestershire 75 119 194 Southampton 108 134 242 Southend-on-Sea 92 167 260 Stockton-on-Tees 93 139 231 Stoke-on-Trent 93 180 273 Swindon 86 121 207 Telford and The Wrekin 89 137 225 Thurrock 94 139 233 Torbay 84 190 274 Warrington 85 138 223 West Berkshire 82 117 199 Windsor and Maidenhead 88 127 216 Wokingham 77 86 163 3178271125 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 222 Health Committee: Evidence
Younger Adults Older People Total Adults FSS FSS FSS per capita per capita per capita all ages all ages all ages Local Authority £m £m £m York 83 118 201 Sub-total 92143 235 Shires Sub-total 83 142 224
Table 4.1.1(c) FORMULA SPENDING SHARES PER CAPITA BASED ON RELEVANT POPULATION FOR 2005–06
Younger Adults Older People Total Adult FSS FSS FSS per capita per capita per capita 18–64 65! adults Local Authority £m £m £m Summary Table Principal Metropolitan Cities 139 951 295 Other Metropolitan Districts 120 823 267 Metropolitan Sub Total 126 860 276 Inner London 212 1,386 362 Outer London 134 859 257 London Sub total 164 1,019 296 Shire Counties 102 631 220 Shire Unitary Authorities 115 722 235 Shire sub total 106 653 224 England Total 119 739 246 Principal Metropolitan Cities Birmingham 142 987 303 Leeds 121 762 248 Liverpool 153 1,117 337 Manchester 158 1,128 315 Newcastle upon Tyne 143 920 298 SheYeld 129 907 290 Sub-Total 139 951 295 Other Metropolitan Districts Barnsley 111 861 269 Bolton 119 843 260 Bradford 124 745 244 Bury 111 734 233 Calderdale 118 702 237 Coventry 123 789 254 Doncaster 110 766 252 Dudley 112 799 262 Gateshead 129 879 297 Kirklees 113 720 231 Knowsley 145 1,063 331 North Tyneside 124 793 277 Oldham 125 851 264 Rochdale 127 837 262 Rotherham 113 874 270 Salford 142 1,022 322 Sandwell 136 1,020 325 Sefton 120 723 269 Solihull 104 621 220 South Tyneside 134 902 313 St Helens 114 875 272 Stockport 109 671 231 Sunderland 123 923 286 Tameside 120 880 269 TraVord 112 720 240 3178271126 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 223
Younger Adults Older People Total Adult FSS FSS FSS per capita per capita per capita 18–64 65! adults Local Authority £m £m £m Wakefield 112 854 261 Walsall 122 907 294 Wigan 109 881 255 Wirral 125 759 276 Wolverhampton 134 935 309 Sub-Total 120 823 267 Metropolitan Sub-total 126 860 276 Inner London City of London 225 1,352 377 Camden 216 1,434 365 Greenwich 190 1,260 361 Hackney 250 1,781 433 Hammersmith and Fulham 198 1,333 336 Islington 235 1,629 404 Kensington and Chelsea 187 1,046 307 Lambeth 220 1,381 351 Lewisham 189 1,292 343 Southwark 239 1,445 396 Tower Hamlets 259 1,783 435 Wandsworth 175 1,248 307 Westminster 198 1,243 336 Sub-total 212 1,386 362 Outer London Barking and Dagenham 147 1,116 329 Barnet 133 869 265 Bexley 113 691 234 Brent 154 1,048 286 Bromley 116 613 223 Croydon 126 732 227 Ealing 147 995 270 Enfield 131 834 254 Haringey 165 1,116 280 Harrow 120 886 262 Havering 112 668 239 Hillingdon 123 807 246 Hounslow 144 987 267 Kingston upon Thames 124 759 227 Merton 128 818 238 Newham 167 1,361 308 Redbridge 121 839 248 Richmond upon Thames 129 787 236 Sutton 126 767 248 Waltham Forest 148 1,040 279 Sub-total 134 859 257 London Sub-total 164 1,019 296 Shire Counties Bedfordshire 102 666 207 Buckinghamshire 100 642 206 Cambridgeshire 100 669 208 Cheshire 101 650 221 Cornwall 104 642 241 Cumbria 105 686 243 Derbyshire 101 746 240 Devon 102 570 226 Dorset 99 499 217 Durham 109 859 270 East Sussex 111 552 238 Essex 103 648 222 Gloucestershire 103 613 218 3178271126 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 224 Health Committee: Evidence
Younger Adults Older People Total Adult FSS FSS FSS per capita per capita per capita 18–64 65! adults Local Authority £m £m £m Hampshire 97 556 195 Hertfordshire 109 742 235 Kent 106 608 218 Lancashire 107 657 226 Leicestershire 91 582 191 Lincolnshire 100 585 217 Norfolk 105 589 228 North Yorkshire 97 560 207 Northamptonshire 101 670 208 Northumberland 106 713 244 Nottinghamshire 101 666 222 Oxfordshire 102 669 208 Shropshire 96 661 229 Somerset 99 591 223 StaVordshire 95 662 213 SuVolk 100 614 222 Surrey 108 632 218 Warwickshire 100 672 219 West Sussex 105 550 220 Wiltshire 96 605 206 Worcestershire 98 632 212 Sub-total 102 631 220 Shire Unitary Authorities Bath & North East Somerset 106 635 225 Blackburn with Darwen 125 828 253 Blackpool 128 755 282 Bournemouth 119 653 252 Bracknell Forest 108 745 203 Brighton & Hove 133 723 246 Bristol 130 861 263 Darlington 118 664 238 Derby 118 734 246 East Riding of Yorkshire 97 584 213 Halton 123 930 268 Hartlepool 126 824 276 Herefordshire 100 610 227 Isle of Wight Council 68 571 167 Isles of Scilly 130 925 314 Kingston upon Hull 133 935 290 Leicester 130 912 266 Luton 118 757 225 Medway 102 631 192 Middlesbrough 134 833 272 Milton Keynes 109 841 209 North East Lincolnshire 117 694 246 North Lincolnshire 104 641 223 North Somerset 102 611 228 Nottingham 138 893 269 Peterborough 118 780 241 Plymouth 117 742 245 Poole 104 549 220 Portsmouth 128 711 238 Reading 125 745 221 Redcar and Cleveland 118 726 254 Rutland 87 511 183 Slough 129 922 250 South Gloucestershire 94 613 194 Southampton 132 761 242 Southend-on-Sea 122 689 260 Stockton-on-Tees 115 722 231 Stoke-on-Trent 117 864 273 3178271126 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 225
Younger Adults Older People Total Adult FSS FSS FSS per capita per capita per capita 18–64 65! adults Local Authority £m £m £m Swindon 105 672 207 Telford and The Wrekin 107 802 225 Thurrock 114 810 233 Torbay 118 669 274 Warrington 104 735 223 West Berkshire 100 654 199 Windsor and Maidenhead 110 643 216 Wokingham 92 528 163 York 105 563 201 Sub -total 115 722 235 Shires Sub-total 106 653 224
Table 4.1.1(d) FORMULA SPENDING SHARES PER CLIENT FOR EACH SUB BLOCK FOR 2005–06
Younger Adults Older People Total Adults FSS FSS FSS per client per client per client 18–64 65! adults Local Authority £m £m £m Summary Table Principal Metropolitan Cities 10,091 7,013 7,938 Other Metropolitan Districts 8,732 6,624 7,246 Metropolitan Sub Total 9,159 6,744 7,461 Inner London 16,201 9,701 12,199 Outer London 11,262 7,667 8,896 London Sub total 13,242 8,394 10,128 Shire Counties 8,560 6,602 7,131 Shire Unitary Authorities 8,846 6,478 7,235 Shire sub total 8,642 6,568 7,160 England Total 9,479 6,843 7,634 Principal Metropolitan Cities Birmingham 10,096 9,397 9,650 Leeds 8,645 4,594 5,633 Liverpool 10,999 6,878 7,973 Manchester 12,015 7,829 9,174 Newcastle upon Tyne 8,503 6,455 7,114 SheYeld 10,863 7,763 8,634 Sub-Total 10,091 7,013 7,938 Other Metropolitan Districts Barnsley 3,257 6,212 4,792 Bolton 8,681 8,254 8,406 Bradford 10,082 6,265 7,421 Bury 7,125 6,161 6,497 Calderdale 16,345 4,835 6,698 Coventry 8,895 7,945 8,291 Doncaster 13,211 10,681 11,434 Dudley 9,115 7,722 8,135 Gateshead 8,723 5,654 6,416 Kirklees 9,365 5,032 6,161 Knowsley 8,786 7,045 7,569 North Tyneside 5,302 3,724 4,151 Oldham 5,605 6,583 6,173 Rochdale 7,958 6,158 6,757 Rotherham 7,422 6,428 6,728 Salford 11,783 8,175 9,163 Sandwell 13,338 9,938 10,848 Sefton 8,249 5,272 5,994 3178271127 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 226 Health Committee: Evidence
Younger Adults Older People Total Adults FSS FSS FSS per client per client per client 18–64 65! adults Local Authority £m £m £m Solihull 11,205 6,225 7,441 South Tyneside 11,336 7,946 8,812 St Helens 6,590 5,301 5,670 Stockport 6,053 4,551 5,011 Sunderland 12,497 5,916 7,219 Tameside 6,871 6,601 6,695 TraVord 12,695 6,092 7,549 Wakefield 9,305 7,371 7,934 Walsall 11,470 10,058 10,474 Wigan 10,234 6,713 7,625 Wirral 9,534 7,730 8,270 Wolverhampton 14,563 9,625 10,873 Sub-Total 8,732 6,624 7,246 Metropolitan Sub-total 9,159 6,744 7,461 Inner London City of London 9,189 6,409 7,600 Camden 14,501 8,679 10,968 Greenwich 18,911 12,312 14,559 Hackney 25,986 16,031 19,899 Hammersmith and Fulham 17,034 8,050 11,074 Islington 20,786 10,551 14,113 Kensington and Chelsea 13,948 9,999 11,743 Lambeth 17,676 9,518 12,801 Lewisham 13,760 9,657 11,250 Southwark 14,278 9,110 11,240 Tower Hamlets 15,123 8,122 10,744 Wandsworth 11,364 7,345 8,928 Westminster 22,536 12,168 15,916 Sub-total 16,201 9,701 12,199 Outer London Barking and Dagenham 15,408 9,938 11,414 Barnet 19,046 9,880 12,322 Bexley 5,984 5,434 5,632 Brent 13,459 9,675 11,114 Bromley 8,446 5,534 6,438 Croydon 11,395 6,557 8,156 Ealing 15,643 6,566 8,997 Enfield 13,165 8,123 9,697 Haringey 11,478 7,480 9,133 Harrow 8,763 10,389 9,715 Havering 7,146 7,450 7,338 Hillingdon 11,062 7,480 8,634 Hounslow 10,950 9,085 9,857 Kingston upon Thames 9,378 6,147 7,300 Merton 14,833 8,992 10,943 Newham 13,346 10,939 11,969 Redbridge 7,232 5,333 5,961 Richmond upon Thames 14,929 7,122 9,365 Sutton 12,562 6,913 8,479 Waltham Forest 12,241 11,617 11,891 Sub-total 11,262 7,667 8,896 London Sub-total 13,242 8,394 10,128 Shire Counties Bedfordshire 8,997 — 8,058 Buckinghamshire 11,877 9,388 10,222 Cambridgeshire 11,360 7,710 8,816 Cheshire 9,027 6,949 7,572 Cornwall 5,855 5,766 5,794 Cumbria 11,006 7,060 8,012 3178271127 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 227
Younger Adults Older People Total Adults FSS FSS FSS per client per client per client 18–64 65! adults Local Authority £m £m £m Derbyshire 8,322 5,854 6,487 Devon 9,679 6,185 7,026 Dorset 6,005 6,499 6,332 Durham 6,634 7,102 6,947 East Sussex 8,822 6,760 7,326 Essex 6,969 5,724 6,120 Gloucestershire 11,064 8,558 9,332 Hampshire 8,435 5,895 6,685 Hertfordshire 8,664 7,067 7,587 Kent 7,575 5,475 6,114 Lancashire 8,502 6,193 6,885 Leicestershire 8,658 5,768 6,601 Lincolnshire 7,272 6,472 6,729 Norfolk 8,888 7,235 7,728 North Yorkshire 9,584 6,142 7,047 Northamptonshire 8,078 6,245 6,862 Northumberland 6,645 5,369 5,737 Nottinghamshire 10,129 7,410 8,201 Oxfordshire 11,878 7,667 8,923 Shropshire 6,437 6,341 6,371 Somerset 6,923 5,674 6,038 StaVordshire 9,277 5,949 6,818 SuVolk 8,932 6,052 6,801 Surrey 10,891 11,074 11,001 Warwickshire 11,310 7,217 8,307 West Sussex 8,616 6,332 6,990 Wiltshire 7,639 5,632 6,230 Worcestershire 9,182 6,301 7,105 Sub-total 8,560 6,6027,131 Shire Unitary Authorities Bath & North East Somerset 8,547 7,220 7,656 Blackburn with Darwen 11,580 6,479 7,888 Blackpool 7,868 6,698 7,056 Bournemouth 7,114 5,738 6,159 Bracknell Forest 20,372 8,196 11,252 Brighton & Hove 9,455 5,689 6,896 Bristol 10,569 6,527 7,725 Darlington 9,641 6,210 7,198 Derby 9,276 5,212 6,259 East Riding of Yorkshire 6,928 4,086 4,759 Halton 8,215 7,466 7,731 Hartlepool 6,477 5,217 5,608 Herefordshire 8,492 6,004 6,647 Isle of Wight Council 3,860 4,310 4,151 Isles of Scilly 17,309 7,471 9,111 Kingston upon Hull 8,252 6,663 7,172 Leicester 9,693 7,851 8,505 Luton 9,857 7,172 8,147 Medway 14,638 6,616 8,712 Middlesbrough 7,575 5,053 5,818 Milton Keynes 12,269 10,396 11,164 North East Lincolnshire 8,245 6,303 6,904 North Lincolnshire 6,704 5,089 5,579 North Somerset 8,606 6,094 6,760 Nottingham 9,040 6,104 7,077 Peterborough 7,169 11,081 9,099 Plymouth 10,003 8,837 9,247 Poole 7,198 5,629 6,093 Portsmouth 10,605 7,624 8,692 Reading 9,178 6,931 7,845 Redcar and Cleveland 10,936 7,631 8,568 3178271127 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 228 Health Committee: Evidence
Younger Adults Older People Total Adults FSS FSS FSS per client per client per client 18–64 65! adults Local Authority £m £m £m Rutland 8,685 4,460 5,433 Slough 10,380 10,321 10,347 South Gloucestershire 11,293 6,178 7,496 Southampton 10,837 6,214 7,680 Southend-on-Sea 5,940 9,555 7,857 Stockton-on-Tees 8,861 5,390 6,390 Stoke-on-Trent 6,757 6,871 6,832 Swindon 7,490 8,061 7,814 Telford and The Wrekin 5,758 7,069 6,487 Thurrock 10,310 8,422 9,094 Torbay 10,586 8,255 8,855 Warrington 10,410 8,076 8,829 West Berkshire 10,553 6,475 7,706 Windsor and Maidenhead 10,807 6,472 7,743 Wokingham 11,732 8,180 9,551 York 9,907 5,102 6,374 Sub-total 8,846 6,478 7,235 Shires Sub-total 8,6426,568 7,160
4.1.2 Could the Department update tables 4.1.2 comparing Personal Social Services (PSS) FSS for each authority in 2005–06 with PSS SSA in 2004–05 adjusted for changes in function and full resource equalisation? [4.1.2] Answer 1. Table 4.1.2 shows for both the adult groups ie Older People and Younger Adults, together the adjusted (for transfers and changes in function) 2004–05 allocations and the 2005–06 allocations, % change and % change by source. Please note that % changes are shown as % of total adjusted 2004–05 FSS (to allow authorities to add up changes across FSS). Changes are shown only for control total and data changes since there were no methodology changes or resource equalisation.
Table 4.1.2 ANALYSIS OF CHANGE FOR ADULT PERSONAL SOCIAL SERVICES
Local Authority Adjusted 2005-06 Change Change Of which: 2004–05 FSSs Control Resource Data Methodology FSSs Total Equalisation £m £m £m % % % % % England 9,036.717 9,551.987 515.270 5.7 0.8 0.0 0.0 0.0 London area 1,609.041 1,707.079 98.038 6.1 0.8 0.0 0.1 0.0 Metropolitan 2,193.636 2,314.219 120.583 5.5 0.9 0.0 0.0 0.0 areas Shire areas 5,233.517 5,530.142 296.625 5.7 0.8 0.0 0.0 0.0 Isles of Scilly 0.522 0.547 0.024 4.7 0.8 0.0 "0.2 0.0 Inner London 711.132 766.929 55.797 7.8 1.0 0.0 0.4 0.0 boroughs incl City Outer London 897.909 940.150 42.241 4.7 0.9 0.0 "0.2 0.0 boroughs London 1,609.041 1,707.079 98.038 6.1 0.9 0.0 0.1 0.0 boroughs Metropolitan 2,193.636 2,314.219 120.583 5.5 1.0 0.0 0.0 0.0 districts Shire unitaries 25.876 27.227 1.350 5.2 1.0 0.0 "0.1 0.0 with fire Shire unitaries 1,421.159 1,499.967 78.807 5.5 0.9 0.0 0.0 0.0 without fire Shire counties 1,522.152 1,607.690 85.538 5.6 1.1 0.0 0.0 0.0 with fire Shire counties 2,264.329 2,395.258 130.928 5.8 1.1 0.0 0.0 0.0 without fire Education 9,036.717 9,551.987 515.270 5.7 1.0 0.0 0.0 0.0 Authorities 3178271129 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 229
Local Authority Adjusted 2005-06 Change Change Of which: 2004–05 FSSs Control Resource Data Methodology FSSs Total Equalisation £m £m £m % % % % % GO REGIONAL SUMMARY South West 850.641 896.354 45.712 5.4 0.9 0.0 0.0 0.0 GOR South East 1,288.362 1,352.778 64.416 5.0 0.8 0.0 "0.1 0.0 GOR London GOR 1,609.041 1,707.079 98.038 6.1 0.8 0.0 0.1 0.0 Eastern GOR 896.366 955.310 58.944 6.6 0.8 0.0 0.1 0.0 East Midlands 702.795 743.723 40.928 5.8 0.8 0.0 0.0 0.0 GOR West Midlands 980.235 1,039.100 58.865 6.0 0.9 0.0 0.0 0.0 GOR Yorkshire and 906.819 952.417 45.598 5.0 0.8 0.0 "0.1 0.0 Humber GOR North East 507.229 540.166 32.937 6.5 0.9 0.0 0.1 0.0 GOR North West 1,295.228 1,365.060 69.831 5.4 0.9 0.0 0.0 0.0 GOR
GREATER LONDON City of London 2.556 2.713 0.158 6.2 0.2 0.0 0.0 0.0 Camden 58.357 63.100 4.743 8.1 1.1 0.0 0.5 0.0 Greenwich 57.375 61.830 4.456 7.8 1.0 0.0 0.3 0.0 Hackney 63.675 67.457 3.782 5.9 1.0 0.0 0.1 0.0 Hammersmith 45.206 48.095 2.890 6.4 1.1 0.0 0.1 0.0 and Fulham Islington 55.185 58.525 3.340 6.1 1.0 0.0 0.1 0.0 Kensington 40.322 44.589 4.267 10.6 1.1 0.0 0.9 0.0 and Chelsea Lambeth 71.448 74.708 3.260 4.6 1.0 0.0 "0.2 0.0 Lewisham 62.654 65.690 3.036 4.8 1.0 0.0 "0.1 0.0 Southwark 73.106 78.604 5.499 7.5 1.0 0.0 0.3 0.0 Tower Hamlets 63.694 67.902 4.208 6.6 0.9 0.0 0.1 0.0 Wandsworth 64.017 70.003 5.986 9.4 1.1 0.0 0.7 0.0 Westminster 53.538 63.712 10.173 19.0 1.0 0.0 2.3 0.0 Barking and 38.717 40.485 1.768 4.6 1.0 0.0 "0.2 0.0 Dagenham Barnet 63.512 66.881 3.369 5.3 1.0 0.0 "0.1 0.0 Bexley 37.660 39.251 1.591 4.2 0.9 0.0 "0.2 0.0 Brent 56.992 59.914 2.922 5.1 0.9 0.0 "0.1 0.0 Bromley 49.945 51.841 1.896 3.8 0.9 0.0 "0.3 0.0 Croydon 56.730 58.275 1.545 2.7 0.8 0.0 "0.4 0.0 Ealing 61.041 64.625 3.584 5.9 0.9 0.0 0.0 0.0 Enfield 52.371 54.680 2.309 4.4 0.8 0.0 "0.2 0.0 Haringey 47.320 48.843 1.523 3.2 0.8 0.0 "0.3 0.0 Harrow 40.464 42.718 2.254 5.6 1.0 0.0 0.0 0.0 Havering 39.592 41.773 2.180 5.5 0.9 0.0 0.0 0.0 Hillingdon 43.949 46.735 2.786 6.3 0.9 0.0 0.1 0.0 Hounslow 41.961 43.982 2.021 4.8 0.9 0.0 "0.1 0.0 Kingston upon 25.755 27.068 1.313 5.1 1.0 0.0 "0.1 0.0 Thames Merton 34.231 36.037 1.806 5.3 1.0 0.0 "0.1 0.0 Newham 53.489 55.658 2.170 4.1 0.7 0.0 "0.2 0.0 Redbridge 44.130 46.364 2.234 5.1 0.9 0.0 "0.1 0.0 Richmond 31.569 33.566 1.997 6.3 1.1 0.0 0.1 0.0 upon Thames Sutton 32.608 34.070 1.462 4.5 0.9 0.0 "0.2 0.0 Waltham 45.874 47.385 1.511 3.3 0.9 0.0 "0.4 0.0 Forest
GREATER MANCHESTER Bolton 48.984 52.157 3.173 6.5 0.9 0.0 0.1 0.0 Bury 30.912 32.314 1.402 4.5 0.9 0.0 "0.2 0.0 Manchester 99.739 105.847 6.108 6.1 0.9 0.0 0.1 0.0 Oldham 40.453 42.962 2.510 6.2 0.9 0.0 0.1 0.0 Rochdale 38.422 40.623 2.200 5.7 0.9 0.0 0.0 0.0 Salford 51.745 54.243 2.498 4.8 1.1 0.0 "0.2 0.0 Stockport 47.959 50.682 2.723 5.7 1.0 0.0 0.0 0.0 Tameside 41.236 43.896 2.660 6.5 0.9 0.0 0.1 0.0 TraVord 37.043 39.302 2.259 6.1 0.9 0.0 0.1 0.0 Wigan 56.273 59.959 3.685 6.5 1.0 0.0 0.1 0.0 3178271129 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 230 Health Committee: Evidence
Local Authority Adjusted 2005-06 Change Change Of which: 2004–05 FSSs Control Resource Data Methodology FSSs Total Equalisation £m £m £m % % % % % MERSEYSIDE Knowsley 35.420 37.302 1.882 5.3 0.9 0.0 "0.1 0.0 Liverpool 112.807 116.456 3.648 3.2 1.0 0.0 "0.5 0.0 Sefton 57.609 58.973 1.364 2.4 1.0 0.0 "0.6 0.0 St Helens 35.084 37.114 2.030 5.8 1.0 0.0 0.0 0.0 Wirral 64.069 66.679 2.610 4.1 1.0 0.0 "0.3 0.0
SOUTH YORKSHIRE Barnsley 43.416 45.873 2.457 5.7 1.0 0.0 0.0 0.0 Doncaster 52.957 55.854 2.897 5.5 0.9 0.0 0.0 0.0 Rotherham 48.884 52.182 3.297 6.7 1.0 0.0 0.2 0.0 SheYeld 112.294 117.367 5.073 4.5 1.1 0.0 "0.2 0.0
TYNE AND WEAR Gateshead 42.044 44.568 2.524 6.0 1.1 0.0 0.0 0.0 Newcastle upon 59.016 63.266 4.250 7.2 1.1 0.0 0.3 0.0 Tyne North Tyneside 39.689 41.585 1.896 4.8 1.1 0.0 "0.2 0.0 South Tyneside 34.651 36.914 2.263 6.5 1.1 0.0 0.1 0.0 Sunderland 58.744 63.105 4.361 7.4 1.0 0.0 0.3 0.0
WEST MIDLANDS Birmingham 211.729 223.376 11.647 5.5 0.9 0.0 0.0 0.0 Coventry 56.299 59.572 3.273 5.8 0.9 0.0 0.0 0.0 Dudley 58.079 62.167 4.089 7.0 1.0 0.0 0.2 0.0 Sandwell 66.161 70.315 4.154 6.3 1.0 0.0 0.1 0.0 Solihull 31.776 33.730 1.954 6.2 0.8 0.0 0.1 0.0 Walsall 52.742 56.318 3.576 6.8 1.0 0.0 0.2 0.0 Wolverhampton 53.499 56.921 3.423 6.4 1.0 0.0 0.1 0.0
WEST YORKSHIRE Bradford 82.964 86.304 3.340 4.0 0.8 0.0 "0.2 0.0 Calderdale 33.547 35.050 1.502 4.5 0.9 0.0 "0.2 0.0 Kirklees 65.120 68.588 3.468 5.3 0.9 0.0 "0.1 0.0 Leeds 131.415 138.247 6.832 5.2 1.0 0.0 "0.1 0.0 Wakefield 60.855 64.409 3.554 5.8 1.0 0.0 0.0 0.0
ALL PURPOSE AUTHORITIES Bath and North 28.658 30.572 1.914 6.7 1.0 0.0 0.2 0.0 East Somerset Blackburn with 24.224 25.446 1.222 5.0 0.8 0.0 "0.1 0.0 Darwen Blackpool 30.292 31.708 1.417 4.7 1.0 0.0 "0.2 0.0 Bournemouth 32.627 33.687 1.060 3.2 1.2 0.0 "0.5 0.0 Bracknell Forest 15.674 16.811 1.137 7.3 0.9 0.0 0.2 0.0 Brighton & 48.289 50.386 2.097 4.3 1.0 0.0 "0.2 0.0 Hove Bristol 76.151 81.655 5.504 7.2 1.1 0.0 0.3 0.0 Darlington 17.285 18.131 0.846 4.9 0.9 0.0 "0.1 0.0 Derby 40.843 44.065 3.222 7.9 0.9 0.0 0.3 0.0 East Riding of 51.993 54.189 2.195 4.2 0.9 0.0 "0.2 0.0 Yorkshire
Halton 22.870 24.121 1.250 5.5 0.9 0.0 0.0 0.0 Hartlepool 17.722 18.871 1.150 6.5 0.9 0.0 0.1 0.0 Herefordshire 29.786 31.631 1.845 6.2 1.0 0.0 0.1 0.0 Isle of Wight 25.876 27.227 1.350 5.2 1.0 0.0 "0.1 0.0 Council Kingston upon 52.291 55.264 2.973 5.7 1.0 0.0 0.0 0.0 Hull
Leicester 54.391 57.181 2.790 5.1 0.9 0.0 "0.1 0.0 Luton 28.898 30.813 1.915 6.6 0.7 0.0 0.1 0.0 Medway 34.882 36.409 1.527 4.4 0.7 0.0 "0.2 0.0 Middlesbrough 26.214 28.682 2.468 9.4 0.9 0.0 0.6 0.0 Milton Keynes 31.484 33.929 2.445 7.8 0.7 0.0 0.3 0.0
North East 28.432 29.282 0.850 3.0 0.9 0.0 "0.4 0.0 Lincolnshire North 25.599 26.829 1.230 4.8 0.9 0.0 "0.1 0.0 Lincolnshire North Somerset 33.138 34.381 1.244 3.8 1.0 0.0 "0.3 0.0 3178271129 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Local Authority Adjusted 2005-06 Change Change Of which: 2004–05 FSSs Control Resource Data Methodology FSSs Total Equalisation £m £m £m % % % % % Nottingham 55.267 58.138 2.871 5.2 1.0 0.0 "0.1 0.0 Peterborough 27.151 28.998 1.847 6.8 0.8 0.0 0.2 0.0
Plymouth 44.962 46.494 1.532 3.4 1.0 0.0 "0.4 0.0 Poole 22.777 23.977 1.200 5.3 1.0 0.0 "0.1 0.0 Portsmouth 33.824 35.496 1.672 4.9 0.9 0.0 "0.1 0.0 Reading 24.120 25.299 1.179 4.9 0.9 0.0 "0.1 0.0 Redcar and 25.837 27.322 1.484 5.7 0.9 0.0 0.0 0.0 Cleveland
Rutland 4.603 4.955 0.351 7.6 0.8 0.0 0.3 0.0 Slough 21.261 22.494 1.232 5.8 0.8 0.0 0.0 0.0 South Gloucestershire 34.623 36.979 2.356 6.8 0.8 0.0 0.2 0.0 Southampton 40.494 42.968 2.473 6.1 1.0 0.0 0.1 0.0 Southend-on- 31.007 32.354 1.347 4.3 1.0 0.0 "0.2 0.0 Sea
Stockton-on- 30.736 32.942 2.206 7.2 0.9 0.0 0.2 0.0 Tees Stoke-on-Trent 48.128 50.693 2.565 5.3 1.0 0.0 "0.1 0.0 Swindon 27.396 28.913 1.516 5.5 0.8 0.0 0.0 0.0 Telford and the 25.543 27.250 1.707 6.7 0.8 0.0 0.1 0.0 Wrekin Thurrock 23.949 25.709 1.760 7.3 0.8 0.0 0.2 0.0
Torbay 27.875 28.725 0.850 3.0 1.1 0.0 "0.5 0.0 Warrington 31.314 33.145 1.831 5.8 0.9 0.0 0.0 0.0 West Berkshire 20.923 21.877 0.954 4.6 0.8 0.0 "0.2 0.0 Windsor and 21.305 22.524 1.219 5.7 0.9 0.0 0.0 0.0 Maidenhead Wokingham 18.053 18.979 0.926 5.1 0.7 0.0 "0.1 0.0
York 28.268 29.695 1.427 5.0 1.0 0.0 "0.1 0.0
Isles of Scilly 0.522 0.547 0.024 4.7 0.8 0.0 "0.2 0.0
SHIRE COUNTIES Bedfordshire 57.569 61.699 4.131 7.2 1.0 0.0 0.2 0.0 Buckinghamshire 71.706 75.508 3.802 5.3 1.0 0.0 "0.1 0.0 Cambridgeshire 86.660 93.183 6.523 7.5 1.1 0.0 0.3 0.0 Cheshire 110.416 117.394 6.978 6.3 1.1 0.0 0.1 0.0 Cornwall 92.522 97.794 5.272 5.7 1.1 0.0 0.0 0.0 Cumbria 87.483 93.883 6.400 7.3 1.1 0.0 0.3 0.0 Derbyshire 132.030 139.569 7.539 5.7 1.2 0.0 0.0 0.0 Devon 123.558 128.695 5.137 4.2 1.2 0.0 "0.3 0.0 Dorset 64.619 68.924 4.305 6.7 1.2 0.0 0.2 0.0 Durham 99.084 105.077 5.993 6.0 1.2 0.0 0.1 0.0 East Sussex 89.755 93.217 3.461 3.9 1.2 0.0 "0.4 0.0 Essex 213.928 229.201 15.274 7.1 1.0 0.0 0.3 0.0 Gloucestershire 91.834 96.620 4.786 5.2 1.0 0.0 "0.1 0.0 Hampshire 178.463 189.830 11.367 6.4 1.0 0.0 0.1 0.0 Hertfordshire 177.558 188.168 10.610 6.0 1.0 0.0 0.0 0.0 Kent 218.170 227.080 8.910 4.1 1.0 0.0 "0.3 0.0 Lancashire 190.874 200.854 9.981 5.2 1.1 0.0 "0.1 0.0 Leicestershire 86.885 92.756 5.872 6.8 1.0 0.0 0.2 0.0 Lincolnshire 108.145 114.068 5.923 5.5 1.0 0.0 0.0 0.0 Norfolk 139.086 147.440 8.354 6.0 1.1 0.0 0.1 0.0 North 88.784 93.285 4.501 5.1 1.0 0.0 "0.1 0.0 Yorkshire Northamptonshire 96.913 102.008 5.095 5.3 0.9 0.0 "0.1 0.0 Northumberland 56.207 59.702 3.495 6.2 1.1 0.0 0.1 0.0 Nottinghamshire 123.718 130.984 7.266 5.9 1.1 0.0 0.0 0.0 Oxfordshire 94.903 100.164 5.261 5.5 1.0 0.0 0.0 0.0 Shropshire 48.854 51.594 2.740 5.6 1.1 0.0 0.0 0.0 Somerset 83.024 88.282 5.258 6.3 1.1 0.0 0.1 0.0 StaVordshire 126.383 134.961 8.577 6.8 1.1 0.0 0.2 0.0 SuVolk 110.560 117.745 7.185 6.5 1.1 0.0 0.1 0.0 Surrey 172.430 181.280 8.850 5.1 1.1 0.0 "0.1 0.0 Warwickshire 84.739 89.235 4.496 5.3 1.1 0.0 "0.1 0.0 West Sussex 126.748 131.301 4.553 3.6 1.1 0.0 "0.4 0.0 Wiltshire 66.355 70.109 3.754 5.7 1.0 0.0 0.0 0.0 Worcestershire 86.518 91.338 4.819 5.6 1.1 0.0 0.0 0.0 3178271130 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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4.1.3 Could the Department update table 4.1.4, setting out how the unit costs of the main social services for adults have changed over time? Could the Department quantify the degree of variation in these unit costs between authorities? Could the Department provide a commentary on these figures? [4.1.4] Answer 1. The unit cost figures in Table 4.1.3 show in cash and real terms (deflated by GDP at 2003–04 prices) the increases in selected unit costs for personal social services from 1999–2000 to 2003–04. The unit costs cover residential and nursing care for older people who are financially supported by the local authorities and hourly costs for home care services. Between 2002–03 and 2003–04 the unit cost for local authority residential care increased by 8% in real terms whilst the unit costs of independent residential care and home care increased by 4% in real terms. It is not possible to compare nursing care costs between these two years because of a change in the treatment of the nursing care element. 2. The real terms weekly unit cost for supporting older people in nursing care placements rose between 1999–2000 and 2000–01 but fell between 2000–01 and 2001–02 before rising again in 2002–03. It is not possible to compare nursing care costs between 2002–03 and 2003–04 because of a change in the treatment of the nursing care element. The real terms unit costs of supporting older people in local authority staVed residential care homes and in independent residential care homes increased each year between 1999–2000 and 2003–04. Costs in the independent sector (private and voluntary residential homes and nursing homes) represent the costs to local authorities in purchasing care, whereas the costs for local authority homes represent the full cost of running such homes, which are declining in number as homes are transferred out of local authority control. The rise in unit costs of residential care for older people may have been associated with better or more intensive services (more space, higher staV/resident ratios) and changes in cost or eYciency. 3.In 2003–04 the majority (84%) of older long stay supported residents were accommodated in independent sector (private and voluntary) residential care homes for older people, the proportion increasing from 75% in 1999–2000. Part of this increase may reflect the inclusion from 2002–03 of former Preserved Rights clients, nearly all of whom are in independent sector homes. 4. The real terms hourly unit cost for home help/care rose from £12.30 in 1999–2000 to £12.60 in 2001–02 before falling back to £12.40 in 2002–03 and rising again to £12.90 in 2003–04. There has been an increase in home care provision over the same period, with an increase from 2.7 million contact hours reported in 1999–2000 to 3.2 million contact hours in 2003–04.
Variation between Authorities
5. There is substantial variation between local authorities in these unit costs, as figures 4.1.3(a)–4.1.3(d) below demonstrate. Such wide variability of individual authority figures points to issues of data quality and there is a risk that misreporting of data by local authorities has had an eVect. In examining unit costs it is likely that extreme high or low values are the result of misreporting of expenditure data by local authorities. It is however notable that even if the more extreme figures are discounted significant variation remains. The Department believes that it would be very helpful for information provided by local authorities to be used in monitoring social services, as this would act as an incentive for councils to improve their management information generally. However, this desire must be balanced against the autonomy of local authorities in allocating their resources and incurring expenditure according to locally determined priorities and local accountability. 6. Figures 4.1.3(a) to 4.1.3(d) show the unit cost values calculated using expenditure data for 2003–04. Where a local authority has reported activity but no expenditure (an implied zero unit cost) they have been excluded from the charts. 7. Figure 4.1.3(a) shows the weekly unit cost for older people in nursing homes in 2003–04. The average weekly unit cost for England was £383 in 2003–04 ranging from under £200 a week in three authorities (Barnsley, Redcar and Cleveland and Stockton on Tees) to more than £700 a week in one authority (Barnet). The middle 50% of the authorities had a unit cost between £338 and £459. 8. The weekly unit cost for residents aged 65 or over in local authority residential homes in 2003–04 is shown in Figure 4.1.3(b). The average for England was £549, with the middle 50% of authorities havinga unit cost between £478 and £703. Three authorities recorded a unit cost of under £100 (Manchester, Milton Keynes and Wigan). Four authorities had a unit cost greater than £1,500 per week (Camden, North East Lincolnshire, Oldham and Oxfordshire). 9. The weekly cost for residents aged 65 or over in independent (private or voluntary) residential homes during 2003–04 for individual authorities is shown in Figure 4.1.3(c). For individual authorities this unit cost varied from under £250 for four authorities (Barnsley, Oldham, Redcar and Cleveland and Torbay) to over £500 in one authority (Islington). The average for England was £335, with the middle 50% of authorities having a unit cost between £307 and £387. 3178271130 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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10. Figure 4.1.3(d) shows the hourly cost of home help/care for individual authorities in 2003–04. The hourly cost varied from £8 to £23, with two thirds of authorities having a unit cost of between £11 and £15 per hour. The average hourly unit cost for England was £12.90. The middle 50% of authorities had a unit cost between £12.00 and £14.70. 11. Variations between authorities in unit costs are to be expected as the demand for services varies, prices will be aVected by regional wage rates (for example higher prices in the South East), and supply factors such as the number of residential care homes will have a bearing. Variations between authorities in dependency of clients may also be relevant. 12. The Performance Assessment Framework for Personal Social Services introduced in 1999 consists of some 50 indicators; seven of these relate to cost and eYciency for services for adults and older people. These are:
Indicator Service area B11 Intensive home care as a percentage of intensive home and residential care Adults B12 Cost of intensive social care for adults and older people Adults B13 Unit cost of residential and nursing care for older people Adults B14 Unit cost of residential and nursing care for adults with learning disabilities Adults B15 Unit cost of residential and nursing care for adults with mental illness Adults B16 Unit cost of residential and nursing care for adults with physical disabilities Adults B17 Unit cost of home care for adults and older people Adults
13. Indicator B12 has been made a Best Value Performance Indicator. Councils have been required to set annual targets for improvement for these indicators consistent with achieving the current top quartile for their family group (Inner London Boroughs, Outer London Boroughs, Metropolitan Boroughs, Unitaries, County Councils (Shires)) over five years. However, these targets have now been withdrawn because of concerns that driving down costs could damage quality. Instead the benchmark unit cost is set as the median (middle) value in groups of councils that face similar costs.
Table 4.1.3 UNIT COSTS (£s) OF SELECTED PERSONAL SOCIAL SERVICES ENGLAND 1999–2000 to 2003–04 £ Unit Cost 1999–2000 2000–01 2001–02 2002–03 2003–04 (est) Gross expenditure per week on supporting residents aged 65 and Cash terms 341 368 368 394 383 over in nursing care(1), (2), (3), (4) Real terms(7) 375 400 390 404 383
Gross expenditure per week on supporting residents aged 65 and over in local authority residential Cash terms 382 426 446 494 549 care(1), (2), (3), (4) Real terms(7) 420 462 472 507 549
Gross expenditure per week on supporting residents aged 65 and over in independent residential Cash terms 271 279 286 313 335 care(1), (2), (3), (4) Real terms(7) 298 302 303 321 335
Gross expenditure per hour of home care for all clients aged 18 Cash terms 11.2 11.4 11.9 12.1 12.9 or over(1), (6) Real terms(7) 12.3 12.4 12.6 12.4 12.9 Notes 1. From 2000–01 total costs (ie total gross current expenditure ! capital costs) as reported on form PSS EX1 are used to calculate unit costs. Expenditure includes a full share of Social Services Management and Support Services (SSMSS) costs. For 1999–2000 gross current expenditure as reported on form RO3 has been used to calculate unit costs; an estimated share of SSMSS costs has been included. 2. From 2000-01 these unit costs have been calculated by taking total costs throughout the year for residential and nursing care placements as appropriate and dividing by the number of weeks older people were supported in such care during the year. A supported resident is one who is supported wholly or in part by the local authority. Residents in local authority homes who are assessed to pay the full costs and residents in other homes whose fees are paid in part or in full or through income support have been included where the relevant expenditure is included in the numerator. 3178271131 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 234 Health Committee: Evidence
3. For 1999–2000 these unit costs have been calculated by taking gross current expenditure throughout the year on residential and nursing homes as appropriate and dividing it by the average number of supported residents in such homes reported at 31 March in consecutive years. Nursing homes includes nursing places in dual registered homes; residential homes includes residential places in dual registered homes. A supported resident is one who is supported wholly or in part by the local authority. Residents in local authority homes who are assessed to pay the full costs and residents in other homes whose fees are paid in part or through income support are not included. 4. From 2003–04 the costs of nursing care placements exclude the nursing costs which have been paid by the NHS from 1 April 2003. 5. The definition of local authority care excludes expenditure on people placed in the home of another local authority. This expenditure is included in the independent sector expenditure. 6. This unit cost is calculated by taking gross current expenditure throughout the year on home care services and dividing it by activity data collected during a sample week in September. 7. Deflated using the GDP deflator at 2003–04 prices.
Figure 4.1.3(a): GROSS WEEKLY COST PER PERSON OF NURSING CARE FOR OLDER PEOPLE, ENGLAND 50 2003-04
40
30
20 No. of authorities
10
0 250 or 251-300 301-350 351-400 401-450 451-500 501+ less
£ per week 3178271131 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Figure 4.1.3(b): GROSS WEEKLY COST PER PERSON OF LOCAL AUTHORITY RESIDENTIAL CARE FOR OLDER PEOPLE, ENGLAND 2003-04
18 16 14 12 10 8 6
No. of authorities 4 2 0 350 351- 401- 451- 501- 551- 601- 651- 701- 751- 801- 851- 901+ or 400 450 500 550 600 650 700 750 800 850 900 less £ per week
Figure 4.1.3(c): GROSS WEEKLY COST PER PERSON OF RESIDENTIAL CARE IN INDEPENDEN T RESIDENTIAL CARE HOMES FOR OLDER PEOPLE, ENGLAND 2003-04 70
60
50
40
30 No. of authorities 20
10
0 250 or less 251-300 301-350 351-400 401-450 451-500 501+
£ per week 3178271132 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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4.1.4 Could the Department update tables 4.1.5., showing for each authority the latest information on the proportion of social services for adults which are purchased from the independent sector rather than being provided directly? Could the Department supply a commentary on these figures? [4.1.5] Answer 1. Table 4.1.4(a) shows for each authority the percentage contribution of the independent sector in respect of two main elements of community-based social services for adults (contact hours of home help/ care and the percentage of local authority supported residents in independent sector residential care homes). Councils are continuing to make increased use of the independent sector. 2. For England as a whole, the independent sector provided 69% of the total contact hours of home help/ care in 2004, as compared with 66% in 2003 and 2% in 1992, prior to the introduction of the Community Care Reforms of 1993. Use of the independent sector varies considerably between authorities and between services within authorities. 14% of authorities have less than 50% of their home help/care services provided by the independent sector and five authorities have all their provision from the independent sector. The variations in the use of the independent sector may reflect historical patterns of provision, local needs and local political priorities. 3. Local authorities place and financially support significant numbers of clients in independent sector residential care homes—83% of all local authority supported residents in residential care (excluding unstaVed homes). This represents a slight increase on the 2003 figure of 82%. Over the last few years a substantial number of authorities have transferred some of their homes to independent ownership. There is some variation in the use of the independent sector. There are three local authorities where all supported residents are completely in independent sector homes, just 2% of councils have less than 50% of their supported residents in independent sector homes. 4. Table 4.1.4(b) shows for supported residents how those in the independent sector are split between private and voluntary homes. Overall, 13% of supported residents in England are in voluntary homes and 70% in private homes, though the figures for some authorities show a markedlydiVerent pattern. 3178271133 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Table 4.1.4 (a) PERCENTAGE OF SOCIAL SERVICES FOR ADULTS WHICH ARE PURCHASED BY THE LOCAL AUTHORITY FROM THE INDEPENDENT SECTOR: ENGLAND: 2004(1)
Percentage Supported residents in Government OYce region and local Contact hours of home residential care authority help/care (2)(3)(4) ENGLAND 69.3 83.0 NORTH EAST Shire Counties Durham 73.3 87.0 Northumberland 60.2 91.7 Unitary Authorities Darlington 58.8 99.1 Hartlepool 83.8 97.3 Middlesbrough 70.7 78.9 Redcar & Cleveland 67.4 76.6 Stockton-on-Tees 74.8 88.8 Metropolitan Districts Gateshead 36.8 84.2 Newcastle-upon-Tyne 69.1 89.4 North Tyneside 27.2 83.5 South Tyneside 63.4 78.3 Sunderland 37.9 81.0 NORTH WEST Shire Counties Cheshire 47.6 89.1 Cumbria 59.6 59.7 Lancashire 93.1 85.0 Unitary Authorites Blackburn with Darwen 56.9 76.6 Blackpool 56.5 88.6 Halton 89.6 85.1 Warrington 78.9 82.8 Metropolitan Districts Bolton 39.3 73.2 Bury 61.1 76.8 Knowsley 68.2 93.7 Liverpool 63.1 93.9 Manchester 75.0 97.3 Oldham 36.8 74.5 Rochdale 52.2 90.2 Salford 75.7 80.9 Sefton 84.3 87.4 St Helens 77.9 61.4 Stockport 44.6 99.0 Tameside 64.8 82.4 TraVord 39.2 35.9 Wigan 45.2 92.9 Wirral 80.0 81.4 YORKSHIRE & THE HUMBER Shire Counties North Yorkshire 68.4 66.3 Unitary Authorities East Riding 83.5 95.5 Kingston-upon-Hull 64.9 93.3 N E Lincolnshire 74.6 95.5 North Lincolnshire 80.0 89.7 York 47.3 60.9 3178271133 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Percentage Supported residents in Government OYce region and local Contact hours of home residential care authority help/care (2)(3)(4) Metropolitan Districts Barnsley 51.5 90.3 Bradford 55.7 72.3 Calderdale 50.6 95.9 Doncaster 59.0 77.3 Kirklees 48.9 76.6 Leeds 30.2 69.0 Rotherham 58.6 79.2 SheYeld 47.6 86.3 Wakefield 42.6 82.4 EAST MIDLANDS Shire Counties Derbyshire 38.8 70.4 Leicestershire 84.0 82.0 Lincolnshire 70.4 93.5 Northamptonshire 69.9 73.0 Nottinghamshire 66.2 80.2 Unitary Authorities Derby 46.4 68.7 Leicester 78.0 81.6 Nottingham 72.8 83.7 Rutland 44.7 71.5 WEST MIDLANDS Shire Counties Shropshire 90.5 92.4 StaVordshire 56.2 68.5 Warwickshire 64.9 82.0 Worcestershire 62.1 92.7 Unitary Authorities Herefordshire 80.1 75.2 Stoke-on-Trent 80.2 56.8 The Wrekin 85.4 95.7 Metropolitan Districts Birmingham 65.1 61.7 Coventry 72.1 87.2 Dudley 37.7 80.4 Sandwell 78.5 73.4 Solihull 78.7 93.4 Walsall 88.8 67.2 Wolverhampton 81.6 67.5 SOUTH WEST Shire Counties Cornwall 65.2 98.9 Devon 71.9 82.8 Dorset 54.4 75.5 Gloucestershire 73.2 94.2 Isles of Scilly 93.5 58.3 Somerset 54.2 89.9 Wiltshire 82.9 91.0 Unitary Authorities Bath & N E Somerset 55.0 73.4 Bournemouth 71.7 82.5 Bristol 42.5 61.6 North Somerset 52.3 98.1 Plymouth 72.6 88.6 Poole 70.7 92.8 South Gloucestershire 63.1 68.4 3178271133 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Percentage Supported residents in Government OYce region and local Contact hours of home residential care authority help/care (2)(3)(4) Swindon 77.7 77.9 Torbay 64.1 95.0 EASTERN Shire Counties Bedfordshire 73.0 92.2 Cambridgeshire 78.1 93.7 Essex 87.8 89.3 Hertfordshire 100.0 99.4 Norfolk 44.7 83.4 SuVolk 73.0 75.8 Unitary Authorities Luton 67.3 56.8 Peterborough 93.9 67.3 Southend 87.1 93.0 Thurrock 78.0 81.4 LONDON Inner London Camden 80.2 76.6 Greenwich 84.0 73.7 Hackney 56.2 94.3 Hammersmith & Fulham 77.8 91.4 Islington 84.8 85.5 Kensington & Chelsea 73.7 70.9 Lambeth 100.0 95.6 Lewisham 81.1 100.0 Southwark 100.0 100.0 Tower Hamlets 66.7 99.9 Wandsworth 72.7 86.3 Westminster 99.7 87.8 City of London 29.5 96.7 Outer London Barking & Dagenham 76.5 67.0 Barnet 100.0 98.0 Bexley 98.7 100.0 Brent 100.0 78.2 Bromley 63.3 98.4 Croydon 80.6 76.2 Ealing 78.0 82.6 Enfield 79.1 84.1 Haringey 78.3 73.0 Harrow 97.1 98.4 Havering 84.8 77.4 Hillingdon 73.7 88.3 Hounslow 75.1 77.6 Kingston-upon-Thames 71.6 74.8 Merton 75.0 94.1 Newham 78.3 89.7 Redbridge 78.6 96.1 Richmond-upon-Thames 77.4 95.5 Sutton 73.6 77.6 Waltham Forest 58.5 42.2 SOUTH EAST Shire Counties Buckinghamshire 72.0 98.3 East Sussex 88.8 89.4 Hampshire 81.9 67.4 Kent 81.5 89.7 Oxfordshire 70.1 94.0 Surrey 68.2 88.1 3178271133 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Percentage Supported residents in Government OYce region and local Contact hours of home residential care authority help/care (2)(3)(4) West Sussex 65.4 77.9 Unitary Authorities Bracknell Forest 78.3 61.8 Brighton & Hove 90.1 90.1 Isle of Wight 64.6 94.7 Medway Towns 94.9 84.4 Milton Keynes 62.7 92.7 Portsmouth 85.7 62.1 Reading 60.3 64.1 Slough 62.0 54.6 Southhampton 83.3 81.6 West Berkshire 83.0 70.8 Windsor & Maidenhead 69.4 74.2 Wokingham 77.1 76.8
Notes 1. Data collected on DH annual returns HH1 (home help) for a survey week during September 2004, and SR1 (supported residents) as at 31 March 2004. 2. These figures do not include clients supported by local authorities in nursing care homes, which are all in the independent sector, or clients supported in any unstaVed homes. 3. Includes residents supported in other authorities. 4. Data includes clients formerly in receipt of preserved rights and Boyd Loophole residents.
Table 4.1.4 (b) PERCENTAGE OF SUPPORTED RESIDENTS IN INDEPENDENT RESIDENTIAL CARE SPLIT BY SECTOR IN 2004(1)(2)(3)(4)
Government OYce region and local authority Percentages Voluntary Private ENGLAND 13.0 69.9 NORTH EAST Shire Counties Durham 2.2 84.8 Northumberland 11.1 80.5 Unitary Authorities Darlington 10.8 88.3 Hartlepool 21.9 75.4 Middlesbrough 5.0 73.9 Redcar & Cleveland 9.3 67.3 Stockton-on-Tees 0.1 88.6 Metropolitan Districts Gateshead 6.9 77.3 Newcastle-upon-Tyne 0.0 89.4 North Tyneside 2.8 80.7 South Tyneside 7.5 70.8 Sunderland 7.5 73.6 NORTH WEST Shire Counties Cheshire 36.1 53.0 Cumbria 12.7 47.0 Lancashire 6.5 78.6 Unitary Authorites Blackburn with Darwen 3.7 72.9 Blackpool 6.1 82.5 Halton 19.7 65.4 Warrington 24.9 57.8 3178271134 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Government OYce region and local authority Percentages Voluntary Private Metropolitan Districts Bolton 6.7 66.5 Bury 14.5 62.3 Knowsley 23.5 70.2 Liverpool 6.0 87.9 Manchester 41.4 55.9 Oldham 9.5 65.0 Rochdale 4.6 85.5 Salford 10.9 69.9 Sefton 15.8 71.7 St Helens 20.2 41.3 Stockport 36.1 62.9 Tameside 0.9 81.5 TraVord 9.2 26.8 Wigan 47.4 45.5 Wirral 12.3 69.1 YORKSHIRE & THE HUMBER Shire Counties North Yorkshire 15.3 51.1 Unitary Authorities East Riding 0.0 95.5 Kingston-upon-Hull 23.9 69.4 N E Lincolnshire 0.0 95.5 North Lincolnshire 6.1 83.6 York 13.2 47.7 Metropolitan Districts Barnsley 0.4 90.0 Bradford 1.3 71.0 Calderdale 0.0 95.9 Doncaster 5.9 71.4 Kirklees 13.5 63.1 Leeds 18.6 50.4 Rotherham 0.0 79.2 SheYeld 12.5 73.9 Wakefield 0.5 81.9 EAST MIDLANDS Shire Counties Derbyshire 4.6 65.8 Leicestershire 8.0 74.0 Lincolnshire 0.0 93.5 Northamptonshire 10.9 62.1 Nottinghamshire 0.2 79.9 Unitary Authorities Derby 12.0 56.7 Leicester 11.5 70.1 Nottingham 8.4 75.3 Rutland 5.8 65.7 WEST MIDLANDS Shire Counties Shropshire 32.5 59.9 StaVordshire 3.8 64.6 Warwickshire 24.5 57.6 Worcestershire 14.6 78.1 Unitary Authorities Herefordshire 9.6 65.6 Stoke-on-Trent 6.8 49.9 The Wrekin 0.0 95.7 Metropolitan Districts 3178271134 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Government OYce region and local authority Percentages Voluntary Private Birmingham 13.2 48.5 Coventry 13.3 74.0 Dudley 5.0 75.4 Sandwell 10.6 62.8 Solihull 9.0 84.3 Walsall 7.1 60.1 Wolverhampton 9.9 57.6 SOUTH WEST Shire Counties Cornwall 19.9 79.0 Devon 15.0 67.8 Dorset 0.0 75.5 Gloucestershire 31.4 62.8 Isles of Scilly 0.0 58.3 Somerset 2.2 87.7 Wiltshire 34.6 56.3 Unitary Authorities Bath & N E Somerset 22.6 50.8 Bournemouth 0.0 82.5 Bristol 17.8 43.8 North Somerset 7.6 90.5 Plymouth 13.8 74.9 Poole 6.1 86.7 South Gloucestershire 23.4 45.0 Swindon 16.6 61.3 Torbay 9.3 85.8 EASTERN Shire Counties Bedfordshire 9.5 82.7 Cambridgeshire 0.1 93.5 Essex 0.0 89.3 Hertfordshire 18.3 81.1 Norfolk 9.3 74.1 SuVolk 16.4 59.4 Unitary Authorities Luton 0.0 56.8 Peterborough 0.0 67.3 Southend 0.0 93.0 Thurrock 5.3 76.1 LONDON Inner London Camden 0.0 76.6 Greenwich 19.1 54.6 Hackney 24.5 69.8 Hammersmith & Fulham 13.5 77.9 Islington 37.9 47.6 Kensington & Chelsea 31.5 39.5 Lambeth 26.4 69.1 Lewisham 0.0 100.0 Southwark 36.2 63.8 Tower Hamlets 27.0 72.9 Wandsworth 23.6 62.8 Westminster 87.8 0.0 City of London 73.3 23.3 Outer London Barking & Dagenham 1.8 65.3 Barnet 59.3 38.7 Bexley 83.2 16.8 Brent 6.9 71.4 3178271134 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Government OYce region and local authority Percentages Voluntary Private Bromley 16.7 81.7 Croydon 24.6 51.6 Ealing 38.5 44.2 Enfield 8.7 75.4 Haringey 17.8 55.1 Harrow 34.9 63.4 Havering 5.1 72.3 Hillingdon 5.0 83.3 Hounslow 29.2 48.5 Kingston-upon-Thames 32.9 41.9 Merton 2.7 91.4 Newham 0.0 89.7 Redbridge 96.1 0.0 Richmond-upon-Thames 33.7 61.7 Sutton 0.0 77.6 Waltham Forest 0.5 41.6 SOUTH EAST Shire Counties Buckinghamshire 66.7 31.6 East Sussex 0.0 89.4 Hampshire 12.8 54.6 Kent 11.4 78.3 Oxfordshire 0.0 94.0 Surrey 22.1 66.0 West Sussex 15.2 62.7 Unitary Authorities Bracknell Forest 5.0 56.9 Brighton & Hove 11.7 78.4 Isle of Wight 3.4 91.3 Medway Towns 12.2 72.2 Milton Keynes 26.4 66.2 Portsmouth 5.3 56.8 Reading 17.7 46.4 Slough 13.1 41.4 Southhampton 7.8 73.8 West Berkshire 24.6 46.3 Windsor & Maidenhead 19.5 54.6 Wokingham 25.3 51.5
Notes 1. Data collected on DH annual returns HH1 (home help) for a survey week during September 2004, and SR1 (supported residents) as at 31 March 2004. 2. These figures do not include clients supported by local authorities in nursing care homes, which are all in the independent sector, or clients supported in any unstaVed homes. 3. Includes residents supported in other authorities. 4. Data includes clients formerly in receipt of preserved rights and Boyd Loophole residents.
4.1.5 Could the Department please provide an update of the information provided in response to last year’s questionnaire relating to the specific inflation index calculated for social services, and the financial eVect of demographic pressures on social services? [4.1.6] Answer 1. The Department of Health produces a Personal Social Services pay and prices index, which is a weighted average of changes in pay, prices and (in the two most recent years) capital costs for the sector. The index covers services for children and adults and covers services directly provided by local authorities and services purchased from independent sector providers. 2. StaV costs are estimated to account for approximately 80% of PSS gross expenditure, capital for approximately 10% and non-staV revenue costs for approximately 10%. This is on the basis that wages paid by independent sector providers to their staV are treated as staV costs. 3178271135 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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3. Changes in pay are based on Annual Survey of Hours and Earnings (ASHE) data on the earnings of staV groups working in social services weighted by their respective share of the pay-bill. Changes in prices are based on the Gross Domestic Product (market prices) deflator. Changes in capital are based on the Tender Price Index of Public Sector Building (non-housing), compiled by DTI. 4. The PSS Pay and Prices index is set out in the Table 4.1.5(a) for the latest three years.
Table 4.1.5(a)
PSS PAY AND PRICE INDEX
% increase Year over previous year April 2002 4.4 April 2003(1) 6.1 April 2004 4.3
Notes: 1. The index for 2003 has been revised in the light of the replacement of the New Earnings Survey with ASHE in 2004, the inclusion of capital in the index and revisions by HM Treasury to the GDP deflator. The figure for 2002 has not been revised. 5. The interpretation of this table is that, for example, PSS pay and prices rose by approximately 4.3% between April 2003 and April 2004. The index runs from April to April because the NES/ASHE data are collected in April.
The financial eVect of demographic changes
6. The Department’s estimates of the notional financial consequences of demographic changes on social services are set out in Table 4.1.5(b) below. These figures were estimated for Spending Review 2004 and have not been changed since last year. Please note only demographic pressures for adult social services are included, as children’s social services are now the responsibility of the Department for Education and Skills. 7. The calculation is based on estimated population changes in younger adults (18–64) and people aged 65 and over. The younger adult age group is further separated into two age bands: 18–44 and 45–64. The older people’s age group is further broken down into five-year age bands: 65–69 years, 70–74 years, 75–79 years, 80–84 years and 85 years and over. For this age group the analysis is also split by gender. 8. Local authority expenditure returns are used to divide total expenditure into children, older people and younger adults’ age groups. 9. Expenditure on older people is additionally separated into four diVerent categories of service: residential PSS, home care, meals and day centres. Growth in demography by age group is estimated for each of the four service areas by the Personal Social Services Research Unit in their “Financing of long-term care project” funded by the Department of Health. This takes into account both the change in the size of the population and also the age profile of population. Resource use tends to rise with age, which means that an ageing population will create additional demand for personal social services.
Table 4.1.5(b)
NOTIONAL FINANCIAL EFFECT ON PSS OF DEMOGRAPHIC PRESSURES
% increase over Year previous year 2005–06 1.0 2006–07 1.6 2007–08 1.4
10. The interpretation of this table is that, for example, on the basis of these estimations, resources for social services need to increase by 1.4% between 2006–07 and 2007–08 in order to keep pace with changes in the age composition of the population, assuming that all other relevant factors remain constant. 4.1.6 Could the Department provide an update of Table 4.1.7 and Figure 4.1.7? [4.1.7] (excluding data on children and families). 3178271135 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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Answer 1. The information requested is given in Tables 4.1.6(a) to (c) and Figures 4.1.6(a) and (b).
Table 4.1.6(a) PSS GROSS EXPENDITURE, 2003–04 England £m Adults aged under 65 with: Total Older a physical learning mental Asylum adults and People1 disabilty or disabilities1 health seekers older people (aged 65 or sensory needs1 and other over) impairment1 adults1 Service strategy 62 ...... Assessment and care management 1,344 737 200 153 255 .. Residential care2 6,314 4,259 330 1,401 324 .. Non-residential care 4,415 2,380 614 1,056 365 .. Supporting People3 585 196 26 239 124 .. Other 3,830 2,184 588 817 241 .. Asylum seekers and other adults 703 ...... 703 Total 12,837 7,376 1,144 2,609 944 703
. Not applicable .. Not available Source: PSS EX1 return 1. In accordance with CIPFA guidance, a number of Support Management costs are reallocated to individual client groups. 2. Excludes the nursing care element which the NHSpays from 1 April 2003. 3. Expenditure funded from the ODPM Supporting People grant introduced in 2003–04 and classified as social services expenditure.
Table 4.1.6(b) PSS GROSS EXPENDITURE, 2002–03 England £m Adults aged under 65 with: Total Older a physical learning mental Asylum adults and People1 disabilty or disabilities1 health seekers older people (aged 65 or sensory needs1 and other over) impairment1 adults1 Service strategy 62 ...... Assessment and care management 1,175 622 181 137 235 .. Residential care 6,315 4,246 345 1,385 338 .. Non-residential care 3,486 1,992 521 732 242 .. Asylum seekers and other adults 664 ...... 664 Total 11,702 6,860 1,047 2,253 815 664
. Not applicable .. Not available Source: PSS EX1 return 1. In accordance with CIPFA guidance, a number of Support Management costs are reallocated to individual client groups. 3178271136 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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FIGURE 4.1.6(a): PSS GROSS EXPENDITURE, 2002-03 AND 2003-04 BY PROVISION OF SERVICE 8
7
6
5 £ billions
4
3
2
1
0 Residential Care* Non Residential Care** Assessment and Care Management Asylum seekers and other adults Service strategy
2002-03 2003-04 * In 2003-04 excludes the nursing care element of nursing care placement costs as this is now paid by the NHS. ** In 2003-04 includes £0.6bn funded from the ODPM Supporting People grant and classified as social services expenditure.
FIGURE 4.1.6(b): PSS GROSS EXPENDITURE, 2002-03 and 2003-04* BY CLIENT GROUP 8
7
6
5
4 £ billions
3
2
1
0 Older people Adults under 65 with learning Adults under 65 with a physical Adults under 65 with Asylum seekers and Service strategy disabilities disability mental health needs other adults
2002-03 2003-04
* In 2003-04 includes expenditure funded from the ODPM Supporting People grant and classified as social services expenditure but excludes the nursing care element of nursing care placement costs as this is now paid by the NHS. 3178271136 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 247 8 £m 1,400.7 3.3 61.9 016.3 2,312.8 2,609.4 3,946.9 4,357.8 4,258.9 6,537.2 7,041.2 7,375.8 2,002.4 2,044.5 2,380.0 .6 11,096.9 12,009.9 12,837.9 01 2001–02 2002–03 2003–04 13.7 123.5 140.4 152.7 165.8 168.8 186.1 199.9 4 208.4 228.6 241.1 254.8 9 540.0 587.8 638.9 737.0 71.3 726.5 679.1 681.8 702.8 payment of this from 1 April 2003. oduced in 2003–04 and classified as social services expenditure. Table 4.1.6 (c) PSS GROSS EXPENDITURE, 2003–04 PRICES 91.9 126.2 147.9 173.0 181.1 194.4 208.6 234.7 244.7 238.8 247.9 365.2 91.6 150.4 166.1 187.555.8 214.2 229.7 130.6 244.3 146.5 266.5 180.5 279.8 219.1 291.8 239.0 354.5 250.7 330.4 265.5 281.7 296.5 347.0 324.0 274.6421.4792.9 540.9 635.3 552.9 1,051.2 730.7147.8 616.8 1,208.9 771.2 1,326.7 687.3 809.0 1,430.7 362.3 786.8 1,522.7 840.5 427.4 847.6 1,675.7 915.4 498.0 1,795.3 939.4 1,901.0 931.8 1,013.6 553.9 2, 1,101.8 981.1 591.7 1,176.5 1,074.8 632.3 1,421.3 1,143. 695.6 734.8 763.9 836.0 944.0 100.2 106.4 106.4 98.9 92.1 96.4 85.4 92.1 ...... 180.6371.5 301.3 349.6 409.0 428.9 422.6 493.7 439.4 527.2 450.4 533.5 499.5 559.6 486.2 622.3 520.5 665.5 534.2 685.6 613.5 716.3 751.1 1,056.1 1,210.0 1,462.8 1,653.4 1,723.2 1,736.0 1,772.5 1,798.7 1,890.1 1,964.1 1,569.32,779.3 2,188.0 2,393.8 3,981.8 2,797.8 4,495.1 3,179.5 4,989.0 3,383.1 5,416.5 3,564.2 5,648.4 3,796.2 5,847.1 3,897.4 6,204.2 6,401.5 6,554.0 7,429.2 7,022.4 7,796.2 8,431.4 8,888.0 9,395.8 10,159.1 10,832 1993–94 1994–95 1994–95 1995–96 1996–97 1997–98 1998–99 1999–2000 2000– central admin.) central admin.) (with unallocated (with unallocated (with allocated central admin) 1,2 2 2 2 2 1 1 1 1 RO3 and PSS EX1 returns cers/Senior Managers .. 150.5 ...... Y 1,2 1,2 1,2 1,2 2. Includes expenditure funded from the ODPM Supporting People grant intr 1. From 2003–04 excludes the nursing care costs element as the NHStook over Source: Total adults and older people Unallocated central admin. 1,522.0 1,125.5 ...... Area O Residential care Residential care Field Social Work 921.0 ...... Occupational Therapy 47.8 51.0 51.0 46.8 54.0 54.5 74.6 86.2 ...... Adults aged under 65 withAssessment mental and health care needs management .. 105.5 133.0 144.5 153.6 158.3 173.0 195. Residential care Residential care Non-residential care Older people (aged 65 orAssessment over) and care management .. 330.9 447.9 468.0 501.0 492.8 484.2 517. Total Total Total Asylum seekers and other adults 116.4 103.2 110.7 107.3 114.0 168.7 233.6 3 Included in the above: Training Non-residential care Non-residential care Total Adults aged under 65 withAssessment learning and disabilities care managementNon-residential care .. 69.3 98.3 112.2 110.4 115.5 114.1 116.1 1 Adults aged under 65 withor a sensory physical impairment disability Assessment and care management .. 89.3 119.6 134.2 134.5 139.8 145.7 149.4 England Service strategy .. 113.8 145.0 147.7 145.1 147.5 166.5 177.4 137.0 119.3 6 3178271138 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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4.1.7 Since April 2004 CSCI has been responsible for leading the work on performance indicators. Could the Department indicate how the new PSS adult services indicators diVer from those used by the Department of Health since 1999? Answer 1. The Commission for Social Care Inspection (CSCI) became responsible for setting the definition of the high level set of PSS Performance Assessment Framework Indicators from 2004–05. 2. Over the last two years, CSCI has advanced some refinements to the definitions of existing indicators of adult services. 3. After consultation with local authorities and the Department of Health, CSCI have made improvements to the following indicators: — four performance indicators that assess how social services users are helped to live at home (AO/C29–32); — permanent admissions to residential and nursing care (AO/C26 and C27)); — the introduction of two new indicators on participation in drug treatment programmes (AO/A60); and — on services for carers for adult social services (AO/C62). 4. Four indicators on unit costs of residential and nursing care (AO/B13–B17) and an indicator on new assessments of older people (AO/E61) have been dropped as performance indicators, although the Department will still have access to data allowing us to assess improvement in both fields. 5. CSCI announced the indicator set for 2005–06 in August 2005. This includes two new measures from council surveys of older people receiving home care—due to be carried out in February 2006. 6. CSCI has also brought in three “key threshold” measures which are not applied as performance indicators, but are of importance in assessing some of its further indicators on ethnicity (AO/E47 and E48). Those further indicators require Councils to ensure that client records for assessments and service use are not missing data on ethnicity and that the same applies for directly employed staV. 7. These changes have improved the robustness of some indicators and expanded the breadth of the evidence included in the set of PIs. 8. CSCI have stated that their intention is to use indicators that reflect more strongly issues of importance to users and carers and to focus more on outcomes. We understand that further work is currently being undertaken by CSCI in collaboration with the Department, the Healthcare Commission and councils to enable further proposals for improved indicators. 9. Internet references for CSCI’s 2004–05 and 2005–06 performance indicators for adults are detailed below: http://www.csci.org.uk/council–performance/paf/pss–paf–indicator–definitions–2004–5.pdf http://www.csci.org.uk/council–performance/paf/pi–letter–2005-05–plus–attachments.pdf
4.1.8 Can the Department provide information on local authority bandings for adult performance indicators? Answer 1. The Commission for Social Care Inspection (CSCI) bands each council for its performance against each of the performance indicators it applies. 2. In the main the bands for each indicator range from band 1 which means “Investigate Urgently” to band 5 which indicates “Very Good”. 3. Bands are intended to be a guide rather than a definitive judgement. The bandings help as a first step in understanding a council’s performance against a particular indicator. We understand that CSCI reviews such bandings annually and relies on the views and judgements of key external stakeholders when setting each. 4. The proportion of councils achieving band 3 or better against a particular indicator in 2003–04 varies from 43% for indicator AO/E47 on ethnicity of individual older people receiving an assessment, to 98% for indicators AO/C26 and AO/C27, on the admissions of supported residents to residential or nursing care. 5. Similarly the proportion of councils achieving the highest band for the indicator ranges from 0% for indicator AO/C51 on direct payments, to 85% for indicator AO/E61, for assessments of new clients aged 65 and over. 6. Further details about the bands for the 2003–04 indicators for each council are given in the CSCI publication Social Services Performance Assessment Framework Indicators 2003–04 available at: www.csci.org.uk/council–performance/paf/paf–reports.htm 7. The national summary of the performance section of this publication provides a summary of the proportion of councils achieving diVerent bands for each indicator. Annex B provides the actual levels for each band for each indicator and Annex A provides a more detailed explanation of the bands. 3178271138 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
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8. In 2004–05 CSCI has made the bandings for three indicators more demanding (the 2004–05 PI set will be published on December 1st 2005). Those changes accord with related policy expectations announced by Ministers. The three PIs concerned are: — percentage of items of equipment delivered within seven working days (AO/D54); — acceptable waiting times for assessments (AO/D55); and — acceptable waiting times for care packages (AO/D56).
4.2 Fees, charges and grants 4.2.1 Could the Department provide an update of Tables 4.2.1 and Figures 4.2.1? [4.2.1] (excluding data on children and families). Answer 1. Table 4.2.1(a) updates last year’s information and provides separate figures on residential care for each client group. Figures 4.2.1(a) and 4.2.1(b) illustrate the recent national trends in the percentage of gross expenditure on home care/home help for all client groups recouped through sales, fees and charges and the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges. The charges are not a social services fixed rate. 2. The table shows that the percentage of gross expenditure recouped in sales, fees and charges for residential care for older people fell from 38% in 2001–02 to 36% in 2002–03 and 32% in 2003–04. The main reason for this is that prior to April 2002, higher rates of income support were available to people entering independent homes compared with councils’ own homes. The chief element of income support accounting for the higher rate is residential allowance (which equates to housing benefit and was introduced in 1993 to give independent residential care an edge over council homes). Most income support is taken into account by the means-test for residential care. Therefore the more people entering independent residential care prior to 2002, the greater the fees and charges councils would recoup—the amount recouped rose from £1,434 million in 2001–02 to £1,531 million in 2002–03. It, however, fell back to £1,377 million in 2003–04. Note that residential allowance is no longer available to individuals entering independent care homes. Transitional arrangements were in place for residents in receipt of the residential allowance prior to April 2002. It ceased entirely for existing residents from October 2003. The fall in the recoupment rate in 2002–03 may, in part, reflect the inclusion of former Preserved Rights clients for whom local authorities assumed responsibility in April 2002. The fall in 2003–04 may, in part, reflect the abolition of the residential allowance. 3. The amount recouped for home care and home help service has remained fairly static at just over £200 million, but because of rising expenditure the rate of recoupment fell from 12% to 10% between 2002–03 and 2003–04.
Variations in charges for domiciliary services 4. Figures 4.2.1(c) and 4.2.1(d) illustrate the percentage of gross expenditure recovered in charges by each local authority for home care and meals services, the two main items of service provided in a domiciliary setting. Table 4.2.1(b) sets out in tabular form the percentage of gross expenditure on home care recouped through sales, fees and charges. 5. At the local council level, there is a wide variation in the amounts raised in sales, fees and charges made for domiciliary provision. Local councils are free to decide on whether to levy charges and upon the level of charges, provided that guidance on assessing ability to pay is observed—although the first statutory guidance published on charges for domiciliary services was not required to be fully implemented until April 2003. Wide ranges of charging policies were in operation during 2001–02, ranging from flat rate charges to income-related charges. We have considered how best to improve the system in the light of both the Royal Commission’s report on the funding of long term care, and the Audit Commission’s study of local council charging practices (published as Charging with Care in May 2000). In November 2001, we issued guidance, Fairer Charging Policies for Home Care and other non-residential Social Services. The guidance should have been implemented in two phases, by 1 October 2002 and 1 April 2003 and is, therefore, fully reflected in the table covering 2003–04. The data for 2003–04 does show some reduction in variation compared to 2002–03. 6. There are a number of instances where local authorities have reported that they raised no sales, fees and charges income for home care services provided; at the other extreme, some authorities reported recouping in excess of 20%. Such wide variability of individual authority figures points to issues of data quality and there is a risk that misreporting of data by local authorities has had an eVect. The current Performance Management Framework for Best Value in Personal Social Services will help to reinforce the message to Local Authorities that it is important they report their PSS financial data accurately on the central returns. 3178271138 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 250 Health Committee: Evidence
7. For England as a whole, 10% of the direct cost of the home care service was recouped in sales, fees and charges to clients. Within authorities, the actual figures reported varied from zero in the case of five authorities to 20% or more in nine authorities. The middle 50% of authorities had recoupment rates between 8% and 13% compared to rates between 8% and 15% for the previous year. 8. For meals services the overall England recoupment rate was 42%: LA figures range from zero in 23 authorities to 100% or more in two authority (five authorities reported no expenditure). The middle 50% of authorities had recoupment rates between 21% and 55% compared to rates between 18% and 54% for the previous year.
Variations in charges for residential services 9. Figure 4.2.1(e) illustrates the percentage of gross expenditure on residential accommodation for older people recouped through sales, fees and charges. Table 4.2.1(c) tabulates these figures. Tables 4.2.1(d) to 4.2.1(f) provide similar information for adults with a physical disability or sensory impairment, adults with learning disabilities and adults with mental health needs. 10. The charges levied on individual residents in care homes are determined nationally. The overall recoupment rate for residential provision for older people in England was 32%. LA figures varied between 3% in one authority and 49% also in one authority. This may again just reflect misreporting by local authorities. The middle 50% of authorities had recoupment rates between 29% and 35%, as against 32% and 39% in the previous year. 3178271138 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 251 % ICE e expenditure and Charges expenditure rrent Gross current Sales, Fees Gross current as a as a as a Table 4.2.1(a): Sales Fees Sales Fees Sales Fees and Charges and Charges and Charges percentage of percentage of percentage of 2001–02 2002–03 2003–04 expenditure and Charges expenditure expenditure andCharges expenditur Gross current Sales, Fees Gross current Gross current Sales, Fees Gross cu SALES, FEES AND CHARGES AS A PERCENTAGE OF GROSS EXPENDITURE BY TYPE OF SERV PSS EX1 returns Source: England £m Residential care for: Older people (aged 65 orAdults over) aged under 65 with: a physical disability or sensorylearning impairment disabilitiesmental health needsNon residential care: of which Home careDay careMeals 276 3,727 75 1,434 1,111 27% 38% 280 283 345 4,246 70 1,712 25% 1,531 71 940 25% 1,385 100 207 36% 21% 338 41 263 4,259 12% 42 330 71 1,377 4% 1,820 19% 42% 57 1,003 21% 32 1,401 211 99 17% 324 38 203 12% 43 1,982 14% 53 4% 43% 1,071 205 16% 101 10% 37 42 3% 42% 3178271140 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 252 Health Committee: Evidence
Table 4.2.1(b): PROPORTION OF NON RESIDENTIAL COSTS RECOUPED IN SALES FEES & CHARGES: HOME CARE, 2003–04 England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Barking & Dagenham 150 10,629 1% Barnet 1,097 11,863 9% Barnsley 1,082 9,004 12% Bath & North East Somerset UA 481 5,485 9% Bedfordshire 396 14,525 3% Bexley 1,722 7,807 22% Birmingham 2,243 36,488 6% Blackburn UA 635 5,764 11% Blackpool UA 348 5,808 6% Bolton 1,092 9,907 11% Bournemouth UA 643 5,234 12% Bracknell Forest UA 354 3,253 11% Bradford 1,499 15,310 10% Brent 1,039 10,380 10% Brighton & Hove UA 1,168 11,986 10% Bristol UA 1,346 13,591 10% Bromley 2,002 11,654 17% Buckinghamshire 2,237 17,671 13% Bury 766 6,906 11% Calderdale 1,053 8,352 13% Cambridgeshire 2,848 22,979 12% Camden 198 12,659 2% Cheshire 3,998 33,536 12% City of London 104 1,175 9% Cornwall 3,000 18,129 17% Coventry 804 18,111 4% Croydon 1,260 12,403 10% Cumbria 4,174 20,111 21% Darlington UA 543 2,846 19% Derby UA 1,135 9,346 12% Derbyshire 161 36,670 0% Devon 2,818 22,248 13% Doncaster 1,806 8,597 21% Dorset 1,634 11,484 14% Dudley 1,143 12,349 9% Durham 3,126 24,050 13% Ealing 1,139 11,693 10% East Riding of Yorkshire UA 101 9,328 1% East Sussex 1,553 15,091 10% Enfield 752 11,312 7% Essex 5,211 62,350 8% Gateshead 1,045 10,138 10% Gloucestershire 3,578 17,957 20% Greenwich 1,036 12,998 8% Hackney 1,364 11,285 12% Halton UA 520 5,241 10% Hammersmith & Fulham 603 10,536 6% Hampshire 3,097 41,836 7% Haringey 1,258 9,754 13% Harrow 1,103 9,687 11% Hartlepool UA 401 2,357 17% Havering 895 9,389 10% Herefordshire UA 699 5,195 13% Hertfordshire 1,767 41,591 4% Hillingdon 1,279 9,991 13% Hounslow 842 7,774 11% Isle of Wight UA 1,051 4,843 22% 3178271140 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 253
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Isles of Scilly 4 37 11% Islington 1,130 11,673 10% Kensington & Chelsea 237 8,814 3% Kent 7,688 47,409 16% Kingston Upon Hull UA 654 7,122 9% Kingston Upon Thames 516 4,763 11% Kirklees 2,080 15,312 14% Knowsley 485 9,492 5% Lambeth 1,335 11,551 12% Lancashire 2,982 52,296 6% Leeds 1,400 30,748 5% Leicester UA 623 9,923 6% Leicestershire 1,637 22,260 7% Lewisham 1,123 14,442 8% Lincolnshire 1,816 19,166 9% Liverpool 2,435 28,535 9% Luton UA 757 6,696 11% Manchester 2,721 20,528 13% Medway Towns UA 1,267 8,065 16% Merton 939 7,323 13% Middlesbrough UA 441 5,075 9% Milton Keynes UA 1,148 7,480 15% Newcastle upon Tyne 827 16,992 5% Newham 0 10,958 0% Norfolk 7,165 33,688 21% North East Lincolnshire UA 551 4,723 12% North Lincolnshire UA 676 4,648 15% North Somerset UA 716 5,718 13% North Tyneside 1,303 7,988 16% North Yorkshire 1,795 17,281 10% Northamptonshire 1,058 16,851 6% Northumberland 1,601 13,819 12% Nottingham UA 472 9,800 5% Nottinghamshire 3,595 21,916 16% Oldham 3,098 17,054 18% Oxfordshire 3,007 37,260 8% Peterborough UA 836 5,138 16% Plymouth UA 245 6,044 4% Poole UA 912 5,414 17% Portsmouth UA 965 9,019 11% Reading UA 586 5,454 11% Redbridge 894 10,562 8% Redcar & Cleveland UA 496 4,166 12% Richmond Upon Thames 772 6,702 12% Rochdale 695 8,776 8% Rotherham 1,431 11,897 12% Rutland UA 137 1,102 12% Salford 5,269 19,958 26% Sandwell 713 14,106 5% Sefton 510 9,367 5% SheYeld 1,941 31,519 6% Shropshire 1,500 11,150 13% Slough UA 651 3,363 19% Solihull 736 6,960 11% Somerset 3,693 16,890 22% South Gloucestershire UA 737 6,532 11% South Tyneside 1,244 10,066 12% Southampton UA 825 8,650 10% Southend UA 588 5,227 11% Southwark 16 11,129 0% St Helens 1,072 8,307 13% StaVordshire 2,999 24,501 12% 3178271140 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 254 Health Committee: Evidence
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Stockport 1,184 10,055 12% Stockton on Tees UA 0 4,924 0% Stoke-on-Trent UA 1,782 9,574 19% SuVolk 2,566 28,718 9% Sunderland 1,607 12,358 13% Surrey 1,027 21,131 5% Sutton 1,091 6,427 17% Swindon UA 869 6,200 14% Tameside 1,286 7,144 18% The Wrekin UA 560 5,968 9% Thurrock UA 607 5,457 11% Torbay UA 732 5,276 14% Tower Hamlets 2 13,874 0% TraVord 975 8,459 12% Wakefield 885 12,846 7% Walsall 1,396 11,360 12% Waltham Forest 899 10,133 9% Wandsworth 852 9,802 9% Warrington UA 685 7,825 9% Warwickshire 2,327 17,764 13% West Berkshire 669 3,762 18% West Sussex 1,612 23,655 7% Westminster 651 13,456 5% Wigan 3,907 16,296 24% Wiltshire 476 13,160 4% Windsor & Maidenhead UA 641 5,937 11% Wirral 1,473 16,290 9% Wokingham UA 606 3,929 15% Wolverhampton 1,233 11,509 11% Worcestershire 1,982 14,393 14% York UA 870 6,344 14% England Total 204,596 1,982,085 10% Source: PSS EX1 return
Table 4.2.1(c): PROPORTION OF RESIDENTIAL COSTS RECOUPED IN SALES, FEES & CHARGES FOR OLDER PEOPLE, 2003–04 England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Barking & Dagenham 3,865 16,239 24% Barnet 6,636 25,578 26% Barnsley 5,865 19,572 30% Bath & North East Somerset UA 4,930 14,877 33% Bedfordshire 7,728 23,119 33% Bexley 6,547 16,386 40% Birmingham 27,330 97,480 28% Blackburn UA 4,218 14,552 29% Blackpool UA 5,335 17,174 31% Bolton 6,734 20,905 32% Bournemouth UA 5,141 17,109 30% Bracknell Forest UA 1,354 5,171 26% Bradford 16,577 48,858 34% Brent 5,742 17,379 33% Brighton & Hove UA 8,955 25,772 35% Bristol UA 13,716 40,258 34% Bromley 7,818 22,614 35% 3178271141 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 255
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Buckinghamshire 11,348 30,703 37% Bury 5,848 15,927 37% Calderdale 6,525 17,078 38% Cambridgeshire 9,802 35,924 27% Camden 4,738 21,951 22% Cheshire 21,764 62,158 35% City of London 192 670 29% Cornwall 15,221 40,912 37% Coventry 6,929 24,318 28% Croydon 10,024 27,280 37% Cumbria 19,880 49,662 40% Darlington UA 3,668 9,857 37% Derby UA 8,786 21,459 41% Derbyshire 25,627 64,082 40% Devon 29,128 86,759 34% Doncaster 9,024 28,618 32% Dorset 9,716 32,967 29% Dudley 7,286 22,842 32% Durham 11,230 49,873 23% Ealing 5,929 18,486 32% East Riding of Yorkshire UA 12,778 34,071 38% East Sussex 20,178 57,191 35% Enfield 6,284 17,475 36% Essex 37,331 110,970 34% Gateshead 9,607 26,180 37% Gloucestershire 9,465 38,946 24% Greenwich 5,080 17,902 28% Hackney 2,956 12,306 24% Halton UA 3,549 10,288 34% Hammersmith & Fulham 3,723 12,951 29% Hampshire 25,038 85,931 29% Haringey 4,499 14,028 32% Harrow 4,095 13,782 30% Hartlepool UA 5,117 10,896 47% Havering 5,899 17,448 34% Herefordshire UA 3,815 13,313 29% Hertfordshire 20,388 78,229 26% Hillingdon 3,961 14,860 27% Hounslow 3,954 15,052 26% Isle of Wight UA 5,575 18,744 30% Isles of Scilly 81 315 26% Islington 3,027 17,026 18% Kensington & Chelsea 2,783 10,499 27% Kent 37,231 119,006 31% Kingston Upon Hull UA 10,696 30,182 35% Kingston Upon Thames 3,570 11,727 30% Kirklees 10,673 33,332 32% Knowsley 3,922 11,641 34% Lambeth 5,874 18,680 31% Lancashire 34,394 111,167 31% Leeds 16,807 62,495 27% Leicester UA 7,157 21,324 34% Leicestershire 14,336 39,359 36% Lewisham 5,702 19,338 29% Lincolnshire 21,200 62,986 34% Liverpool 11,479 45,996 25% Luton UA 3,811 11,173 34% Manchester 14,778 39,546 37% Medway Towns UA 5,725 16,932 34% Merton 3,852 10,436 37% Middlesbrough UA 4,240 13,232 32% Milton Keynes UA 4,668 11,591 40% 3178271141 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 256 Health Committee: Evidence
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Newcastle upon Tyne 9,934 28,671 35% Newham 3,391 15,551 22% Norfolk 36,569 86,080 42% North East Lincolnshire UA 6,327 17,493 36% North Lincolnshire UA 4,921 14,132 35% North Somerset UA 6,568 19,658 33% North Tyneside 6,507 20,570 32% North Yorkshire 18,221 51,018 36% Northamptonshire 15,540 52,206 30% Northumberland 14,119 35,422 40% Nottingham UA 8,957 24,662 36% Nottinghamshire 23,734 63,739 37% Oldham 432 15,825 3% Oxfordshire 14,498 44,427 33% Peterborough UA 3,295 11,236 29% Plymouth UA 9,075 25,756 35% Poole UA 2,419 10,223 24% Portsmouth UA 5,598 16,970 33% Reading UA 1,974 8,504 23% Redbridge 4,737 16,994 28% Redcar & Cleveland UA 1,337 11,826 11% Richmond Upon Thames 4,085 12,093 34% Rochdale 8,293 21,739 38% Rotherham 7,260 22,837 32% Rutland UA 1,135 2,932 39% Salford 8,108 22,445 36% Sandwell 8,187 28,799 28% Sefton 11,728 35,183 33% SheYeld 9,167 59,888 15% Shropshire 7,756 22,331 35% Slough UA 2,368 7,748 31% Solihull 3,723 11,702 32% Somerset 14,273 42,718 33% South Gloucestershire UA 6,673 17,304 39% South Tyneside 5,818 17,288 34% Southampton UA 5,210 17,390 30% Southend UA 6,475 18,563 35% Southwark 5,630 21,553 26% St Helens 7,358 18,152 41% StaVordshire 22,607 61,528 37% Stockport 9,340 24,046 39% Stockton on Tees UA 5,707 16,996 34% Stoke-on-Trent UA 8,562 26,461 32% SuVolk 19,671 54,781 36% Sunderland 10,046 29,467 34% Surrey 21,225 72,694 29% Sutton 4,377 14,172 31% Swindon UA 6,646 15,083 44% Tameside 12,340 25,288 49% The Wrekin UA 3,447 9,852 35% Thurrock UA 2,924 8,488 34% Torbay UA 10,015 21,331 47% Tower Hamlets 3,611 14,679 25% TraVord 6,117 18,963 32% Wakefield 9,263 31,465 29% Walsall 6,400 25,142 25% Waltham Forest 3,715 14,992 25% Wandsworth 7,487 21,023 36% Warrington UA 5,471 17,409 31% Warwickshire 11,417 34,592 33% West Berkshire 1,996 7,368 27% West Sussex 24,087 69,521 35% 3178271141 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 257
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Westminster 4,078 15,819 26% Wigan 8,105 23,130 35% Wiltshire 7,077 23,674 30% Windsor & Maidenhead UA 2,524 8,018 31% Wirral 11,979 33,247 36% Wokingham UA 1,626 6,917 24% Wolverhampton 8,795 26,382 33% Worcestershire 10,576 39,321 27% York UA 3,422 12,259 28% England Total 1,376,508 4,258,853 32% Source: PSS EX1 return
Table 4.2.1(d) PROPORTION OF RESIDENTIAL COSTS RECOUPED IN SALES, FEES & CHARGES FOR ADULTS WITH A PHYSICAL DISABILITY OR SENSORY IMPAIRMENT, 2003–04 England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Barking & Dagenham 74 725 10% Barnet 244 1,662 15% Barnsley 490 1,081 45% Bath & North East Somerset UA 250 933 27% Bedfordshire 350 1,537 23% Bexley 240 1,895 13% Birmingham 680 6,902 10% Blackburn UA 243 1,241 20% Blackpool UA 134 929 14% Bolton 233 1,254 19% Bournemouth UA 169 1,432 12% Bracknell Forest UA 83 292 28% Bradford 730 3,230 23% Brent 175 1,822 10% Brighton & Hove UA 396 1,680 24% Bristol UA 1,307 2,835 46% Bromley 424 2,127 20% Buckinghamshire 365 3,162 12% Bury 221 989 22% Calderdale 182 1,137 16% Cambridgeshire 509 3,844 13% Camden 283 2,055 14% Cheshire 615 2,633 23% City of London 0 0 . Cornwall 165 2,978 6% Coventry 298 2,086 14% Croydon 318 2,618 12% Cumbria 689 2,534 27% Darlington UA 127 707 18% Derby UA 693 1,398 50% Derbyshire 552 4,148 13% Devon 956 4,810 20% Doncaster 222 2,118 10% Dorset 328 2,163 15% Dudley 122 862 14% Durham 606 2,158 28% Ealing 386 1,225 32% East Riding of Yorkshire UA 373 2,296 16% 3178271142 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 258 Health Committee: Evidence
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure East Sussex 592 3,806 16% Enfield 183 1,409 13% Essex 761 6,978 11% Gateshead 194 1,203 16% Gloucestershire 771 4,148 19% Greenwich 252 1,452 17% Hackney 306 1,937 16% Halton UA 83 679 12% Hammersmith & Fulham 264 1,036 25% Hampshire 1,054 7,135 15% Haringey 323 1,537 21% Harrow 136 901 15% Hartlepool UA 68 289 24% Havering 277 2,090 13% Herefordshire UA 126 1,106 11% Hertfordshire 1,820 5,816 31% Hillingdon 532 2,319 23% Hounslow 270 2,100 13% Isle of Wight UA 81 624 13% Isles of Scilly 0 59 0% Islington 276 1,598 17% Kensington & Chelsea 113 928 12% Kent 1,861 13,133 14% Kingston Upon Hull UA 488 3,182 15% Kingston Upon Thames 102 914 11% Kirklees 327 1,475 22% Knowsley 274 1,130 24% Lambeth 706 3,264 22% Lancashire 1,739 9,785 18% Leeds 694 4,625 15% Leicester UA 162 1,072 15% Leicestershire 461 3,197 14% Lewisham 589 2,012 29% Lincolnshire 933 4,975 19% Liverpool 980 5,252 19% Luton UA 277 1,719 16% Manchester 495 2,315 21% Medway Towns UA 409 3,145 13% Merton 102 980 10% Middlesbrough UA 231 1,266 18% Milton Keynes UA 198 1,014 20% Newcastle upon Tyne 247 1,507 16% Newham 436 1,484 29% Norfolk 1,187 7,086 17% North East Lincolnshire UA 173 863 20% North Lincolnshire UA 207 1,236 17% North Somerset UA 385 1,417 27% North Tyneside 143 860 17% North Yorkshire 624 2,947 21% Northamptonshire 644 7,566 9% Northumberland 486 1,825 27% Nottingham UA 513 2,432 21% Nottinghamshire 1,543 4,661 33% Oldham 0 1,591 0% Oxfordshire 443 1,514 29% Peterborough UA 157 1,012 16% Plymouth UA 419 1,940 22% Poole UA 62 450 14% Portsmouth UA 175 1,341 13% Reading UA 128 834 15% Redbridge 203 2,027 10% Redcar & Cleveland UA 27 910 3% 3178271142 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 259
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Richmond Upon Thames 160 1,338 12% Rochdale 459 1,511 30% Rotherham 183 826 22% Rutland UA 0 69 0% Salford 323 2,129 15% Sandwell 232 1,409 16% Sefton 899 4,398 20% SheYeld 1,129 4,182 27% Shropshire 211 996 21% Slough UA 177 829 21% Solihull 167 878 19% Somerset 409 3,291 12% South Gloucestershire UA 435 954 46% South Tyneside 157 467 34% Southampton UA 312 1,312 24% Southend UA 162 1,093 15% Southwark 454 3,205 14% St Helens 330 1,374 24% StaVordshire 712 3,598 20% Stockport 230 2,035 11% Stockton on Tees UA 215 626 34% Stoke-on-Trent UA 284 1,588 18% SuVolk 445 4,111 11% Sunderland 304 1,847 16% Surrey 685 9,251 7% Sutton 117 851 14% Swindon UA 112 960 12% Tameside 535 1,784 30% The Wrekin UA 106 656 16% Thurrock UA 123 891 14% Torbay UA 79 366 22% Tower Hamlets 341 2,458 14% TraVord 94 1,217 8% Wakefield 244 1,283 19% Walsall (31) 1,369 -2% Waltham Forest 369 1,715 22% Wandsworth 187 1,224 15% Warrington UA 221 1,236 18% Warwickshire 572 3,452 17% West Berkshire 71 469 15% West Sussex 648 5,788 11% Westminster 177 1,106 16% Wigan 453 1,852 24% Wiltshire 255 1,968 13% Windsor & Maidenhead UA 111 650 17% Wirral 450 3,241 14% Wokingham UA 95 454 21% Wolverhampton 245 1,098 22% Worcestershire 386 3,003 13% York UA 273 1,381 20% England Total 57,252 330,395 17% Source: PSS EX1 return . % not applicable 3178271143 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 260 Health Committee: Evidence
Table 4.2.1(e): PROPORTION OF RESIDENTIAL COSTS RECOUPED IN SALES, FEES & CHARGES FOR ADULTS WITH LEARNING DISABILITIES, 2003–04
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Barking & Dagenham 268 3,188 8% Barnet 1,106 12,255 9% Barnsley 698 2,294 30% Bath & North East Somerset UA 733 6,549 11% Bedfordshire 842 12,365 7% Bexley 783 6,444 12% Birmingham 3,385 33,005 10% Blackburn UA 244 1,529 16% Blackpool UA 287 2,998 10% Bolton 548 8,723 6% Bournemouth UA 353 2,275 16% Bracknell Forest UA 480 3,742 13% Bradford 2,270 8,068 28% Brent 732 7,416 10% Brighton & Hove UA 1,737 15,427 11% Bristol UA 3,800 14,145 27% Bromley 1,476 9,340 16% Buckinghamshire 1,535 14,116 11% Bury 382 4,849 8% Calderdale 449 5,353 8% Cambridgeshire 2,868 19,984 14% Camden 392 4,984 8% Cheshire 1,065 7,995 13% City of London 4 171 3% Cornwall 877 9,201 10% Coventry 911 9,733 9% Croydon 1,989 12,766 16% Cumbria 1,339 8,148 16% Darlington UA 326 2,974 11% Derby UA 1,216 6,276 19% Derbyshire 3,181 17,794 18% Devon 3,114 22,227 14% Doncaster 663 6,672 10% Dorset 771 6,901 11% Dudley 1,167 9,003 13% Durham 5,265 13,514 39% Ealing 1,068 11,587 9% East Riding of Yorkshire UA 1,111 9,239 12% East Sussex 2,671 23,588 11% Enfield 1,108 9,760 11% Essex 3,485 36,104 10% Gateshead 1,018 6,133 17% Gloucestershire 5,184 21,516 24% Greenwich 889 8,432 11% Hackney 1,477 7,817 19% Halton UA 48 1,468 3% Hammersmith & Fulham 392 5,171 8% Hampshire 3,475 29,320 12% Haringey 1,199 9,991 12% Harrow 742 6,982 11% Hartlepool UA 453 1,796 25% Havering 503 6,338 8% Herefordshire UA 791 6,063 13% Hertfordshire 7,107 30,257 23% Hillingdon 1,400 9,903 14% Hounslow 812 8,237 10% 3178271143 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 261
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Isle of Wight UA 771 4,911 16% Isles of Scilly 0 0 . Islington 818 9,903 8% Kensington & Chelsea 505 4,642 11% Kent 5,211 50,332 10% Kingston Upon Hull UA 900 4,687 19% Kingston Upon Thames 583 4,899 12% Kirklees 1,859 12,209 15% Knowsley 1,213 3,721 33% Lambeth 1,452 14,612 10% Lancashire 92 25,614 0% Leeds 5,721 23,723 24% Leicester UA 1,944 9,880 20% Leicestershire 1,748 13,068 13% Lewisham 672 10,540 6% Lincolnshire 3,057 8,348 37% Liverpool 5,005 14,134 35% Luton UA 410 4,517 9% Manchester 945 6,648 14% Medway Towns UA 755 6,419 12% Merton 459 5,173 9% Middlesbrough UA 769 3,617 21% Milton Keynes UA 713 3,007 24% Newcastle upon Tyne 341 4,231 8% Newham 749 8,736 9% Norfolk 6,078 25,962 23% North East Lincolnshire UA 853 2,998 28% North Lincolnshire UA 581 3,086 19% North Somerset UA 802 6,528 12% North Tyneside 275 4,143 7% North Yorkshire 1,710 14,468 12% Northamptonshire 1,163 16,836 7% Northumberland 1,562 6,905 23% Nottingham UA 1,137 5,732 20% Nottinghamshire 3,131 19,069 16% Oldham 3 950 0% Oxfordshire 599 2,519 24% Peterborough UA 355 3,303 11% Plymouth UA 1,173 8,891 13% Poole UA 178 1,733 10% Portsmouth UA 524 3,958 13% Reading UA 713 6,455 11% Redbridge 745 6,185 12% Redcar & Cleveland UA 216 2,900 7% Richmond Upon Thames 1,330 7,308 18% Rochdale 782 4,852 16% Rotherham 695 4,854 14% Rutland UA 105 555 19% Salford 629 2,408 26% Sandwell 763 6,623 12% Sefton 1,275 9,131 14% SheYeld 2,320 9,591 24% Shropshire 1,770 6,574 27% Slough UA 2,027 4,944 41% Solihull 1,129 6,478 17% Somerset 1,153 11,669 10% South Gloucestershire UA 1,834 8,567 21% South Tyneside 1,099 4,647 24% Southampton UA 679 5,421 13% Southend UA 1,070 6,846 16% Southwark 890 12,445 7% 3178271143 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 262 Health Committee: Evidence
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure St Helens 532 5,401 10% StaVordshire 2,532 16,525 15% Stockport 386 7,697 5% Stockton on Tees UA 853 4,520 19% Stoke-on-Trent UA 1,178 6,127 19% SuVolk 2,278 18,613 12% Sunderland 1,940 5,001 39% Surrey 5,171 36,954 14% Sutton 641 6,223 10% Swindon UA 1,697 10,838 16% Tameside 4,384 6,190 71% The Wrekin UA 431 2,282 19% Thurrock UA 427 4,476 10% Torbay UA 977 5,632 17% Tower Hamlets 521 6,401 8% TraVord 300 4,557 7% Wakefield 1,289 8,901 14% Walsall 430 13,022 3% Waltham Forest 559 6,374 9% Wandsworth 2,819 13,967 20% Warrington UA 302 1,459 21% Warwickshire 2,758 13,044 21% West Berkshire 300 4,032 7% West Sussex 1,795 20,577 9% Westminster 869 10,375 8% Wigan 641 4,446 14% Wiltshire 1,900 13,869 14% Windsor & Maidenhead UA 419 5,716 7% Wirral 1,046 10,609 10% Wokingham UA 696 7,582 9% Wolverhampton 443 4,275 10% Worcestershire 2,293 15,745 15% York UA 327 4,009 8% England Total 203,364 1,400,670 15% Source: PSS EX1 return . % not applicable
Table 4.2.1(f): PROPORTION OF RESIDENTIAL COSTS RECOUPED IN SALES, FEES & CHARGES FOR ADULTSWITH MENTAL HEALTH NEEDS,2003–04 England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Barking & Dagenham 38 391 10% Barnet 319 3,023 11% Barnsley 407 1,224 33% Bath & North East Somerset UA 427 1,571 27% Bedfordshire 104 873 12% Bexley 186 1,664 11% Birmingham 304 5,563 5% Blackburn UA 193 559 35% Blackpool UA 142 1,796 8% Bolton 75 2,187 3% Bournemouth UA 84 978 9% Bracknell Forest UA 346 1,053 33% Bradford 1,512 2,254 67% 3178271144 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 263
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Brent 658 3,527 19% Brighton & Hove UA 437 2,881 15% Bristol UA 867 2,836 31% Bromley 225 2,431 9% Buckinghamshire 335 1,945 17% Bury 272 1,170 23% Calderdale 303 1,168 26% Cambridgeshire 157 2,823 6% Camden 432 3,532 12% Cheshire 454 2,921 16% City of London 47 708 7% Cornwall 231 1,459 16% Coventry 296 1,870 16% Croydon 1,392 5,667 25% Cumbria 161 1,641 10% Darlington UA 39 287 14% Derby UA 331 1,579 21% Derbyshire 309 2,101 15% Devon 792 4,350 18% Doncaster 158 1,082 15% Dorset 141 700 20% Dudley 314 1,588 20% Durham 493 1,847 27% Ealing 195 3,575 5% East Riding of Yorkshire UA 375 1,937 19% East Sussex 1,115 4,997 22% Enfield 193 3,029 6% Essex 586 5,984 10% Gateshead 160 1,310 12% Gloucestershire 258 1,222 21% Greenwich 334 1,755 19% Hackney 300 3,831 8% Halton UA 2 724 0% Hammersmith & Fulham 401 2,268 18% Hampshire 353 3,141 11% Haringey 877 4,271 21% Harrow 373 2,834 13% Hartlepool UA 158 538 29% Havering 179 886 20% Herefordshire UA 253 1,450 17% Hertfordshire 786 4,356 18% Hillingdon 115 1,669 7% Hounslow 92 995 9% Isle of Wight UA 196 1,072 18% Isles of Scilly 0 0 . Islington 372 3,383 11% Kensington & Chelsea 168 2,541 7% Kent 811 5,929 14% Kingston Upon Hull UA 429 2,221 19% Kingston Upon Thames (23) 1,245 -2% Kirklees 393 1,657 24% Knowsley 162 1,823 9% Lambeth 426 4,276 10% Lancashire 1,399 7,209 19% Leeds 785 3,828 21% Leicester UA 63 3,573 2% Leicestershire 225 1,645 14% Lewisham 555 3,491 16% Lincolnshire 901 4,708 19% Liverpool 1,885 7,500 25% Luton UA 78 538 14% Manchester 448 4,130 11% 3178271144 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 264 Health Committee: Evidence
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Medway Towns UA 122 602 20% Merton 244 1,455 17% Middlesbrough UA 219 1,233 18% Milton Keynes UA 28 217 13% Newcastle upon Tyne 316 1,227 26% Newham 482 4,530 11% Norfolk 1,745 8,421 21% North East Lincolnshire UA 394 1,421 28% North Lincolnshire UA 143 767 19% North Somerset UA 541 2,421 22% North Tyneside 235 1,258 19% North Yorkshire 270 1,438 19% Northamptonshire 198 4,476 4% Northumberland 657 1,557 42% Nottingham UA 567 2,167 26% Nottinghamshire 538 2,183 25% Oldham 0 3,791 0% Oxfordshire 115 1,288 9% Peterborough UA 25 132 19% Plymouth UA 204 1,360 15% Poole UA 40 306 13% Portsmouth UA 260 1,573 17% Reading UA 137 1,431 10% Redbridge 298 1,386 22% Redcar & Cleveland UA 88 1,566 6% Richmond Upon Thames 120 1,081 11% Rochdale 127 1,358 9% Rotherham 217 935 23% Rutland UA 27 119 23% Salford 891 2,619 34% Sandwell 148 2,354 6% Sefton 364 2,312 16% SheYeld 400 2,993 13% Shropshire 213 1,106 19% Slough UA 142 1,123 13% Solihull 53 611 9% Somerset 340 2,329 15% South Gloucestershire UA 130 489 27% South Tyneside 125 1,030 12% Southampton UA 169 1,328 13% Southend UA 162 1,165 14% Southwark 626 4,441 14% St Helens 276 1,533 18% StaVordshire 561 2,364 24% Stockport 304 2,244 14% Stockton on Tees UA 257 1,333 19% Stoke-on-Trent UA 241 1,275 19% SuVolk 481 3,650 13% Sunderland 589 1,704 35% Surrey 701 2,805 25% Sutton 232 1,361 17% Swindon UA 313 1,522 21% Tameside 138 797 17% The Wrekin UA (148) 511 -29% Thurrock UA 39 299 13% Torbay UA 216 1,705 13% Tower Hamlets 437 3,724 12% TraVord 211 1,829 12% Wakefield 396 1,321 30% Walsall 233 1,536 15% Waltham Forest 199 1,250 16% Wandsworth 1,332 4,343 31% 3178271144 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 265
England £ thousands Sales, Fees and Charges as a Sales, Fees and Gross current percentage of Gross Charges expenditure current expenditure Warrington UA 189 868 22% Warwickshire 380 2,267 17% West Berkshire 40 324 12% West Sussex 704 4,046 17% Westminster 530 5,952 9% Wigan 516 1,800 29% Wiltshire 296 2,051 14% Windsor & Maidenhead UA 118 738 16% Wirral 416 3,039 14% Wokingham UA (32) 305 -10% Wolverhampton 633 1,872 34% Worcestershire 482 2,322 21% York UA 210 902 23% England Total 52,970 323,977 16% Source: PSS EX1 return . % not applicable
FIGURE 4.2.1(a): RECENT TRENDS IN SALES, FEES AND CHARGES RECOUPMENT RATES ON HOME CARE 14 FOR ALL CLIENT GROUPS
12
10
8
6 recoupment rate (%)
4
2
0 1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 3178271144 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 266 Health Committee: Evidence
FIGURE 4.2.1(b): RECENT TRENDS IN SALES, FEES AND CHARGES RECOUPMENT RATES ON RESIDENTIAL 45 ACCOMMODATION FOR OLDER PEOPLE
40
35
30
25
20 recoupment rate (%)
15
10
5
0 1995-96 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04
FIGURE 4.2.1(c): SALES, FEES AND CHARGES RECOUPMENT RATES FOR ALL CLIENT GROUPS - HOME CARE, 2003-04
70
60
50
40
30 No. of LAs
20
10
0
4% or less 5 % - 8% 9% - 12% 13% - 16% 17% - 20% 21% - 24% 25% or over 3178271144 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 267
FIGURE 4.2.1(d): SALES, FEES AND CHARGES RECOUPMENT RATES FOR ALL CLIENT GROUPS - MEALS, 2003-04
45
40
35
30
25
20 No. of LAs 15
10
5
0 15% or less 16 % - 30% 31% - 45% 46% - 60% 61% - 75% 76% - 90% 91% and over
FIGURE 4.2.1(e): SALES, FEES AND CHARGES RECOUPMENT RATES, OLDER PEOPLE - RESIDENTIAL ACCOMMODATION, 2003-04 100
90
80
70
60
50 40 No. of LAs 30
20
10
0
10% or less 11 % - 20% 21% - 30% 31% - 40% 41% - 50% 51% or over
4.2.2 Could the Department provide an update of Table 4.2.2? [4.2.2] Answer 1. An update of Table 4.2.2 is provided below.
Table 4.2.2 GRANTS AVAILABLE FOR PERSONAL SOCIAL SERVICES: 2003–04 TO 2005–06 £ miilion 2003–04 2004–05 2005–06 Preserved Rights 508.5 458.3 348.2 Residential Allowance 182.5 409.5 214.5 Delayed Discharges 50.0 100.0 100.0 Mental Health 133.5 133.0 133.0 AIDSSupport 16.5 16.5 16.5 Training Support Programme 56.5 53.3 Access and Systems Capacity 170.0 486.0 642.0 Child and Adolescent Mental Health Services 51.0 66.0 90.5 Carers 100.0 125.0 185.0 Care Direct 2.2 Deferred Payments 40.0 Improving Information Management 25.0 25.0 25.0 3178271145 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 268 Health Committee: Evidence
£ miilion 2003–04 2004–05 2005–06 Performance Fund 100.0 National Training Strategy 24.9 31.0 94.9 Human Resources Development Strategy 9.5 23.9 62.8 Children’s Services(1) 566.5 Children’s Trusts(1) 1.0 1.0 1.0 Secure Accommodation(1) 6.2 Teenage Pregnancy Local Implementation(1) 27.4 Treatment Foster Care(1) 3.0 3.0 Young People’s Substance Misuse Planning(1) 6.7 4.5 4.5 Total 2,077.9 1,936.0 1,920.8 Notes 1. Responsibility for allocating these grants has been transferred to another Government Department.
5. Capital expenditure and investment
5.1 General 5.1.1 Could the Department provide an update of Table 5.1.1? [5.1.1] Answer 1. The information requested is given in Table 5.1.1.
Table 5.1.1 NHS CAPITAL SPENDING 2004–05 to 2007–08 (RESOURCES) & PFI
2004–05 2005–06 Plan 2006–07 Plan 2007–08 Plan Forecast Outturn £ million £ million £ million £ million Government Spending (Excluding 3,049 3,737 5,163 6,133 Foundation Trusts) Foundation Trust Capital 350 500 na na Expenditure Receipts from Land Sales 582 200 200 200 Total public capital funding for 3,981 4,437 5,363 6,333 capital investment Percentage Real Terms Growth 8.7 17.7 15.0 PFI Investment 883 1,650 2,238 1,949 Percentage Real Terms Growth 82.3 32.1 -15.2 Total investment 4,864 6,087 7,601 8,282 Percentage Real Terms Growth 22.1 21.6 6.1 Notes 1. Real Terms Growth calculated using GDP deflator of 2.14%/2.53%/2.70%/2.70%. 2. NHSfoundation trust capital spend in 2006-07 and 2007-08 will depend on the number of NHS foundation trusts in operation, which will depend on 2005 star-ratings and the Healthcare Commission’s review of NHSfoundation trusts, both due in the summer.
5.2 Primary care capital investment and facilities 5.2.1 Could the Department update of table 5.2.2 and figure 5.2.2, providing a trend analysis of the costs of the rental reimbursement schemes by category (e.g. notional, actual etc) and an explanation for any changes? [5.2.2] Answer 1. The information requested is provided in Table 5.2.1 and Figures 5.2.1(a) and (b). 3178271149 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 269
Table 5.2.1 GMS PREMISES EXPENDITURE: SPEND ON GMS PREMISES (ENGLAND) 1997–98 TO 2003–04 £ million 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 Non Discretionary (Non Cash-limited) Notional Rents 68.2 75.9 85.6 93.6 87.4 87.7 84.6 Actual rent 18.2 24.7 28.2 18.6 17.3 21 37.7 Actual rent -*Health centres (incl Lease and Licence payments only) 18.1 20.7 19.8 37.5 36.1 34.3 23.5 Rates /water/sewage 56.9 63.6 68.1 71.8 72.5 59.3 50.0 *Health centre Rates/ water/sewage 7.1 8.1 7.1 5.7 6.3 4.3 5.4 Ongoing rental on vacated premises, SFA para 55 0.1 4.0 0.0 0.0 0.7 0.2 Non Discretionary Premises total 168.5 193.1 212.8 227.2 219.6 207.3 201.4
Discretionary (Cash-limited) Cost Rents & LA Economic Rents 96.3 98.2 88.9 85.6 65.1 56.1 43.3 Improvement grants 20.3 22.2 16.9 16.9 14.2 13.5 17.5 Improvement grants *(for Health centres) 7.1 5.6 2.9 4.5 3.6 5.1 7.9 Grants to surrender leases on poor premises under SFA para 55 N/A 0.2 0.0 0.0 0.0 0.3 0.3 Discretionary Premises total 123.7 126.2 108.7 107.0 82.9 75.0 69.0 Notes: 1. Non Discretionary: non cash-limited Please note that from 1997–98 actual rents was split to additionally show introduction of Health Centre rents incurred. Health centre rates were created in 1997–98 to identify costs incurred. 2. Discretionary: cash limited Again with the introduction of monitoring Health centre spend from 1997–98—Improvement Grants have been split to separately identify Health Centre spend. 3. Please note that 2003–04 information is based on Final HFR/PFR discretionary and non-discretionary summarised accounts outturn. 4. Data up to 1995–96 is based on the returns of the former 90 FHSAs upto 1996, the 100 England HAs and PCTs from 2000–01. Data from 1996 onwards is based on HA returns. 2002–03 data is split between 28 SHA Qtr1- 2 reporting and 303 PCTs. Q3 & 4 combined returns, owing to PCTs not having non-discretionary banking rights up until September 2003. 2003–04 data is based on 304 audited PCT returns. 5. Data on PMSpremises spend is not collected centrally. 6. Decreases in all premises spend in 2003–04 are due mainly to the impact on GP transfers from GMSto PMS and increased waves 1-5b PMSpilots going live. 7. Please note that all figures up to 2001–02 are cash based. Due to changes in Government Accounting regulations, figures for 2002–03 and 2003–04 are now resource based. 3178271149 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 270 Health Committee: Evidence
Figure 5.2.1(a): GMS non discretionary premises expenditure
250.0 227.2 219.6 212.8
207.3 Non Discretionary (Non 201.4 Cash-limited)
200.0 193.1 Notional Rents 168.5 Actual rent
150.0 Actual rent -*Health centres (incl Lease and Licence payments only) £m Rates /water/sewage
100.0 93.6 87.7 87.4 *Health centre 85.6 84.6 Rates/water/sewage 75.9 72.5 71.8 68.2 68.1
63.6 Ongoing rental on vacated 59.3
56.9 premises, SFA para 55 50.0 50.0 Non Discretionary 37.7 37.5 36.1
34.3 Premises total 28.2 18.2 24.7 23.5 21 20.7 19.8 18.6 18.1 17.3 7.1 5.7 8.1 7.1 6.3 5.4 4.3 4.0 0.7 0.2 0.1 0.0 0.0 0.0 Year 1997-98 1998-99 1999-2000 2000-01 2001-02 2002-03 2003-04
Figure 5.2.1(b): GMS discretionary premises expenditure
140.0 126.2 123.7 120.0 108.7 107.0 98.2
100.0 96.3 Discretionary (Cash-limited) 88.9 85.6
82.9 Cost Rents & LA Economic Rents 80.0 75.0 Improvement grants 69.0 65.1 £m Improvement grants *(for Health centres)
60.0 56.1 Grants to surrender leases on poor premises under SFA para 55
43.3 Discretionary Premises total 40.0 22.2 20.3 17.5 20.0 16.9 16.9 14.2 13.5 7.9 7.1 5.6 5.1 4.5 3.6 2.9 0.3 0.3 0.2 0.0 0.0 0.0 0.0 0.0 1997-98 1998-99 1999-2000 2000-01 2001-02 2002-03 2003-04 Year
5.2.2 Could the Department provide an account of the total value of the asset base in primary care by category of owner, eg NHS, GP, private provider? [5.2.3] Answer 1. The total value of premises occupied by GPs, providing General Medical Services, is around £1.891 billion. This comprises £1.279 billion owner-occupied premises, £377 million rented from the private sector and £235 million for NHS-owned health centres. These figures are based on an amortisation of actual, notional and cost rents reimbursed to GPs providing GMS. Data is not collected centrally in respect of premises occupied by GPs providing Personal Medical Services. 2. These figures are lower than last year due to the increase in PMSpractices .
5.2.3 Could the Department update information on the backlog in repairs and maintenance for primary care nationally and by strategic health authority? [5.2.4] 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 271
Answer 1. Full financial data on the value of backlog repair and maintenance for the primary care estate is not held centrally. However, from a total of around 11,000 GP premises, analysis of a sample of 3,912 rented facilities made in 2001–02 (excluding health centres) and notional rented owner-occupied premises showed the following (see pie charts) 2. It is expected that because of the investment in primary care premises, this picture is improving, but no definitive survey has been carried out to confirm this.
External Decorations: All Regions
Poor 5%
Average Good 50% 45%
Internal Decorations: All Regions
Poor 6%
Average 44%
Good 50%
External Repair: All Regions
Poor 3%
Average 48%
Good 49% 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 272 Health Committee: Evidence
Internal Repair: All Regions
Poor 3%
Average 42%
Good 55%
5.2.4 Could the Department provide update information on the changing ownership of primary care premises and provide details of the top ten new provider companies? [5.2.5] Answer 1. The ratios for GP premises are about 63% owner-occupied, 21% private sector owned and 16% are NHS-owned health centres. To date, premises built by third party developers have mainly replaced existing premises already rented in the private sector. It is expected therefore that the above ratios currently remain fairly constant with a gradual move away from NHSand GP owned premises towa rds rented premises. 2. The leasing of purpose built premises to GPs is still a relatively new concept involving an increasing number of developers with varying numbers of completed projects. A “top ten” list of companies is not yet feasible in this maturing sector of the GP estate. However, the Department has issued standards of size, design, construction and lease terms that all third party developers should give regard when building premises suitable for modern primary care.
5.2.5 Could the Department please update data provided on all grants, public loans and capital receipts used to fund or finance primary care facilities on an annual basis since 1997. [5.2.6] Answer 1. The majority of funding for capital in GMSor PMSis made available throug h revenue funding streams—former health authority and now primary care trust revenue allocations which include GMS discretionary, PMSfunding and GMSnon-discretionary spend. 2. Capital related expenditure in the discretionary element includes cost rents, improvement grants and computer purchases and PMSfunding, while the non-discretionary element includes GMSnotional rents. 3. Up to 2002–03 a transfer was made each year from HCHScapital to revenue to fund an element of the total discretionary GMSprovision. The sums are shown in Table 5.2.5. 4. From 2003–04 onwards the GMSelement is fully met from the Department’s r evenue stream following the introduction of a further stage of Resource Allocation and Budgeting (RAB).
Table 5.2.5
TRANSFER OF HCHS CAPITAL FOR UNIFIED REVENUE ALLOCATIONSFOR 1997–98 TO 2002–03
Year £ million 1997–98 25 1998–99 26 1999–2000 26 2000–01 27 2001–02 27 2002–03 28
5. In addition, £35 million of public funding has been invested since 2002–03 in the most under doctored areas of the country to improve nearly 500 practice premises to accommodate 600 new GP registrars. This supported the NHSPlan target of improving 3,000 GP practices. 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 273
5.2.6 Could the Department please update table 5.2.7, providing a list of primary care premises which have signed or in the process of signing up for the use of PFI, together with their total capital cost, the length of contract, the annual unitary charge and availability fee and FM fee. Where projects are bundled with non-NHS facilities, could they also provide details of the other income streams e.g. from commercial and retail, local authority. [5.2.7] Answer 1. As reported for the past three years, NHSLIFT is the procurement route fo r the development of Primary Care Facilities. 2. PFI has only been used once to provide primary care based facilities, at North Kirklees PCT. Details of this scheme appear in the answer to question 5.3.3.
5.2.7 Could the Department please list all the LIFT schemes currently under way, and their costs? [5.2.8] Answer 1. The information requested in given in Table 5.2.7.
Table 5.2.7 NHSLIFT SCHEMES
Capital Capital cost £m cost £m LIFT Scheme Status 1st tranche 2nd tranche Buildings open to patients 1st Wave Barnsley LIFTCO 13.12 Goldthorpe—Dec 2004 established Worsbrough—Dec 2004 Thurnscoe—Dec 2004 Camden & Islington LIFTCO 3.50 Hanley Road—June 2005 established East London LIFTCO 29.19 The Centre Manor Park—Sept established 2004 Manchester, Salford LIFTCO 18.40 20.66 and TraVord established Newcastle and LIFTCO 13.40 Brunton Park—March 2005 North Tyneside established Shiremoor—March 2005 Walker—June 2005 Sandwell LIFTCO 7.40 2.40 Birmingham Rd Health established Centre—April 2005 2nd Wave Barking & Havering LIFTCO 25.00 Thamesview—April 2005 established Broad Street—June 2005 Birmingham & LIFTCO 9.10 Chemsley Wood—July 2005 Solihull established Woodgate Valley—July 2005 Bradford LIFTCO 14.00 established Cornwall & Isles of LIFTCO 3.46 Liskeard Health Centre—June Scilly established 2005 Coventry LIFTCO 7.00 established East Lancashire LIFTCO 23.00 30.8 Bacup—March 2005 established Nelson—May 2005 Darwen—June 2005 Hull LIFTCO 6.55 established Leicester LIFTCO 8.90 6.5 established Liverpool LIFTCO 10.64 Ainsdale—June 2005 established West Everton—July 2005 Medway LIFTCO 18.20 established North StaVordshire LIFTCO 7.50 established Redbridge & LIFTCO 15.06 Waltham Forest established 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 274 Health Committee: Evidence
Capital Capital cost £m cost £m LIFT Scheme Status 1st tranche 2nd tranche Buildings open to patients 3rd Wave Ashton, Leigh & LIFTCO 17.00 13.00 Atherton—January 2005 Wigan established Lower Ince—May 2005 Worsley Mesnes—June 2005 Barnet, Enfield & LIFTCO 13.60 Haringey established Brent & Harrow LIFTCO 17.50 established Bristol LIFTCO 15.9 established Bromley, Bexley & LIFTCO 25.30 3.40 Greenwich established Colchester & LIFTCO 35.80 Tendring established Derby LIFTCO 16.80 established Doncaster Preferred 0.0 Bidder Dudley Preferred 0.0 Bidder Ealing, LIFTCO 28.60 Hammersmith & established Hounslow East Hampshire, LIFTCO 7.80 Fareham & Gosport established Greater Notts LIFTCO 33.50 established Lambeth, Preferred 0.0 Southwark & Bidder Lewisham Leeds LIFTCO 18.10 established Norfolk LIFTCO 3.98 Plowright Medical Centre, established SwaVham—May 2005 North Notts Preferred 0.0 Bidder Oldham LIFTCO 2.52 established Oxford LIFTCO 16.00 established Plymouth LIFTCO 14.60 established SheYeld Preferred 0.0 Bidder South West London LIFTCO 18.48 established St Helens, Knowsley LIFTCO 12.30 and Warrington established Tees LIFTCO 7.00 established Wolverhampton LIFTCO 8.00 established 4th Wave Bolton, Rochdale, Pre OJEU 0.00 Heywood and Middleton Bury, Glossop and Pre OJEU 0.00 Tameside Southend, Castle Pre OJEU 0.00 Point and Rochford South East Pre OJEU 0.00 Midlands South Midlands Pre OJEU 0.00 South West Pre OJEU 0.00 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 275
Capital Capital cost £m cost £m LIFT Scheme Status 1st tranche 2nd tranche Buildings open to patients Hampshire Sustainable Pre OJEU 0.00 Communities in Kent Wiltshire OJEU 0.00 Total 546.20 76.76 Notes: 1. The above table reflects the position as of end of July 2005. Capital costs have been calculated using the following definition: 2. “Capital cost includes the costs of land, construction, equipment and professional fees but excludes VAT, rolled up interest and financing costs such as bank arrangement fees, bank due diligence fees, banks’ lawyers fees and third party equity costs.”
5.3 Long Term Capital Projects and PFI 5.3.1 Could the Department provide please update table 5.3.1, showing all publicly funded capital projects with a total cost above £10 million which are under construction during 2004–05? Could this also show the original and current estimated completion dates along with a percentage figure for any additional time overrun/ saving? Likewise, the original total cost and current estimated out-turn cost should be provided along with a percentage cost performance figure. [5.3.1] Answer 1. The information requested is no longer available.
5.3.2 Could the Department provide a commentary on cases where there are significant discrepancies between original estimates of completion dates and/or expenditures and current estimates? [5.3.2] Answer 1. The information requested is no longer available.
5.3.3 Could the Department provide an update of Tables 5.3.3? [5.3.3] Answer 1. The information requested is given in Tables 5.3.3(a) to (e). 2. The NHSBank took over responsibility from DH for providing transitiona l revenue support to a number of the earlier PFI schemes for 2004–05. In April 2005 the NHSBank app roved the policy for 2005–06 and future years for these existing and future schemes, which is set out below. 3. The existing transitional support for the earlier schemes will still be phased out. However, to prevent sharp and in some instances material cut-oVs of income, it was agreed that the support mechanisms would be phased out over a longer period. All existing central revenue support schemes for PFI are now to have ceased by the end of 2007–08. 4. All new PFI schemes are now subject to the same accounting rules and from 2005–06 (and particularly 2006–07) Payment by Results (PbR) will increasingly standardise the income that all providers receive for their operations. 5. From 2005–06, a system of revenue support will apply evenly to all new major schemes—both PFI and publicly funded—coming on stream and with transitional arrangements applying to all schemes that came on stream in the five years up to and including 2005–06. The key elements are: — all schemes in excess of £25 million (whether public capital or PFI) will receive a revenue payment from the NHSBank of 2.5% of their capital cost in their first year of operatio n; — this will become 2% in the 2nd year of operation and decline a further 0.5% in each subsequent year until it ceases after the 5th year; and — this makes 7.5% of capital cost in total for the life of the project. This total is fixed, but the NHS Bank will oVer some flexibility over draw-down. 6. In addition, the NHSBank will provide a contribution to PFI project cost s (eg external advisers) equal to 2% of total scheme value, also commencing in 2005–06. 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 276 Health Committee: Evidence
7. The principle behind the new system is recognition of the fact that all capital investment projects, whether PFI or publicly funded, bring additional revenue costs. These reflect new building stock, higher quality services and decanting and commissioning costs. The progressive phasing out of support reflects the fact that there will improved operating synergies and increased patient through-put resulting from the new, superior facilities in the longer term. 8. We are not aware of any local arrangements to help provide revenue support to PFI schemes but we are not asking the NHSto collect this information. 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 277 55.9 £ million 0 277.8 .0 96.3 0.0 253.3 -13 2013-14 Total 07.5 470.7 405.3 255.1 3,278.5 7.9 364.5 316.0 215.0 152.0 4,160.9 20.2 375.9 212.3 129.9 32.8 3,875.6 .0 907.0 897.0 527.5 394.8 178.8 6,448.5 .2 2,277.9 2,333.1 2,144.8 1,526.5 1,145.0 618.7 17,763.5 4 1,602.3 1,991.5 2,279.0 2,334.2 2,144.8 1,526.5 1,145.0 618.7 18,294.5 Table 5.3.3(a) -04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012 Spend Profile of the Total Capital Cost EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEMES ! Overall Total for PFI 57.9 183.0 361.5 595.4 533.5 445.1 527.4 680.3 1,268. Total 15.4 18.0 17.0 22.6 54.6 29.8 27.2 25.9 19.6 19.2 1.8 1.1 1.1 0.0 0.0 0.0 South 7.6 6.8 4.7 5.5 2.4 8.4 15.0 13.0 17.7 9.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 90.6 Midlands London 2.1 4.2 1.5 0.0 13.6 12.2 0.2 0.1 1.1 0.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 35.8 Eastern and 0.0 0.0 4.9 12.8 15.5 0.0 6.0 8.3 0.0 8.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Schemes with capital cost between £1m - £10m North 5.7 7.0 5.9 4.3 23.1 9.2 6.0 4.5 0.8 1.1 1.2 1.1 1.1 0.0 0.0 0.0 0.0 71.0 Total 0.0 1.5 11.4 24.2 69.8 47.5 44.9 35.3 22.1 16.6 4.5 0.0 0.0 0.0 0.0 0.0 0. South 0.0 0.0 0.0 1.0 6.6 5.5 19.0 7.3 1.8 11.7 4.5 0.0 0.0 0.0 0.0 0.0 0.0 57.4 Midlands London 0.0 1.5 9.8 7.4 23.5 9.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 51.1 Eastern and 0.0 0.0 1.7 14.1 28.2 26.1 6.9 1.9 12.6 4.9 0.0 0.0 0.0 0.0 0.0 0.0 0 Schemes with capital cost £10m to £20m North 0.0 0.0 0.0 1.8 11.6 6.9 19.0 26.1 7.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 73.0 Eastern andSouth 15.8 38.8 87.9 13.9 133.5 52.8 74.6 65.8 61.1 160.3 48.1 236.1 41.4 357.3 75.1 605.6 88.0 837.6 59.9 935 166.6 194.6 168.5 307.0 358.1 5 Regional Summary 1997-98 1998-991999-2000 2000-01 2001-02 2002-03 2003 Total 42.5 163.5 333.1 548.5 409.0 367.8 455.4 619.1 1,226.7 1,566.5 1,985 Midlands London 0.0 26.8 67.4 200.1 189.3 170.7 167.6 204.5 388.4 318.3 430.2 441.3 5 North 12.8 45.1 112.0 166.9 103.8 61.0 39.5 118.6 314.5 448.0 548.9 594.6 54 Schemes with capital cost £20m 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 278 Health Committee: Evidence 22.0 29.1 30.1 31.8 24.0 63.6 24.2 24.9 27.0 35.0 109.6 £ million 26.0 39.0 65.0 52.0 52.0 234.0 50.0 75.0 125.0 100.0 100.0 450.0 5.0 32.5 12.5 50.0 30.0 45.0 90.0 90.0 45.0 300.0 12.0 18.0 36.0 36.0 18.0 120.0 7.8 19.5 35.1 15.6 78.0 5.0 32.5 12.5 50.0 95.0 76.0 76.0 38.0 380.1 79.7 79.7 39.9 265.7 7 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 Total 2.4 15.7 6.1 2.5 16.2 6.2 11.5 28.7 51.6 22.9 114.7 19.0 28.5 57.0 57 28.50 190.0 2.4 15.6 6.0 6.4 15.9 28.6 12.7 29.9 44.8 74.7 59.7 59.7 29.9 298.6 38.0 57.0 26.6 39.9 3.2 20.7 8.0 2.7 17.6 6.8 3.5 22.8 8.8 22.1 33.2 55.3 44.2 44.2 22.1 221.0 19.6 7.5 51.2 76.7 127.9 102.3 102.3 51.2 511.6 3.0 11.0 16.4 32.9 32.9 16.4 Spend Profile of the Total Capital Cost 2.9 18.9 7.3 Table 5.3.3(b) 8 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-0 008 010 Being Being Being Being Being Being EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEME Sector Capital Cost Site Date Date to the Private ! Northern Lincolnshire OP 22.0 08/12/2000 29/03/2003 2.2 14.3 5.5 Northern Lincolnshire OBC 24.2 2006/07 finalised North & East Yorkshire & Northumberland, Tyne & eld Teaching Hospitals South Yorkshire FC 35.0 19/12/2004 01/10/2006 Y Hull & East Yorkshire Hospitals - Maternity & AcuteNorth & East Yorkshire & Hexham Wear OP 29.1 27/04/2001 12/07/2003 Northumbria Healthcare - Northumberland, Tyne & East Lancashire Hospitals - Blackburn Cumbria & Lancashire FC 109.6 09/07/2003 01/08/2006 Burnley Cumbria & Lancashire FC 30.1 13/10/2003 01/06/2006 East Lancashire Hospitals - North Kirklees PCT West Yorkshire FC 27.0 21/04/2004 31/10/2005 and Northumberland MH Wear FC 31.8 10/05/2004 01/03/2006 Newcastle, North Tyneside Northumberland, Tyne & Leeds Teaching Hospitals West Yorkshire FC 221.0 15/10/2004 01/08/2008 Manchester Children’s University Hospitals Greater Manchester FC 511.6 14/12/2004 01/06/2009 Central Manchester & She Hospitals Wear FC 298.6 27/04/2005 01/10/2007 Newcastle Upon Tyne Northumberland, Tyne & Neuro Disability Centre Wear FC 24.0 21/07/2005 01/02/2007 Northgate & Prudoe Trust - Northumberland, Tyne & Hospitals Cheshire & Merseyside OBC 380.1 30/10/2005 01/10/2008 St Helens & Knowsley Hull & East YorkshireHospitals North & East Yorkshire & Northern Lincolnshire OBC 63.6 10/11/2005 01/12/2007 Wakefield West Yorkshire OBC 265.7 01/06/2006 01/01/2010 Mid Yorkshire Hospitals - Selby & York PCT North & East Yorkshire & Being Salford Royal Hospitals Greater Manchester OBC 190.0 01/03/2006 01/03/2 East Lincolnshire PCT Northern Lincolnshire OBC 24.9 01/07/2006 01/07/2 Tameside & Glossop Acute Services Greater Manchester OBC 114.7 01/09/2006 01/01/2009 Tees & North East Yorkshire Wear SOC 78 01/08/2007 01/10/2009 Aintree Cheshire & Merseyside SOC 50 2007/08 finalised Royal Liverpool Children’s Hospital Cheshire & Merseyside SOC 300 2008/09 finalised Mersey Care Cheshire & Merseyside SOC 120 2008/09 finalised Mental Health Wear SOC 50 2008/09 finalised South of Tyne & Wearside Northumberland, Tyne & Leeds Teaching Hospitals - Childrens West Yorkshire SOC 260 2009/10 finalised Hospital Cheshire & Merseyside SOC 500 2009/10 finalised Royal Liverpool & Broadgreen University NORTH Strategic Health Authority Status Total Start on Completion 1997-9 Schemes with capital cost £20m 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 279 0.0 0.0 0.0 0.0 0.0 0.0 0.0 17.8 10.4 14.1 15.7 66.7 61.0 66.7 64.6 48.0 47.0 15.0 121.9 £ million 547.9 364.5 316.0 215.0 152.0 4160.9 549.0 364.5 316.0 215.0 152.0 4,304.9 7 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 Total 4.5 0.8 1.1 1.2 1.1 1.1 9.8 1.6 10.2 3.9 1.5 9.8 3.8 1.0 6.8 2.6 1.4 9.2 3.5 Spend Profile of the Total Capital Cost 9 1.8 13.3 3 36.6 36.6 18.3 13.3 (continued) 8 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-0 Table 5.3.3(b)— EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEME 0.0 9.8 5.7 7.0 5.9 4.3 23.1 9.2 6.0 4.5 0.8 1.1 1.2 1.1 1.1 0.0 0.0 0.0 0.0 71.0 0.0 0.0 0.0 0.0 9.8 73.0 0.0 0.0 0.0 1.8 11.6 6.9 19.0 26.1 7.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 73.0 Sector 4,236.9 12.8 45.1 112.0 166.9 103.8 61.0 39.5 118.6 314.5 448.0 548.9 594.6 4,319.7 18.5 52.1 117.9 172.9 138.5 77.1 64.5 149.2 322.9 449.1 550.1 595.7 llion schemes. From 2003–04 individual SHA returns are provided. Capital Cost Site Date Date to the Private Valley OP 61.0 31/03/1998 02/04/2001 6.1 15.3 27.5 12.2 Valley OP 48.0 28/05/1999 08/06/2002 4.8 31.2 12.0 County Durham & Tees OVERALL TOTAL FOR PFI AGGREGATE TOTAL Wear North & East Yorkshire & Northern Lincolnshire Northumberland, Tyne & Cheshire & Merseyside Valley Greater Manchester West YorkshireCumbria & Lancashire 0.0 South Yorkshire County Durham & Tees Capital value 97/98 - 03/041 Schemes with capital cost between £1m - £10m TOTAL Wansbeck Wear OP 17.8 16/11/2000 25/03/2003 1.8 11.6 4.5 Northumbria Health Care - Northumberland, Tyne & Acute Hospitals - Chester-le-street County Durham & Tees Valley OP 10.4 30/05/2002 18/11/2003 County Durham & Darlington Leeds Teaching Hospitals - Wharfedale West Yorkshire OP 14.1 20/09/2002 30/11/2004 Durham & DarlingtonPriority Services - West Park Valley County Durham & Tees OP 15.7 04/07/2003 20/08/2004 Doncaster and South Humber South Yorkshire OP 15.0 11/08/2003 01/01/2005 Schemes with capital cost £10m to £20m TOTAL North Cumbria - Cumberland Infirmary Cumbria & Lancashire OP 66.7 03/11/1997 10/04/2000 6.7 16.7 30.0 Acute Hospitals - North County Durham & Tees County Durham & Darlington South Manchester University Hospitals Greater Manchester OP 66.7 08/06/1998 25/07/2001 6.7 16.7 30.0 Calderdale and Huddersfield Healthcare West Yorkshire OP 64.6 31/07/1998 08/04/2001 6.5 16.2 29.1 12. Acute Hospitals - South County Durham & Tees County Durham & Darlington South Tees Acute Hospitals Valley OP 121.9 16/08/1999 01/08/2003 12.2 18. NORTH Strategic Health Authority Status Total Start on Completion 1997-9 Leeds Community - High Royds Reprovision West Yorkshire OP 47.0 01/03/2000 16/12/2002 4.7 30.6 1 1. Up until last year aggregated figures were provided for £1 million—£10 mi 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 280 Health Committee: Evidence 64.1 28.5 25.0 86.6 28.1 26.1 76.0 28.2 31.0 67.2 35.0 25.8 216.0 312.2 158.0 696.0 296.0 137.0 378.9 186.0 391.3 164.5 £ million 013–14 Total .0 527.5 394.8 178.8 6,448.5 88.0 132.0 220.0 176.0 176.0 88.0 880.0 10.0 15.0 30.0 30.0 15.0 100.0 59.1 88.7 147.8 118.2 118.2 59.1 591.0 14.8 22.2 44.4 44.4 22.2 148.0 31.7 47.6 79.3 63.4 63.4 31.7 317.0 2.9 18.5 7.1 3.1 20.2 7.8 2.6 16.8 6.5 6.7 16.8 30.2 13.4 38.1 57.2 95.3 76.2 76.2 38.1 381.0 57.4 86.1 143.5 114.8 114.8 57.4 574.0 16.5 24.7 49.4 49.4 24.7 2.8 18.3 7.1 3.5 22.8 8.8 2.5 16.3 6.3 18.6 27.9 55.8 55.8 27.9 21.6 32.4 54.0 43.2 43.2 21.6 39.1 58.7 97.8 78.3 78.3 39.1 69.6 104.4 174.0 139.2 139.2 69.6 29.6 44.4 74.0 59.2 59.2 29.6 7.6 19.0 34.2 15.2 004–05 2005–06 2006–07 2007–08 2008–09 2009–10 2010–11 2011–12 2012–13 2 45.4 86.1 54.6 43.3 66.7 16.1 Spend Profile of the Total Capital Cost 2.6 17.0 6.5 37.9 56.8 94.7 75.8 75.8 37.9 .7 13.7 20.6 41.1 41.1 20.6 2.8 18.2 7.0 16.0 28.8 12.8 Table 5.3.3(c) .7 21.7 39.0 17.3 15.8 38.8 87.9 133.5 74.6 61.1 160.3 236.1 357.3 605.6 837.6 935.0 907.0 897 2 2012 1/12/2004 pletion Date 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 2 09/2005 01/06/2009 Total EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEMES 6,448.5 Private Start on Capital Cost to the FC 312.2 12/09/2003 01/05/2008 SOC 67.2 2006/07 2010/11 SOC 317.0 2008/09 Being finalised SOC 100.0 2008/09 Q1 2012 OBC 296.0 01/09/2005 01/04/2009 OBC 25 2005/06 Being finalised OBC 28.5 01/04/2006 01/08/2007 OBC 164.5 01/01/2007 01/03/2009 OBC 25.8 2006/07 Being finalised OBC 186.0 01/09/2005 01/07/2009 OBC 216.0 01/11/2005 01/09/2007 OBC 574.0 01/04/2006 01/02/2011 OBC 31.0 01/12/2006 01/12/2008 2 2 ordshire OP 28.1 08/12/1999 01/09/2001 ordshire OBC 391.3 31/09/2005 01/02/2010 V V olk & Cambridgeshire SOC 148.0 2008/09 Q3 2011 olk & Cambridgeshire OP 158.0 09/01/1998 21/09/2001 15.8 23.7 47.4 47.4 23 olk & Cambridgeshire FC 76.0 27/10/2004 01/02/2007 olk & Cambridgeshire OBC 381.0 31/03/2006 01/01/2012 olk & Cambridgeshire OBC 35 01/10/2005 Being finalised V V V V V Shropshire & Sta Birmingham & Black Country OP 26.1 19/12/2002 15/10/2004 West Midlands South FC 378.9 27/11/2002 01/07/2006 Rutland FC 28.2 03/03/2005 01/01/2008 Norfolk, Su Leicestershire, Northamptonshire & Leicestershire, Northamptonshire & Leicestershire, Northamptonshire & ! ordshire Combined V ordshire Shropshire & Sta V TOTAL Norfolk & Norwich Norfolk, Su Worcestershire Acute West Midlands South OP 86.6 18/03/1999 18/03/2002 8 North Sta Hereford Hospitals West Midlands South OP 64.1 31/03/1999 01/03/2002 6.4 Healthcare Dudley Group of Hospitals Birmingham & Black Country OP 137.0 01/05/2001 0 Sandwell & W Birmingham—City Hospital Warwickshire—Walsgrave University Hospitals Coventry & Derby Hospitals Trent Cambridge University Hospitals— Addenbrookes Daventry & South NorthamptonshirePCT Leicestershire, Northamptonshire & University Hospitals of North Sta Mid Essex Hospitals Essex University Hospitals Birmingham Birmingham & Black Country OBC 696.0 01/ Sherwood Forest Hospitals Trent Ipswich Hospital Norfolk, Su Essex Rivers Healthcare Essex South Essex Partnership Essex Derbyshire Mental Health Trent Walsall Hospitals Birmingham & Black Country Peterborough Hospitals Norfolk, Su University Hospitals of Leicester Rutland Southend Hospital Essex Northamptonshire Healthcare Rutland Sandwell & W Birmingham Birmingham & Black Country SOC 591.0 2008/09 Q2 201 Papworth Hospitals Norfolk, Su EASTERN & MIDLANDS Strategic Health Authority Status Sector Site DateCom Brentwood, Billericay & Wickford PCT Essex Leicestershire Partnership Rutland East & North Hertfordhire Bedfordshire & Hertfordshire SOC 880 2008/09 Q2 Royal Wolverhampton Hospitals Birmingham & Black Country Schemes with capital cost £20 million 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 281 l 8.3 0.0 3.4 0.0 0.0 0.0 0.0 19.4 16.6 18.0 14.7 12.8 14.8 14.4 £ million 7.0 527.5 394.8 178.8 6,600.6 –06 2006–07 2007–08 2008–09 2009–10 2010–11 2011–12 2012–13 2013–14 Tota 1.9 12.6 4.9 6.0 8.4 6.0 2.3 Spend Profile of the Total Capital Cost 1.3 8.3 3.2 1.5 9.6 3.7 1.5 9.6 3.7 1.8 11.7 4.5 3.4 (continued) 1.7 10.8 4.2 0.0 0.0 1.7 14.1 28.2 26.1 6.9 1.9 12.6 4.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 96.3 0.0 0.0 4.9 12.8 15.5 0.0 6.0 8.3 0.0 8.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 55.9 Table 5.3.3(c)— 15.8 38.8 94.4 160.3 118.287.1 173.2246.3369.9 618.9 837.6 935.0 907.0 89 e 1997–98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005 eview. Due to report in October 2005. 2000 09/09/2002 3/2002 23/06/2003 08/2000 18/03/2002 llion schemes. From 2003–04 individual SHA returns are provided. 0.0 0.0 0.0 3.4 0.0 0.0 0.0 17.3 96.3 13.9 Total EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEMES 6,562.0 Private Start on Completion Capital Cost to the OP 16.6 24/05/1999 01/10/2000 FC 19.4 23/12/2004 01/02/2007 1 ordshire V olk & Cambridgeshire V Schemes with capital cost betweenCapital £1 value million–£10 97/98–03/04 million TOTAL QMC, Nottingham University Hospital Trent EASTERN & MIDLANDS Strategic Health Authority Status Sector Site Date Dat Birmingham & Solihull Mental Health Birmingham & Black Country OP 18.0 15/ 2. Values and dates may change as a result of the Birmingham & Black Country r Luton and Dunstable Hospitals Befordshire & Hertfordshire OP 14.7 21/11/ OVERALL TOTAL FOR PFI Royston Buntingford & Bishop Stortford PCT Befordshire & Hertfordshire OP 14.8 04/05/2001 28/04/2003 The Royal Wolverhampton Hospitals Birmingham & Black Country OP 12.8 20/0 Essex AGGREGATE TOTAL West Midlands South Leicestershire, Northamptonshire & Rutland Shropshire & Sta Trent Norfolk, Su Schemes with capital cost £10million to £20 million Nottinghamshire Healthcare Trent Befordshire & Hertfordshire 1. Up until last year aggregated figures were provided for £1 million–£10 mi Birmingham & Black Country 3178271150 Page Type [E] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Ev 282 Health Committee: Evidence 0.0 2.0 0.0 0.0 0.0 14.5 54.3 46.1 72.0 15.0 96.1 60.0 31.9 75.4 54.8 32.7 10.8 10.8 75.5 79.8 21.9 69.3 117.9 108.0 422.0 238.0 1,128.0 £ million 5.9 212.3 129.9 32.8 3,962.5 5.9 212.3 129.9 32.8 3,875.6 32.8 49.2 82.0 65.6 65.6 32.8 328.0 33.8 50.7 84.5 67.6 67.6 33.8 337.9 12.1 18.2 36.3 36.3 18.2 121.0 30.5 45.8 76.3 61.0 61.0 30.5 305.0 8.0 20.0 35.9 16.0 10.8 16.2 32.4 32.4 16.2 6–07 2007–08 2008–09 2009–10 2010–11 2011–12 2012–13 2013–14 Total 112.8 169.2 282.0 225.6 225.6 112.8 7.5 49.0 18.9 3.3 21.3 8.2 0.1 1.1 0.2 0.6 7.2 46.8 18.0 Spend Profile of the Total Capital Cost 6.9 17.3 31.2 13.9 5.5 35.6 13.7 23.8 35.7 71.4 71.4 35.7 2.2 14.2 5.5 3.2 20.7 8.0 1.1 7.0 2.7 6.0 15.0 27.0 12.0 1.5 9.4 3.6 42.2 63.3 105.5 84.4 84.4 42.2 7.6 18.9 34.0 15.1 4.6 30.0 11.5 Table 5.3.3(d) 9.6 24.0 43.2 19.2 98 1998–99 1999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 200 0.0 1.5 9.8 7.4 23.5 9.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 51.1 2.1 32.5 78.7 207.5 226.3 191.9 167.8 204.6 389.5 318.5 430.8 441.3 520.2 37 0.0 26.8 67.4 200.1 189.3 170.7 167.6 204.5 388.4 318.3 430.2 441.3 520.2 37 2.1 4.2 1.5 0.0 13.6 12.2 0.2 0.1 1.1 0.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 35.8 06 008 007 000 1.5 9.8 3.8 /2002 1.1 7.0 2.7 3/2002 5.4 13.6 24.4 10.9 05/2009 /06/2002 g finalised 16/05/2003 08 Q2 2010 004 15/11/2006 2000 12/06/2005 07/08 Q4 2010 llion schemes. From 2003–04 individual SHA returns are provided. 2.0 0.0 0.0 0.0 0.0 2.0 51.1 Total EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEMES 3,875.6 3,928.7 Private Start on Capital Cost to the South East London OP 75.5 06/12/1999 07/10/2002 South East London OP 10.8 04/07/2000 20/12/2001 South East London FC 72.0 08/07/2004 01/09/2006 North East London OBC 1,128.0 01/09/2005 01/09/2013 North West London SOC 337.9 2007/08 Q2 2010 North West London OP 117.9 19/11/1998 29/03/2003 11.8 17.7 35.4 35.4 17.7 South West London FC 75.4 06/05/2004 01/01/2006 South West London FC 32.7 23/11/2004 01/05/2006 Strategic Health Authority Status Sector Site DateCompletion Date 1997– South West London OP 46.1 20/03/2000 11/09/2003 North West London OP 21.9 05/12/2002 21/04/2005 North East London FC 54.8 27/01/2004 01/06/2006 ! 1 Schemes with capital cost betweenCapital £1 value million–£10 97/98—03/04 million TOTAL Queen Mary’s Hospital Sidcup South East London OP 15.0 11/12/1998 30/03/2 North East London Mental Health North East London OP 10.8 04/07/2000 04/03 Oxleas East London & the City Mental Health North East London OP 14.5 05/09/2000 11 Schemes with capital cost £10 million to £20 million TOTAL Queen Elizabeth Hospital South East London OP 96.1 01/07/1998 28/02/2001 Bromley Healthcare Barnet & Chase Farm Hospitals North Central London OP 54.3 01/02/1999 02/0 Kings Healthcare St Georges Hospital University College London Hospitals North Central London OP 422.0 12/07/ West Middlesex University Hospitals North West London OP 60.0 30/01/2001 Brent PCT—Willesden The Whittington Hospital North Central London FC 31.9 09/10/2002 01/01/2 North West London Hospitals North West London FC 69.3 06/11/2003 01/01/20 Newham Healthcare Barking Havering & Redbridge Hospitals North East London FC 238.0 15/01/2 Wandsworth PCT—Roehampton Lewisham Hospital Kingston Hospital Barts & The London North Middlesex Hospitals North West London OBC 108.0 31/03/2006 31/12/2 Barnet & Chase Farm Hospitals North Central London SOC 79.8 30/09/2006 01/ North West London Hospitals—Northwick Park North West London SOC 305.0 20 Hillingdon Hospital OVERALL TOTAL FOR PFI LONDON Royal National Orthopaedic Hospital North Central London SOC 121.0 2007/ AGGREGATE TOTAL South West London North West London South East London Whipps Cross University Hospital North East London SOC 328.0 2008/09 Bein North Central London Schemes with capital cost £20 million North East London 1. Up until last year aggregated figures were provided for £1 million–£10 mi 3178271150 Page Type [O] 27-04-06 16:18:05 Pag Table: COENEW PPSysB Unit: PAG1
Health Committee: Evidence Ev 283 9.5 9.7 0.0 0.0 0.0 10.5 94.0 22.0 29.0 24.1 10.2 10.4 18.8 18.0 37.0 36.0 36.0 10.5 45.1 29.7 32.0 83.0 46.6 134.0 100.2 129.0 193.0 £ million 70.7 405.3 255.1 3,278.5 470.7 405.3 255.1 3,426.5 55.0 82.5 137.5 110.0 385.0 40.0 60.0 100.0 80.0 80.0 360.0 8.0 12.0 24.0 24.0 12.0 80.0 34.1 51.2 85.3 68.2 68.2 34.1 341.2 31.0 46.5 77.5 62.0 62.0 31.0 310.0 10.4 15.6 31.2 31.2 15.6 104.0 20.0 30.0 60.0 60.0 30.0 200.0 8 2008–09 2009–10 2010–11 2011–12 2012–13 2013–14 Total 9.5 19.3 29.0 57.9 57.9 29.0 42.8 64.1 106.9 85.5 85.5 42.8 427.6 1.8 11.7 4.5 9.7 12.9 19.4 38.7 38.7 19.4 3.6 23.4 9.0 6.5 4.0 4.7 30.3 11.7 6.5 4.0 2.4 15.7 6.0 8.3 20.8 37.4 16.6 3.6 23.4 9.0 Spend Profile of the Total Capital Cost 13.4 20.1 40.2 40.2 20.1 3.7 24.1 9.3 1.0 6.8 2.6 3.2 20.8 8.0 3.0 19.3 7.4 2.9 18.9 7.3 1.0 6.6 2.6 10.0 15.0 30.1 30.1 15.0 999–2000 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07 2007–0 Table 5.3.3(e) .5 29.3 11.3 0.0 0.0 0.0 1.0 6.6 5.5 19.0 7.3 1.8 11.7 4.5 0.0 0.0 0.0 0.0 0.0 0.0 57.4 7.6 6.8 4.7 5.5 2.4 8.4 15.0 13.0 17.7 9.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 90.6 13.9 52.8 65.8 48.1 41.4 75.1 88.0 59.9 166.6 194.6 168.5 307.0 358.1 507.5 4 21.5 59.6 70.5 54.7 50.5 89.0 121.9 80.2 186.1 215.8 173.0 307.0 358.1 507.5 10 001 2.2 14.3 5.5 /2003 3/2006 09 Q4 2010 04 30/04/2007 /2004 11/08/2006 llion schemes. From 2003–04 individual SHA returns are provided. 0.0 0.0 0.0 0.0 0.0 0.0 13.0 57.4 13.0 Total EXPENDITURE PROFILE OF CAPITAL SPEND ON PFI SCHEMES 3,483.5 3,553.9 Private Start on Completion Capital Cost to the South West Peninsula OP 10.4 01/07/2002 25/05/2004 South West Peninsula OP 10.2 31/10/2000 01/06/2002 Dorset & Somerset OBC 18.0 01/09/2005 01/08/2007 Dorset & Somerset FC 24.1 04/03/2004 01/02/2006 Hampshire & Isle of Wight OBC 193.0 01/09/2005 01/10/2008 South West Peninsula SOC 341.2 2007/08 Q1 2010 Thames Valley OP 18.8 04/07/2002 01/03/2004 1.9 12.2 4.7 Kent & Medway OP 94.0 30/07/1997 11/09/2000 9.4 23.5 42.3 18.8 Avon, Gloucestershire & Avon, Gloucestershire & Avon, Gloucestershire & Hampshire & Isle of Wight FC 36.0 18/11/2004 01/11/2006 Avon, Gloucestershire & Avon, Gloucestershire & Wiltshire SOC 104.0 2008/09 Being finalised Strategic Health Authority Status Sector Site Date Date 1997–98 1998–99 1 South West Peninsula SOC 200.0 2008/09 Being finalised South West Peninsula SOC 400.0 2009/10 Being finalised ! 1 e Hospitals Thames Valley FC 134.0 19/12/2003 30/05/2007 e Hospitals Thames Valley OBC 129.0 14/08/2005 01/02/2008 V V eld Orthopaedic Centre Thames Valley FC 37.0 20/04/2002 01/09/2006 Y Schemes with capital costCapital between value £1 97/98–03/04 million–£10 million TOTAL Cornwall Healthcare Mid Devon PCT Newbury PCT Taunton & Somerset Schemes with capital cost £10 million to £20 million TOTAL Dartford & Gravesham Buckinghamshire Hospitals Thames Valley OP 45.1 14/12/1997 17/10/2000 4 West Sussex Health & Social Care Surrey & Sussex OP 22.0 24/06/1999 31/01/2 Swindon & Marlborough Wiltshire OP 100.2 05/10/1999 03/12/2002 Berkshire Health Care Thames Valley OP 29.7 02/05/2001 29/04/2003 Guildford & Waverley PCT—Farnham Surrey & Sussex OP 29.0 29/10/2001 01/11 Gloucestershire Royal Wiltshire OP 32.0 01/05/2002 30/11/2004 Nu Oxford Radcli Salisbury Healthcare Avon & Western Wiltshire Mentral Health Wiltshire FC 83.0 01/03/2004 31/0 Buckinghamshire Hospitals—Stoke Mandeville Thames Valley FC 46.6 21/05 Brighton and Sussex University Hospitals Surrey & Sussex FC 36.0 10/06/20 New Forest PCT—Lymington Oxford Radcli Portsmouth Hospitals Maidstone & Tunbridge Wells Surrey & Sussex OBC 427.6 01/11/2006 01/08/20 South Devon Healthcare Southampton University Hospitals Hampshire & Isle of Wight SOC 80.0 2008/ North Bristol / South Gloucestershire Wiltshire SOC 310.0 2008/09 Q1 2013 United Bristol Plymouth Hospitals SOUTH Plymouth Hospitals OVERALL TOTAL FOR PFI Kent & Medway Surrey & Sussex Thames Valley Dorset & Somerset Heatherwood & Wexham Park Thames Valley SOC 550.0 2010/11 Being finalised Avon, Gloucestershire & Wiltshire AGGREGATE TOTAL Hampshire & Isle of Wight Schemes with capital cost £20 million South West Peninsula 1. Up until last year aggregated figures were provided for £1 million–£10 mi 3178271156 Page Type [SE] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 284 Health Committee: Evidence
5.3.4 Could the Department provide an update of Tables 5.3.4? [5.3.4] Answer 1. The information requested is provided in Table 5.3.4.
Table 5.3.4 INCREASES TO THE CAPITAL COST OF PFI SCHEMES
ABCDEF Capital Capital Cost at Cost Capital % Increase % Increase OBC Stage Reported Value This Since OBC Since Last Last Year Year Stage Year North £m £m £m Leeds Teaching Hospitals 125.0 221.0 221.0 76.8% 0.0% Newcastle upon Tyne Hospitals 129.5 256.2 298.6 130.6% 16.5% Mid Yorkshire Hospitals 164.1 256.0 265.7 61.9% 3.8% Hull & East Yorkshire Hospitals 37.6 60.4 63.6 69.1% 5.3% (Oncology) Northgate & Prudhoe PCT 14.0 24.0 24.0 71.4% 0.0% SheYeld Teaching Hospitals 30.0 31.2 35.0 16.7% 12.2% Central Manchester & Manchester 199.0 413.0 511.6 157.1% 23.9% Children’s St Helens & Knowsley 229.8 257.8 380.1 65.4% 47.4% Salford Royal Hospitals 114.0 186.2 190.0 66.7% 2.0% Tameside & Glossop 41.0 84.2 114.7 179.8% 36.2% Selby & York PCT 23.6 24.2 24.2 2.5% 0.0% East Lincolnshire PCT 24.0 24.0 24.9 3.7% 3.7% Leeds Teaching Hospitals—Childrens 229.0 N/A 260.0 13.5% N/A Tees & North East Yorkshire 73.0 N/A 78.0 6.8% N/A South of Tyne & Wearside MH 50.0 N/A 50.0 0.0% N/A Aintree Hospitals 50.0 N/A 50.0 0.0% N/A Mersey Care 120.0 N/A 120.0 0.0% N/A Royal Liverpool Children’s Hospital 300.0 N/A 300.0 0.0% N/A Royal Liverpool University Hospital 500.0 N/A 500.0 0.0% N/A TOTAL NORTH 2,453.6 1,838.2 3,511.4
COMMENT ON ANY INCREASE OVER 10%
Leeds Teaching Hospitals Initial OBC cost 125 Increased Multi-storey car park requirement 21 Increased building size requirements including incorporation of elements of “improving the patient experience” 25 Detailed review of fixture and fittings 3 Development of M&E services 5 Inclusion of PACS 2 Other equipment changes 2 Specification developments and reviews including linnear accelerator shielding requirements and service requirements 20 MIPSuplift 26 Reduction to enabling schemes "8 PFI Capital value 221
Newcastle Upon Tyne Hospitals Increases since last year: The 16.5% uplift since last report has arisen from inflation (as a result of a protracted construction programme c10 years in the PSC and the further uplift in MIPS to 423); a correction of the DCAG Circulation allowances in the PSC to reflect actual standards in Building Notes as well as inclusion of all Trust alteration schemes necessary to deliver the project. 3178271157 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 285
Mid Yorkshire Hospitals—Wakefield Capital cost at SOC stage 164.1 increase relating to the NHSEstates Departmental Cost Allowance Guides ( DCAGs) taking into account the new principles in order to produce a better patient environment. 23.3 Changes in functional content 12.6 Additional scope and space requirements 3.2 MIPSto present base 66.6 Increases at BAFO stage 21.4 Decreases post preferred bidder "17.6 Other reductions "7.9 Current Capital value 265.7 Hull and East Yorks Capital cost at SOC stage 37.6 Improving the patient environment 2.9 Increased linnear accelerators (3 to 6) 6.1 Inflation 5.8 Undergraduate teaching accomodation 1.2 Reprovision of boiler house 1.5 Other functional and infrastructure changes 1.4 Increase in planning contingency 0.3 Inreased equipment costs 0.8 MIPSincreases 6.0 63.6 Northgate & Prudhoe PCT The change from £14 million to £24 million at financial close was due to to a revised OBC (Version 1 was RO approved and needed re-approval when the SHAs were founded) and uplift for MIPS. SheYeld Teaching Hospitals Inflationary increases to MIPS427 2.7 Refinements to design at Output specification stage 1.6 Reassessment of contingency provision 0.6 other changes 0.1 Total increases 5 Central Manchester & Manchester Children’s Original OBC figure 199 MIPSincrease 12.6 Adult NBI growth & children’s Burns and Cleft Lip 36 Energy targets, building regulations and Health and safety 7.75 Mental Health reprovision 7.75 Early Delivery of Children’s facilities 26.9 Modernisation Equipment consequences 7.9 Cardiac services 1.7 Obstetrics new model of care 1.5 Improving the Patient Experience 30.8 New Guidance (Health and Safety, building regulations etc) 12 Service Developments—Nationally/Regionally driven 10.4 Service Developments University or Trust driven 6.9 Spacial/equipment re-alignment 5.2 Other 12.05 Capital Costs as per FBC 378.45 FBC Inflation 53.4 reduction "7.1 FBC Cost 424.75 Inflation 86.8 Financial close outturn 511.55 St Helens & Knowsley Hospitals OBC costs 229.8 Exclusion of Primary Care Elements (inc. Newton, Millenium Centre, Elyn Lodge) "21.8 Consumerism/Capacity Planning/Service changes 17.8 Additional on cost items, (inc Highways, drainage, contamination) 15.8 Functional content changes 18.4 Exclusion of IT elements "6.1 3178271157 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 286 Health Committee: Evidence
Equipment requirements 16.5 Inflation Adjustment 47.1 Indexation to MIPS415 (VOP) 62.6 Revised PSC costs (inc VAT) 380.1 Salford Royal SOC cost 114 Building Inflation 12 Improving the patient experience 10 Estates standard 9 A&E 4.1 Shift to HDU beds 3.8 Post acute bed 2.5 Neonatal & Childrens 2.2 On costs 18.3 Ceiling limits 1.5 Decked car park 4 Equipment 4.6 Contingency 3.9 Reduction in VAT free costs 3.1 Increase in Health and Social Care centre costs. 3.3 Total 196.3 This figure represents the capital costs of both the Hospital PFI scheme and the four Health and Social Care Centres, these have now been grouped together to reflect the scope and content of the OBC. However, the HSCCs are being procured under Lift and therefore not part of the PFI procurement. The capital costs below show the costs of the Hope Hospital PFI scheme only: Withdrawal of HSCCs from scheme costs "19.4 Reconciliation "3.2 Reduction of new build following review in 2003 "3.6 Increase in MIPs for Hope Hospital from 360 to 395 16.1 186.2 Acute wards, Childrens Unit omitted "16.0 Research—retained in existing "4.0 Womens—retained in existing (previously adapted) "6.0 General changes in dermatology/diabetes etc "8.2 sub-total 152.0 Inflation to out-turn 38.0 Planned out-turn capital value 190.0 Tameside & Glossop SOC cost 41.0 Improving the Patient Experience/modernisation 18.3 Equipment 3.5 Renal 1.0 MRI 1.6 Opthamology 4.2 NBI growth 4.5 EMI 10.1 Total OBC 84.2 Increase in MIPs from 395 to 425 7.4 Original scheme at MIPs 425 91.6 Reduction in scheme content "8.3 revised scheme at MIPs 425 83.3 Inflation adjustment to out-turn 30.5 Planned out-turn capital value 114.7 Leeds Teaching Hospitals—Children’s Addition of Optimism bias 3178271158 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 287
ABCDEF Capital Capital Cost at Cost Capital % Increase % Increase OBC Stage Reported Value This Since OBC Since Last Last Year Year Stage Year Midlands and Eastern £m £m £m University Hospital of North 224.0 308.0 391.3 74.7% 27.0% StaVordshire University Hospitals Birmingham 291.0 440.1 696.0 139.2% 58.1% Peterborough & Stamford Hospitals 135.0 293.0 381.0 182.2% 30.0% Cambridge University Hospitals— 30.0 76.0 76.0 153.3% 0.0% Addenbrookes Mid Essex hospitals—Chelmsford 80.0 121.0 186.0 132.5% 53.7% Essex Rivers Healthcare—Colchester 79.0 139.0 216.0 173.4% 55.4% Sherwood Forest Hospitals 66.0 147.4 296.0 348.5% 100.8% Nottinghamshire Healthcare 13.9 19.4 19.4 39.6% 0.0% University Hospitals of Leicester 286.0 447.0 574.0 100.7% 28.4% Daventry & South Northants PCT 19.5 28.2 28.2 44.6% 0.0% Northamptonshire Healthcare 19.5 28.9 31.2 60.0% 8.0% Ipswich Hospital 24.9 26.0 35.0 40.6% 34.6% Brentwood, Billericay & Wickford 20.0 20.0 25.8 29.0% 29.0% PCT South Essex Partnership 17.0 17.0 25.0 47.1% 47.1% Derbyshire Mental Health 31.6 31.6 28.5 "9.8% "9.8% Royal Wolverhampton1 110.0 312.0 317.0 188.2% 1.6% Walsall Hospitals1 43.0 127.0 164.5 282.6% 29.5% East Lincolnshire PCT 24.1 N/A 24.1 0.0% N/A East & North Herts/West Herts 880.0 N/A 880.0 0.0% N/A Hospitals Papworth Hospital 148.0 N/A 148.0 0.0% N/A Sandwell & West Birmingham 591.0 N/A 591.0 0.0% N/A Hospitals Southend Hospital 100.0 N/A 100.0 0.0% N/A Leicestershire Partnership 52.0 N/A 67.2 29.2% N/A TOTAL MIDLANDS & EASTERN 3,285.5 2,581.6 5,301.2 Notes: 1. Schemes may change in scope after completion of Black Country review
COMMENT ON ANY INCREASE OVER 10%
North StaVordshire Hospitals Uplift from MIPS345 to MIPS415 Inclusion of expansion and education space Adjustment to outturn price level University Hospitals Birmingham MIPSincreases (including shift to outturn MIPSreporting) Additional carparks Miscellaneous works including Trend Growth, enhanced external fac¸ade, extra curtain walling, comfort cooling, patient hotel etc. Cambridge University Hospitals Inclusion of a genetics centre—capital cost £9 million. This was originally a separate scheme but has now been merged with the larger scheme. Inclusion of new DCAGs for “improving the patient environment”. Inclusion of an integrated capital development to be funded by the University of Cambridge and the MRC (c £20 million) Mid Essex Hospital Inclusion of new DCAGs for “improving the patient environment”; 70 extra beds and two additonal theatres; removal of staV accommodation element. Cost now based on outturn MIPSof 469 and 510 (two phased construction). Peterborough Inclusion of new DCAGs for “improving the patient environment”. Expansion of cancer, renal and neo-natal intensive care services. Inclusion of £23.8 million Mental Health scheme. Capital cost now based on outturn MIPS 3178271158 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 288 Health Committee: Evidence
Essex Rivers Inclusion of new DCAGs for “improving patient experience”, indexation and incorporation of NHSPlan targets and revised activity figures. Capital cost now based on outturn costs Sherwood Forest Hospitals Inclusion of “improving the patient experience” standards; expansion of services, including emergency care and pathology; indexation. Changes since last year are mainly due to the impact of inflation (MIPS415), development of the clinical design, inclus ion of backlog maintenance, equipment requirements and increasing car park capacity. Nottinghamshire Healthcare Improvement of ICU facilities; additional oYce space; indexation University Hospitals of Leicester UHL Pathway project has increased by 56.3% since SOC approval. This is due to a number of factors: the application of “improving the patient environment” standards, inflation and the inclusion of the reprovision of academic space due to be replaced within the PFI. The diVerence between £447 million and £574 million is partly represented by £33 million on design development costs and the balance is due to inflation (MIPS) Daventry & South Northants Increase in capital cost due to inclusion of VAT, recalculation of inflation allowance and additional costs related to Local Authority planning requirements. Northampton Healthcare Revised models of care and “improving the patient environment”. Trust currently working with commissioners to reduce the impact of changes to the original proposal. Ipswich Capital cost now based on outurn MIPS Brentwood Billericay Wickford Capital cost now based on outturn MIPS452 South Essex Partnership Inclusion of “improving the patient experience”, indexation and the inclusion of additional community services Derbyshire Mental Health Derbyshire Mental Health—capital sum now excludes group 3 & 4 equipment and construction cost amendments Wolverhampton SHA has not yet signed oV OBC due to Trust financial position; case being reworked for 2006 Walsall Hospitals £127 million based on MIPS385; latest value based on MIPS448; further incr ease due to inclusion of Multi Professional Education Scheme in PFI (previously separate scheme) Leicestershire Partnership Leicestershire Partnership (AMHIRP) at SOC stage only—OBC expected March 2006. Figure quoted in column B at SOC stage—subsequent increase due to Building Inflation (MIPs).
Table 5.3.4 INCREASES TO THE CAPITAL COST OF PFI SCHEMES
ABCDEF Capital Cost Capital Cost Capital % Increase % Increase London at OBC Reported Value This Since OBC Since Last Stage Last Year Year Stage Year £m £m £m
Barts & The London 620.0 1,052.0 1,128.0 81.9% 7.2% Wandsworth PCT 20.5 57.4 75.4 267.8% 31.4% Kingston Hospital 22.1 32.7 32.7 48.0% 0.0% North Middlesex 73.0 100.8 108.0 47.9% 7.1% Barnet & Chase Farm 41.0 79.8 79.8 94.6% 0.0% Whipps Cross1 184.0 329.7 328.0 78.3% "0.5% 3178271159 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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ABCDEF Capital Cost Capital Cost Capital % Increase % Increase London at OBC Reported Value This Since OBC Since Last Stage Last Year Year Stage Year £m £m £m
North West London Hospitals—Northwick Park 305.0 N/A 305.0 0.0% N/A Royal National Orthopaedic Hospital 121.0 N/A 121.0 0.0% N/A Hillingdon Hospital 314.9 N/A 337.9 7.3% N/A
LONDON TOTAL 960.6 1,652.4 2,515.8 Notes 1. Whipps Cross is writing an options paper after second bidder pulled out of scheme. It is not yet known what format the new scheme will take.
Comment on any increase over 10%
Barts and The London
The Barts and The London OBC was approved at a cost of £462 million. The figure reported previously (£620 million) included an estimate for building cost inflation, due to the complexity and duration of the scheme. The increase to the current forecast outturn is explained as follows: £m OBC approved capital cost (MIP295) 462 Changes in scope of project (MIP295) 237 Building cost inflation 429 Current forecast outturn cost (equivalent to MIPS460) 1,128 The OBC was submitted in November 1999 and used the then current MIPSindex o f 295 giving a base date for inflation calculation of 1997. The changes in scope include an additional 125 beds and other supporting facilities, improvements to the patient environment in line with the NHSPlan, and the removal of ICT system s (to be procured separately) from the scheme. All changes have been agreed with the Trust’s commissioners. The current forecast outturn assumes construction takes place between 2005 and 2013. The £353 million building cost inflation equates to an increase of 51%. Building cost inflation, as measured by the NHS Estates MIPSindex, has increased by 33% since 1997. Building cost inflation is estimated to be rising at approximately 3% to 5% per annum (this needs to be treated with caution as the predictive accuracy of the MIPSindex is not str ong and building costs can be volatile, particularly in London). The current forecast outturn includes an estimate of inflation up to the completion of the majority of the new build in the scheme in 2009. It should be noted that the increase from £620 million to £1,128 million is the cumulative increase over the last four years since the OBC was approved. All these figures relate to the Trust’s Public Sector Comparator that has been updated periodically throughout the last four years to reflect the changing content of the scheme. A full review of the of the PSC was carried out during summer 2002 and more recently building cost inflation assumptions were updated in the light of information available to the Trust from its bid development process.
Wandsworth PCT
The building price index (MIPS) has increased the base capital cost by £13.170 million. The location factor has increased from 12% to 23% as Wandsworth is deemed an Inner London Borough. This has increased costs by a further £2.551 million. Gross inflationary increases are £15.721 million. The SHA took a decision to include Mental Health (69 beds, Day Hospital and CMHT bases) and Shell Space to allow for future service provision in Summer 2002 amounting to a furhter cost of £19.236 million. Additional costs of equipment, lifecycle costs and revisions to programme resulted in an extra cost of £2.036 million.
Kingston
OBC capital cost was £22.1 million based on a MIPSindex of 310. The FBC capit al cost is £32.7 million based on a MIPSindex of 422. The movement due to inflation is £8.1 million. Th e movement due to changes in specification is £2.5 million which is 11% of the OBC cost. 3178271159 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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North Middlesex Hospital NHS Trust
The main reason for the increase is the 18% increase in out-turn inflation of £13.2 million due to upwards revision of MIPSindices since OBC. Pressures on accommodation requireme nts, including the issue of new HBNs has resulted in an increase in functional content of £4.8 million, or 4.6%. The active switching element of IT—£1.2 million—was expected to be funded directly by the Trust, however there is insuYcient block capital funding available. The overall increase in the net cost of equipment is £3.7 million. The scheme also now includes Ophthalmology—£1.7 million, which the PCTs have asked to be included but was not in the original OBC, and approximately 2,200 sq m of shell space—£3.0 million. Since the last return the increase is primarily made up of some minor content changes and a separate Business Case approval (July 2005) for a new energy centre and 100% standby generation facility for the site which is now part of the project scope.
Barnet & Chase Farm Hospitals NHS Trust
The functional content of the project has been revised to include an additional two theatres and an additional endoscopy suite. An additional 17 beds are also to be provided. The capital costs have also increased in line with the increase in MIPSand the consequent increases ge nerated by this in fees, contingencies etc. The Trust has reviewed project scope and functional content with PCTs and the SHA to ensure congruence with Local Delivery Plans and commissioners’ expectations. A revised OBC is being prepared and next year’s return will reflect the agreed OBC position.
Whipps Cross University Hospital NHS Trust1
The OBC was approved in principle in July 2003 and finally approved by the SHA in January 2004. The scheme cost has increased due to: changes in the MIPSindex, change in locat ion factor and the consequent increases in associated costs (fees, contingencies etc). The project has also responded in full to improving the patient experience and the revised space standards. The approved OBC sum was £328 million (with the SOC being £184 million). A schedule of decanting and enabling works has been developed to assist the future PFI provider in clearing the site. One of these early schemes is the creation of a new energy centre on the site which would have been necessary in any event. An uplift was agreed to the cost of this (due to building price inflation) which added a further net £1.7 million to the project control total.
Table 5.3.4 INCREASES TO THE CAPITAL COST OF PFI SCHEMES
ABCDEF South Capital Capital Cost Capital % Increase % Increase Cost at Reported Value This Since OBC Since Last OBC Stage Last Year Stage Year Year £m £m £m Taunton and Somerset—Cardiac 16.0 18.0 18.0 12.5% 0.0% Portsmouth Hospitals 127.7 192.0 193.0 51.1% 0.5% Oxford RadcliVe Hospitals—Cancer 60.0 99.7 129.0 115.0% 29.4% Plymouth Hospitals1 101.0 274.4 N/A N/A N/A New Forest PCT—Lymington 36.0 36.0 36.0 0.0% 0.0% South Devon 65.0 250.0 341.2 424.9% 36.5% Southampton 52.0 80.0 80.0 53.8% 0.0% Maidstone & Tunbridge Wells 175.0 292.5 427.6 144.3% 46.2% Heatherwood & Wexham Park Hospitals 550.0 N/A 550.0 0.0% N/A Taunton & Somerset 75.0 N/A 75.0 0.0% N/A Plymouth Hospitals1 200.0 N/A 200.0 0.0% N/A Plymouth Hospitals1 400.0 N/A 400.0 0.0% N/A North Bristol/South Gloucestershire 310.0 N/A 310.0 0.0% N/A
TOTAL SOUTH 2,167.7 1,242.6 2,759.8 Notes 1. The scheme at Plymouth has been halted due to lack of bidder interest. After rescoping it plans to go out to market as two separate schemes. 3178271160 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Comment on any increase over 10%
Taunton & Somerset Increase from MIPS325 to MIPS360
Portsmouth Hospitals Impact of change from MIPs 378 to MIPs 415 Improving the patient environment Additional 20 Maternity beds Impact of building regulations
Oxford—Cancer Centre Scheme Scheme increase from last year’s figure of £99.7 million is optimism bias and VAT
South Devon Healthcare
Increases since last year The movement in MIPSto take us from current cost, which the estimate last ye ar was based on, to outturn cost when the hospital is completed is £76 million. 76 In addition we have reviewed the provision of a small number of services and made some minor amendments to the scheme to incorporate the Breast Care Unit, the TAIRU Unit and Occupational Therapy Building, Total Value £6 million. Previously the services provided in these areas were not being included within the PFI project. 6 In addition the figure submitted last year of £250 million was an estimated figure prior to the completion of an OBC. Since that time we have completed an OBC which was signed oV by the SHA in May of this year. The work conducted for the OBC provided a more accurate costing and meant a movement in the figures of £9 million. 9 Total Increase in Year 91 Southampton Change to scope of scheme as SOC is updated.
Maidstone & Tunbridge Wells MIPS VAT & Optimism bias
5.3.5 Could the Department provide an update of Tables 5.3.5, showing, for major projects (those greater than £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 as follows: Basic construction contract, broken down between pre-implementation and post implementation costs; The value of risk adjustment, again broken down between pre-implementation and post implementation costs, in both pounds and percentage terms, and The final total real full life cost of both options. [5.3.5] Answer 1. The information requested is given in Tables 5.3.5(a) to (f).
Table 5.3.5(a) NEWCASTLE UPON TYNE HOSPITALS
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 178.7 24.3 13.6 N/a 6.8 N/a Post-implementation 85.6 17.1 20.0 N/a 1.3 N/a Total 264.3 41.4 15.7 288.4 8.1 2.8 Risk adjusted total 305.7 296.5 3178271162 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 292 Health Committee: Evidence
Table 5.3.5(b) CENTRAL MANCHESTER & MANCHESTER CHILDREN’S HOSPITALS
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 1,765.2 4.6 0.3 N/a 4.6 N/a Post-implementation 2,856.7 64.7 2.3 N/a 5.2 N/a Total 4,621.9 69.3 1.5 4,658.3 9.7 0.2 Risk adjusted total 4,691.2 4,668.0
Table 5.3.5(c) LEEDSTEACHING HOSPITALS
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 383.7 7.5 2.0 N/a 1.1 N/a Post-implementation 146.3 22.7 15.5 N/a 5.6 N/a Total 530.0 30.2 5.7 535.7 6.7 1.3 Risk adjusted total 560.2 542.4 CGF benefit (1) 535.3 Notes 1. Leeds is the first of two pilot schemes to sign that utilises the Credit Guarantee Finance (CGF). 2. Under CGF, instead of the private sector raising the money through traditional bond or bank debt finance, the Government provides the project funding (Senior debt) through issuing Government gilts. Benefits are that Government gilts are always cheaper than private sector borrowing. The private sector still retains the financial risks on the projects for which it adds a premium. The trust noted that the use of CGF in this case had created a £7 million saving to the public sector.
Table 5.3.5(d) SHEFFIELD TEACHING HOSPITALS
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 29.2 4.4 15.1 N/a 1.0 N/a Post-implementation 107.0 3.3 3.1 N/a 0.3 N/a Total 136.2 7.7 5.7 140.5 1.3 0.9 Risk adjusted total 143.9 141.8
Table 5.3.5(e) KINGSTON HOSPITAL
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 24,502.7 4,147.4 16.9 N/a 2,015.0 N/a Post-implementation 187,511.5 26,288.1 14.0 N/a 6,809.1 N/a Total 212,014.2 30,435.5 14.4 228,098.0 8,824.1 3.9 Risk adjusted total 242,449.7 236,922.1
Table 5.3.5(f) NEW FOREST PCT—LYMINGTON
Publicly funded option PFI option Phase of project NPC (£m) Risk (£m) Risk (%) NPC (£m) Risk (£m) Risk (%) Pre-implementation 32,113.0 5,909.0 18.4 N/a 1,364.0 N/a Post-implementation 174,790.0 6,281.0 3.6 N/a 3,074.0 N/a Total 206,903.0 12,190.0 5.9 211,708.0 4,438.0 2.1 Risk adjusted total 219,093.0 216,146.0 3178271163 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 293
5.3.6 Could the Department provide an update of Table 5.3.6? [5.3.6] Answer 1. The information requested is given in Table 5.3.6.
Table 5.3.6 DONATED CAPITAL ADDITIONS(BY REGION) 1999–2000 TO 2001–02
Land Buildings, Installations & Fittings Assets under Construction Equipment Totals 1999–2000 2000–01 2001–02 1999–2000 2000–01 2001–02 1999–2000 2000–01 2001–02 1999–2000 2000–01 2001–02 1999–2000 2000–01 2001–02 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
Northern & Yorkshire 0 1 0 1,149 2,004 139 2,676 776 86 5,186 8,051 8,601 9,011 10,832 8,826 Trent 0 5 0 2,820 4,612 2,322 509 778 6,571 6,196 8,304 8,369 9,525 13,699 17,262 Eastern 96 0 0 3,318 3,356 1,269 2,128 1,304 2,828 2,805 5,316 5,842 8,347 9,976 9,939 London 192 115 0 18,443 6,478 5,791 9,665 22,875 20,603 8,558 12,281 12,837 36,858 41,749 39,231 South East 186 0 20 5,002 8,275 1,530 4,949 4,602 8,456 10,317 12,681 10,388 20,454 25,558 20,394 South West 0 0 0 4,517 4,142 2,825 5,822 6,094 12,953 4,000 9,526 5,590 14,339 19,762 21,368 West Midlands 0 0 115 2,305 3,190 1,614 2,947 3,558 1,354 4,354 7,580 7,701 9,606 14,328 10,784 North West 52 450 0 2,040 1,703 2,580 6,185 10,482 12,954 4,766 4,329 5,807 13,043 16,964 21,341 Total 526 571 135 39,594 33,760 18,070 34,881 50,469 65,805 46,182 68,068 65,135 121,183 152,868 149,145
DONATED CAPITAL ADDITIONS(BY DIRECTORATE OF HEALTH AND SOCIAL CARE) 2002 –03
Assets under Buildings construction excl. & payments Plant & Transport Information Furniture & Land dwellings Dwellings on account Machinery Equipment Technology fittings Totals £000 £000 £000 £000 £000 £000 £000 £000 £000
London 3 4,604 0 41,494 7,334 0 968 54 54,457 Midlands & the East 0 6,305 284 9,141 14,662 183 494 102 31,171 North 0 5,294 52 4,908 14,926 128 476 115 25,899 South 64 4,252 216 13,061 19,490 120 346 847 38,396 Total 67 20,455 552 68,604 56,412 431 2,284 1,118 149,923
DONATED CAPITAL ADDITIONS(BY STRATEGICHEALTH AUTHORITY AREA) 2003–04
Assets under Buildings construction excl. & payments Plant & Transport Information Furniture & Land dwellings Dwellings on account Machinery Equipment Technology fittings Totals £000 £000 £000 £000 £000 £000 £000 £000 £000
Avon, Gloucestershire and Wiltshire SHA 0 653 0 152 1,858 19 10 43 2,735 Bedfordshire and Hertfordshire SHA 0 2,571 0 84 196 713 8 153 3,725 Birmingham and the Black Country SHA 0 643 0 532 3,387 0 70 26 4,658 Cheshire and Merseyside SHA 0 1,655 0 457 1,697 13 78 13 3,913 County Durham and Tees Valley SHA 0 17 0 28 658 0 0 107 810 Cumbria and Lancashire SHA 0 148 0 906 2,975 0 7 23 4,059 Dorset and Somerset SHA 0 909 0 495 1,939 0 0 9 3,352 Essex SHA 0 30 0 0 1,708 0 5 5 1,748 Greater Manchester SHA 29 819 0 682 1,916 0 30 57 3,533 Hampshire and Isle of Wight SHA 0 6,988 0 537 2,448 30 0 0 10,003 Kent and Medway SHA 0 103 0 0 1,502 0 10 0 1,615 Leicestershire, Northamptonshire and 0 141 0 0 894 0 0 0 1,035 Rutland SHA Norfolk, SuVolk and Cambridgeshire SHA 0 234 0 217 1,286 0 72 3 1,812 North and East Yorkshire and Northern 0 1,322 0 0 385 0 2 0 1,709 Lincolnshire SHA North Central London SHA 0 1,272 0 27,379 854 0 295 5 29,805 North East London SHA 0 1,945 0 6,326 2,527 0 23 5 10,826 North West London SHA 0 3,565 0 532 3,424 0 537 92 8,150 Northumberland, Tyne and Wear SHA 0 537 0 179 2,849 27 117 6 3,715 Shropshire and StaVordshire SHA 0 1,107 0 954 1,397 0 28 24 3,510 South East London SHA 0 810 1 22,148 2,337 37 185 20 25,538 South West London SHA 0 274 0 4,224 2,851 0 0 0 7,349 South West Peninsula SHA 0 435 0 790 1,337 0 5 0 2,567 South Yorkshire SHA 0 464 7 9,093 2,527 130 111 45 12,377 Surrey and Sussex SHA 0 1,332 0 2,427 3,271 40 35 17 7,122 Thames Valley SHA 0 2,079 10 1,747 1,905 0 8 6 5,755 Trent SHA 0 1,538 0 3,068 1,695 22 5 7 6,335 West Midlands South SHA 0 214 0 0 965 8 81 0 1,268 West Yorkshire SHA 0 1,248 0 27 2,647 94 86 32 4,134 Total 29 33,053 18 82,984 53,435 1,133 1,808 698 173,158
Notes: 1. Figures for 2003–04 are final and are shown by Strategic Health Authority area. Figures for 2004–2005 are not available. 2. Figures for 2002–03 and 2003–04 are presented under diVerent categories from previous years and cannot be readily shown by the old Regions. 3. Donated capital additions is not separately disclosed in the NHStrust s ummarisation schedules from 2001–02 onwards and a proxy figure has been calculated from the total donated and government granted additions less the movement in government granted assets during the year. 4. This introduces a small variance due to depreciation charged in the year on the government granted assets in eVect increasing the value of donated additions in the table by the amount of depreciation. 5. 2004–05 figures (when available) will not include data from NHSfoundati on trusts. 3178271165 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 294 Health Committee: Evidence
5.3.7 Could the Department provide an update of Table 5.3.7, specifying the cost of the unitary fee for PFI hospitals above that negotiated in the original contract? [5.3.7] Answer 1. The information requested is given in Table 5.3.7.
Table 5.3.7 INCREASE IN UNITARY FEE
ABCDE Trust Unitary fee Revised at FC Unitary Fee % change Reason £000 £000
Worcestershire Acute Hospitals 19,399 22,280 14.9 Additional services extended to Newtown Site, Additional Equipment and other design and building changes required by the Trust. Luton & Dunstable 1,021 1,139 11.6 Provision of an additional ward West Middlesex University 9,700 10,746 10.8 Variations relating to new areas and charges for other areas Hospital receiving more usage than designed in the contract. In the first year of the scheme, other variable costs were incurred not identified in original unitary charge calculation. A 2.35% increase is reported over last year for further changes to the FM contract. North Cumbria 13,377 14,772 10.4 Clinical & Domestic waste, Utilities and cumulatative eVect of Acute Hospitals minor change orders. South Manchester University 19,754 21,697 9.8 Increased maintenance costs for the non-PFI estate. Increased Hospital Trust number of wards and patient numbers leading to increased portering and catering requirements across the site and triggering volume payments for these services (totalling £3.14m) since FC. Also to note that the unitary fee is not level throughout the contract and some increases are due to the approved payment profile.. NuYeld Orthopaedic Centre 3,973 4,358 9.7 Contract variation the result of enhanced plant and changes to decant programme. Queen Elizabeth Hospital 16,649 18,192 9.3 FM in the Education Centre (£114k), increase in Linen volumes due to additional activity (£188k), 24 hour food (snack boxes) (£50k), enhanced security (£78k), increased maintenance (£25k), enhanced catering (£150k), night service (£65k) and a reduction in payment for waste (£13k). Leeds Teaching hospitals— 1,579 1,717 8.7 RPI from FC to completion, additional services. Wharfedale University Hospitals Coventry 50,211 53,926 7.4 In this first negotiation of the new Retention of Employment & Warwickshire (ROE) model, trust accepted risk that Whitley pay rises would exceed RPI. Barnet & Chase Farm Hospitals 16,679 17,775 6.6 Increase in IM&T Services (£138k), additional medical equipment (£691k), increased domestic and catering services (£321k) and maintenance (£17k). Whittington Hospital 3,460 3,690 6.6 Variation to include retail area fit-out in scheme. Trust recoup money by acting as direct leaser of retail units. Barking, Havering & Redbridge 31,003 32,653 5.3 The increased unitary charge arose from the first Deed of Hospitals Variation signed in August 2005. A new coronary care unit has been commissioned, (utilising “grey space” from the original design) which will create additional capacity for ITU and HDU beds in the hospital. A 60-bed emergency ward (again utilising “grey space”) is being constructed, not to be immediately staVed, but to be set in reserve to accommodate future pressures on bed demand. The Trust has also strengthened the hospital’s IT infrastructure by enhancements to cabling, cooling and physical security specification. Within the increase there are other variations such as increased cot space within NCIU/Neonatal services and the construction of an additional bunker for a linear accelerator for Cancer services. The increased unitary tariV arises from both the construction and on-going facilities management costs. Norfolk & Norwich 28,401 29,788 4.9 Variations for provision of additional 144 beds; other variations including additional renal and cardiology facilities. In 2003–04 a refinancing of original deal led to a £1m reduction to the Unitary payments for a 30 year period. Variations on soft FM services. The revised fee is 0506 forecast fee and includes indexation increases. 3178271166 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 295
ABCDE Trust Unitary fee Revised at FC Unitary Fee % change Reason £000 £000
King’s Healthcare 17,989 18,811 4.6 Activity & meterage variation £411k, single use theatre drapes account for £504k increase, average service deduction £72k (increase in cost to Trust of theatre drapes partially oVset by cessation on non-PFI external contract saving £208k). St George’s Healthcare 7,327 7,629 4.1 Last year’s increase was due to an additional cardiac theatre, 12 cardiac beds, hot laboratory and additional ITU pendants reported in 2003/04. For this year an additional 126k per annum variation for ward hostess service is included. County Durham & Darlington 10,916 11,303 3.5 8.3% Contract variation; 16.5% Benchmarking of FM services Hospitals - North Durham Berkshire Healthcare 4,020 4,151 3.3 Contract variation to include relocation of Reading PCT intermediate care beds. Greenwich Healthcare 18,620 19,073 2.4 Last years real terms increase due to Maintenance requirements of conference centre and IT. This year the Unitary Payment has increased for introduction of Better Hospital Food, Increased laundry volumes, increased cleaning and MRSA control, increased clinical waste volumes and portering changes. Dudley 26,727 27,277 2.1 0.9% Pathology Contract variation; Extension of IT services Northumbria Healthcare 3,706 3,779 2.0 Variation to add a small residences block. Wandsworth PCT—Queen 9,700 9,840 1.4 Increase relates to Trust variationsforinclusionofaBurns Mary’s Roehampton Dressing Clinic, amendments to Trust Equipment Specification due to changes in technology (under Managed Equipment Service) and minor design changes. All figures are Trust estimates as the revised financial model has not yet been agreed. RBBSPCT—Essex & Herts 1,873 1,895 1.2 Additional £158k of capital works, c hange to scope of Hospital portering and estates management services Hereford Hospitals 9,690 9,803 1.2 Additional services and upgrade costs required by the Trust. Swindon & Marlborough 17,956 18,121 0.9 Contract variation County Durham & Darlington 5,728 5,743 0.3 Contract variation Hospitals—Bishop Auckland Cambridge University 6,295 6,308 0.2 Comfort cooling systems Hospitals Brent PCT—Willesden Health 2,911 2,913 0.1 Minor variation Centre
5.4 Capital investment in social services 5.4.1 Could the Department update the figures provided last year on the acquisition, upgrade and sale of personal social services assets? [5.4.1]
Answer 1. The information requested is provided in Table 5.4.1.
Table 5.4.1 LOCAL AUTHORITY PERSONAL SOCIAL SERVICES CAPITAL EXPENDITURE AND INCOME 2000–01 TO 2004–05
2000–01 2001–02 2002–03 2003–04 £ million 2004–05 provisional Maintenance 12.3 12.5 New acquisitions 143.7 145.5 TOTAL SPEND 156.1 158.3 199.3 260.0 299.0 Sale of buildings 49.6 64.5 Sale of equipment 12.4 5.5 TOTAL SALES 62.8 70.4 75.0 74.5 77.0 NET SPEND 93.3 87.9 124.3 185.5 222.0 Notes: 1. Figures may not sum due to rounding. 2. From 2002–03 the breakdown between maintenance and new acquisitions and the sale of buildings and equipment is no longer available. 3. Figures include children’s services. 3178271167 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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5.4.2 Could the Department provide an update on PFI projects currently supported, or being considered by the Departments? [5.4.2] Answer 1. The Department’s criteria for supporting PFI projects remain broadly unchanged: the Department is seeking to support innovative approaches to problems associated with social exclusion. This can apply to any social services client group such as older people, people with learning disabilities and people with mental health needs. The Department sponsors projects that are part of long term strategic service planning, that provide evidence of value for money and of flexibility. A joint white paper, designed to deliver integrated health and social care systems, will bring together proposals for both adult social care and all care received outside of hospitals. We will evaluate the criteria against the new White Paper. 2. Table 5.4.2 shows the PFI projects that have been approved to date.
Table 5.4.2 APPROVED PFI PROJECTS
Coventry New Homes for Older People Croydon Older People Dudley Health and Social Care Centre Ealing Resource Centres for Older People Enfield Resource Centre for Older People with Cognitive Impairment Greenwich Neighbourhood Resource Centres for Older People Hammersmith and Fulham Nursing Care and Extra Care Housing for Older People Harrow Care Services for Older People Harrow Mixed Services for People with Learning Disability and Mental Health needs Hertfordshire Children’s Homes Project Kent Integrated Health and Social Care Services Leeds Learning Disabilities Northampton Specialist Care Services for Older People with dementia Portsmouth Mixed Services for People with Learning Disabilities Richmond Care Services for Older People SheYeld Intermediate Care Shropshire Community Services for people with Learning Disabilities and Older People including a Joint Service Centre StaVordshire Children’s Small Homes Surrey Services for Older People Westminster Resource Centre for Older People
3. Ministerial approval has been given to the following schemes on 29 July 2005:
Birmingham This bid, for £34.7 million, is set in the context of a five-year strategy for future provision of services to older people.
East Sussex This bid focuses on services for older people, and contains a very clear description of the intended sites (4) and the nature and quantity of services to be provided from them. PFI credits of £34.7 million have been requested.
Medway This bid, proposed to be procured via a LIFT, is for developing two centres of excellence focused on older people. The services will include preventative, enabling, recuperative and rehabilitative facilities (separate bid to ODPM). PFI credits of £17.34 million are sought.
Tower Hamlets This bid, for PFI credits of £15.97 million, is to deliver three health and social care centres via LIFT. The focus is independent living—people with disabilities, people with learning disabilities. 3178271167 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Wolverhampton This bid is for £22.6 million of PFI credits, DH only, to deliver a range of social care services through LIFT. The services will be a range of adult social services: older people, mental health and learning disabilities, provided on a “hub and spoke” model. Three hubs and three spokes are envisaged. 4. Social Services PFI continues to increase, including for people with learning disabilities and people with mental health needs. The demand for services for older people remains the highest. Generally, much of the demand is in response to Local Authorities’ long-term strategic planning and Best Value reviews of their current provision of care services for social services client groups, for example, residential and nursing care for older people. Social Services’ joint working with health is well established, with some developing partnerships with other key services such as housing, where the Department of Health works with ODPM. Links are developing with NHSLIFT sc hemes (Local Investment Finance Trusts, for capital investment in primary care building stock), particularly in SheYeld where the PSS scheme is joint with the local LIFT.
5.4.3 Could the Department compare actual capital spend by social services departments with the funding provided through credit approvals and capital grants? [5.5.4] Answer 1. Table 5.4.3 compares total actual capital spend by social services departments with the funding provided by the Department through supported capital expenditure. The table shows that capital support provided by the Department is only one source of capital for local authorities. Local authorities can fund their capital requirements in other ways, through capital receipts, joint funding, EC funding and through the Private Finance Initiative. Additional capital support is also provided by the Department for Education and Skills which took over responsibility for children’s social services from 1 April 2003.
Table 5.4.3 LOCAL AUTHORITY PERSONAL SOCIAL SERVICES CAPITAL EXPENDITURE, DEPARTMENTAL SUPPORTED CAPITAL EXPENDITURE 2001–02 TO 2004–05
£ million 2004–05 2001–02 2002–03 2003–04 provisional
TOTAL SPEND 158.0 199.3 260.0 299.0 Capital grants 9.3 40.7 25.0 25.0 Credit approvals/supported capital expenditure (revenue) 55.7 55.7 50.2 52.9 TOTAL PROVISION 65.0 96.5 75.2 77.9 Notes: 1. Figures may not sum due to rounding. 2. Figures include children’s services up to 2002–03. 3. Credit approvals were abolished on 31 March 2004.
6. Questions on the Departmental Annual Report 6.1 The Department has re-profiled administration spending review figures for 2004–05, 2005–06 and 2006–07, bringing forward £23 million from the latter two periods to 2004–05 to meet the upfront costs of the change programme. Can you provide more detail of this re-profiling. What has the £23 million been spent on? Is this a straight transfer, or will further savings need to be found in 2005–06 and 2006–07 to pay for this movement? Answer
Detail of re-profiling 1. £12 million was brought forward from 2005–06 to 2004-05 and £11 million from 2006–07.
What was the £23 million spent on 2. The money contributed to the upfront costs of the Department’s major change programme which saw the Department slim down from 3,645 to 2,245 staV and refocus to become a more strategic organization with operational delivery devolved throughout the system. 3178271168 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Is this a straight transfer? 3. This is a straight transfer; no specific further savings will need to be made in 2005–06 or 2006–07 to accommodate it. However, the Department—along with the NHS and Social Services—is committed to making eYciency gains in the region of 2.5% per year over the period.
6.2The Department has exceeded its own target of reducing data collection by 20% by March 2005. Can you list the data no longer collected. Do you have any sense of the extent to which data users have been aVected by the cessation of such collections and associated Departmental analyses. Can you list any new data collection that has been undertaken since the setting of the target. Answer 1. Table 6.2(a) lists all ongoing (ie recurrent) DH data collections discontinued between 1 April 2004 and 31 March 2005. Table 6.2(b) details new ongoing DH collections approved from 1 April 2004 to the present.
Target and achievement 2. In March 2004 PS(L) set a target for the reduction of the burden of ongoing data collection by DH from the NHSby 20% by the end of March 2005. The burden is expressed in person years, which are an estimate of the total time the NHSspends on producing information for othe rs. The target implied a cut of about 120 person years from the estimated total of 600 in March 2004; in fact a net reduction of one third or 200 person years was achieved.
Reduced burden 3. The total reduction included collections completely discontinued, as well as those reduced in scope; both are shown in Table 6.2(a).
EVects of cutting collections 4. All proposals to drop or reduce central collections were subject to consultation with internal DH and (where applicable) external users. The risks of stopping collection, eg perceived reductions in accountability or ability to manage through lack of information were considered and weighed against the benefit to the service of freeing resources for more patient related work. In all cases agreement was reached that the information was no longer required for central purposes, or could be satisfied by less frequent returns (eg reducing quarterly returns to annual). Generally there has been no adverse reaction to the cuts, though through the consultation process the Society of Chiropodists and Podiatrists did initially raise objections to the discontinuation of the annual KT23 Chiropody activity return; these were withdrawn when assured that alternative data would continue to be collected.
New collections 5. Table 6.2(b) lists all new ongoing DH data collections approved since 1 April 2004, when the target for reduction in burden was set. The list excludes changes to existing collections, and as noted above the net eVect on the overall burden was a reduction of one third by March 2005. Since the target was set, agreed new collections have had only small burdens—those listed amount to less than 10 person years in total.
Background 6. All information collections by the NHSand its arm’s length bodies (ALBs ) are regulated by the Review of Central Returns (ROCR) process, which since 1 April 2005 has been based in the NHSHealth and Social Care Information Centre. The process ensures that all collections are fit for purpose, keep the burden on the NHSto a minimum, and that only essential information is collected. ROC R’s remit until recently covered only DH returns, but has now been extended to regulate those from ALBs too, as well as the burdens placed on the service by other Government Departments, regulatory bodies and the private sector. 7. The burden of an information collection is the amount of work the NHShave to do to collect, complete and return the data required to the collecting organisation; if the NHSalr eady gathers the information for its own purposes, those¸ internal¸ costs are not included. ROCR was created in 1997 to regulate this overall burden and measure the impact on the service, and person years was chosen as it allows us to quickly establish an estimate of burden, providing a useful balance between accuracy and timeliness. In particular, it has proven beneficial when considering the relative merits of collections and should be seen in that light rather than an absolute measure. It is understood by the service, is used by the NHSand as the basis of other burden measurement systems in government. 3178271169 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Table 6.2(a) ONGOING COLLECTIONS DISCONTINUED OR REDUCED IN SCOPE 1 APRIL 2004–31 MARCH 2005
Name of collection Description
Discontinued collections Patient Care in the Community: District Nursing KC56 Annual collection of District Nurse activity data, previously used in the implementation and monitoring of Caring for People and Community Care Reforms. Patient Care in the Community: Community Mental Annual collection of Community Psychiatric Nurse Health Nursing KC57 activity data, previously used to monitor the provision of Care in the Community and implementation of NSFs. Replaced by data available from the Mental Health Minimum Dataset. Patient Care in the Community: Community Learning Annual collection of Community Learning Disability Disability Nursing KC58 Nurse activity data, previously used in the implementation and monitoring of Caring for People and Community Care Reforms. Patient Care in the Community: Specialist Care Annual collection of Specialist Care Nurse activity Nursing KC59 data, previously used in the implementation and monitoring of Caring for People and Community Care Reforms. Practices below a minimum standard Collected annual data on Practices below a minimum standard to monitor against the improvement of GP practice premises against targets. Discontinued as the Disability Discrimination Act changes criteria for measuring premises compliance. Summary of Chiropody Services KT23 Annual returns on activity of these Allied health Summary of Clinical Psychology Services KT24 professionals groups; discontinued as similar Summary of Occupational Therapy Services KT26 information already available from DH Reference Summary of Physiotherapy Services KT27 costs data. Summary of Speech and Language Therapy Services KT29 Cancer Waiting Times (Monitoring the two week target Quarterly information on full range of cancer waiting QMCW times by time bands, superceded by Cancer waiting times database Consultant Outpatient Clinical Activity KH09 Annual performance management data on “did not attends” and ratio of first to subsequent attendances; central monitoring no longer required NHSDay Care Availability and Use of Facilities KH14 Annual return used to m onitor NHSDay Care Facilities; central monitoring no longer required Summary of Ward Attenders KH05 Measures hospital activity for patients seen in hospital by nursing staV; central monitoring no longer required GP Landlords expenses survey: notional rents and interest Survey of HAs, Health Boards and GP accountants to on loans establish what proportion of the notional rent payments are used to cover interest on loans; superceded due to new GP contract GP Accounts Survey Collected financial information from GPs and their accountants; superceded due to new GP contract Acute Hospital Patient Centred and Clinical Information Annual survey providing feedback on the level and Systems Survey status of systems implementation in England Monitoring violence, accidents and harrasment targets Annual return monitoring progress towards NHSPlan targets, now expired Progress on implementing S21 of the Disability Annual return of resources and workload of the units Discrimination Act comparisons by authority area; no longer required as monitoring completed Controls Assurance Data Provided evidence for the system of internal control in NHSTrusts, and underpinned the Duty of Quality. Information no longer required centrally under Shifting the Balance of Power (StBOP) arrangements. Health Visiting and other professional advice and support Annual activity data on Health Visitors. Monitored in the community KC55 changes in health visitng workload, also used in negotiations, resource allocation to the NHSand departmental accountability Quarterly monitoring of Cancer Bookings (QMCB) Collection from trusts and PCTs monitoring target that all cancer patients benefit from pre booked care from 2004 Discontinued as the introduction of Choose and Book whic changed the processes by which GP referrals are made has made and which also covers cancer patientshas made a separate collection unnecessary. 3178271169 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Name of collection Description
NHSPlan - Monitoring of planned workforce increases Monitors proposed in creases in staV numbers as part of the NHSPlan; no longer required as targets met or monitored adequately by other returns. Collections reduced in scope Weekly SITREPS Collection focusing on emergency care; information collected on capacity, demand and performance. Some data items discontinued—ambulance B&C category calls, A&E closure times, ordinary and day case admissions. Emergency and cancelled operations data changed from weekly to monthly collection. ERIC return (collection of data on NHSEstates and Discontinuation of some data items, others made facilities) voluntary General Opthalmic Services Sight tests, vouchers and Reduced in scope and burden; data now obtained repairs/replacements survey SBE515 from central payments system Medical and Dental workforce census and other Reduction in frequency of workforce collections from workforce returns quarterly to annual Patient’s Charter Key Standards return QMOP Quarterly monitoring of outpatients; reduction in number of questions DH Finance returns A general review of financial data led to reductions in scope and frequency of many returns Workforce Vacancies collection Reduction in level of detail, removal of staV in post element Monthly Monitoring Return Data on progress towards key waiting times targets and underpinning capacity assumptions; reduced in burden by stopping returns in quarter ending months, already collected elsewhere Community Dental Health Services KC64 Emergency Annual collections of dental data; reduced in scope Dental Services EDS1 and now collected online Newly Reported HIV Infected Persons (Cumulative) Reports prepared under the AIDS(Control) Act 1987. To provide information about the progress and treatment of the disease; three reports amalgamated into one and reduced in scope.
*Source: Review of Central Returns database.
Table 6.2(b) NEW ONGOING COLLECTIONSAPPROVED SINCE1 APRIL 2004
Name of collection Description
New collections approved 1 April 2004–31 March 2005 NHSPension SchemeContributions Collection to gather assurance from con tributors to the NHSPension Schemethat they are paying the correct level of contributions. Department of Health Stakeholder Perceptions Audit Biannual survey to obtain more rigorous data on how (DH Stakeholder Survey) DH is perceived as a department. Number of frontline 999 ambulances in full operational To establish ambulance service capacity of 12 Lead use with 12 lead ECG equipment ECG equipment. National Orthopaedics Project—position statement A quarterly collection of a position statement from SHAs as part of the National Orthopaedic Project. Primary Care Modernisation Programme—Market Biannual research project to help improve Research Project communications on aspects of the NHSmodernisation programme amongst primary care health professionals. Monitoring PPF Cancer Targets (T10 and T11) Biannual collection to support performance management of cancer targets untiol 2010, when cancer mortality target is due to be met. National Programme for IT—Baseline NHSTracker Annual survey to assess aw areness and understanding and support for the National Programme for Information Technology. Health Professionals 2004 Childhood Immunisation Annual telephone survey to ascertain the impact of the survey Childhood Immunisation campaign amongst GPs, health visitors and practice nurses. Consultants Claiming an Award Annual collection of information from commissioning organisations to support allocation of money to pay the Distinction and Clinical Excellence Awards. Consultants Clinical Excellence Awards Information collected for the Annual Report for Clinical Excellence Awards from Local Awards Committees, used to demonstrate that the process was completed fairly and in accordance with guidelines issued by ACCEA. 3178271170 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Name of collection Description
Genito-Urinary Medicine waiting times A six monthly audit of attendees at GUM clinics, to monitor a 48 hour access to services target. Supply Chain Excellence Programme Monthly collection of pharmacy purchasing data by download from NHSTrust systems, to enable e Vective national contracting for the supply of pharmaceuticals to the NHSin England. New collections approved since 1 April 2005 Database of Countermeasures A quarterly report on maintenance of emergency equipment held for chemical, biological, radiological or nuclear incidents by Ambulance Trusts. “Buy back” of local NHSdental capacity Numbers of additional dentists SHA ’s have purchased with the £50 million special allocation of 2004–05; time limited collection until targets are met.
*Source: Review of Central Returns database. 6.3 No explanations are given for any of the four PSA targets described as being subject to “slippage”. Can this be provided please.
Answer
Teenage Pregnancy Targets 1. Over the five years from 1998 (the baseline year for the Teenage Pregnancy Strategy) to 2003, the under 18 conception rate for England fell by 10%. This rate of decline suggests the 2004 15% reduction target is likely to be missed. Furthermore, to reach the target of halving the under 18 conception rate by 2010 there needs to be a markedly steeper rate of decline from 2003 onwards. 2. A regional breakdown shows that under 18 conception rates in all regions, apart from London, have declined overall between 8% and 16% from 1998–2003 (Table 6.3(a)). In London, rates have remained unchanged.
Table 6.3(a) CHANGE IN UNDER 18 CONCEPTION RATESBY REGION 1998–2003 1998 2003 1998 2003 % change Region Number Number Rate Rate (1)1998–2003 England 41,089 39,560 46.6 42.1 "9.8 North East 2,731 2,604 56.5 51.9 "8.1 North West 6,457 6,149 50.3 44.9 "10.7 Yorkshire & Humber 4,806 4,587 53.1 46.7 "11.9 East Midlands 3,632 3,323 48.8 41.2 "15.5 West Midlands 5,085 4,957 51.7 47.2 "8.7 East 3,592 3,369 37.9 33.3 "12.2 London 6,042 6,500 51.1 51.1 0.0 South East 5,384 4,927 37.8 33.0 "12.7 South West 3,360 3,144 39.4 34.2 "13.3 Source: National Statistics and Teenage Pregnancy Unit, 2005 Notes: 1. Change in rates calculated from unrounded figures 3. Local authority and ward level data show the geography of teenage pregnancy is strongly associated with deprivation and is highly concentrated, with 50% of teenage pregnancies occurring in the 20% of wards with the highest under 18 conception rates. To achieve the steeper rate of decline required to meet targets the Teenage Pregnancy Strategy is strengthening and intensifying delivery of the Strategy to high rate neighbourhoods and vulnerable groups. Additional work with Government OYce for London is also underway to address the increasing teenage pregnancy rates in many London Boroughs. 4. Provision of eVective contraceptive services is a key aspect of the strategy to reduce teenage pregnancies. The Government recognised in the Choosing Health White Paper that contraceptive services are in need of resources and increased priority. £40 million will be invested in 2006–07 and 2007–08 (£20 million each year) to address gaps in service provision. This will be informed by a comprehensive national contraceptive audit so that we can be sure that we are clear, both locally and nationally, exactly how to best modernise this important part of sexual health services. In addition, £50 million is being invested, in a new high profile media campaign aimed at young people. This will highlight the risks of unsafe sex and promote the use of condoms, which can prevent sexually transmitted infections and unintended pregnancies. Both of these measures should support achievement of the Teenage Pregnancy Strategy targets. 3178271171 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Accident Death Rates and Serious Accidental Injury 5. Latest data for 2001–03 for CSR 1998 target 3 (reduction in the death rate from accidents) show an increase of 0.8% from the baseline (1995–97). The 65 and over group accounts for the main part of the increase in the death rate from accidents, and falls account for the main part of the increase in the death rate from accidents in those over 65. See Tables 6.3(b) and 6.3(c). 6. Latest data for 2002–03 for CSR 1998 target 4 (reduction in the rate of hospital admission for serious accidental injury) show an increase of 3.8% from the baseline (1995–96). Again, the 65 and over group accounts for the main part of the increase in the admission rate. Falls account for nearly three-quarters of admissions for serious accidental injury in the 65 and over group, and are a key factor in the increase in the admission rate. See Table 6.3(d). 7. The latest data for CSR 1998 targets 3 and 4 (for 2001–03 and 2002–03 respectively) pre-date many of the interventions put in place to tackle falls in older people, whose impact is not yet reflected in the currently available data: — The prevention of falls is the subject of Standard Six of the NHS National Service Framework for Older People. — The NHSPriorities and Planning Framework for 2003–06 required the estab lishment of an integrated falls service across all local health and social care systems by April 2005. The main increase in integrated falls services took place towards the end of 2003 and throughout 2004. By April 2005 nearly 90% of primary care trusts had met the milestone, and full compliance is expected by October 2005. — In November 2004, the National Institute for Clinical Excellence (NICE) published guidelines on falls prevention. Also NICE published in January 2005 a technology appraisal on “The clinical eVectiveness of technologies for the secondary prevention of osteoporotic fractures in postmenopausal women.” In addition it is due to publish another technology appraisal covering the clinical eVectiveness of technologies associated with primary prevention in September 2005, and comprehensive guidelines on the assessment of future risk of osteoporosis and the prevention of fractures in individuals at high risk in February 2006. — Lessons learned from the Healthy Communities Collaborative have been disseminated through workshops and the Department of Health has contributed to disseminating other examples of eVective falls reduction eg examples of falls services across England published in 2003, and guidance for staV in residential care homes in May 2004. — Help the Aged have continued development of the Slip, Trips and Broken Hips website which dedicates a section for practitioners providing resources, research and links to help work with older people and to reduce the risk of falling — The Department of Health is also funding projects on increasing and encouraging physical activity in residential care and the availability of training for those oVering exercise as part of falls prevention. 8. Despite the slippage in the over 65 age range, there are encouraging signs with the latest data for 2001–03 showing a reduction in accident mortality rates in age bands under 15 and 15-24 years. This suggests that various Government funded initiatives and partnerships with organisations such as the Child Accident Prevention Trust and the Royal Society for the Prevention of Accidents are contributing to reducing deaths and serious injury in younger age groups. (see tables 6.3(b) to 6.3(d))
Health Inequalities—Infant Mortality 9. The PSA target for health inequalities is: — by 2010 to reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth. 10. This target is underpinned by the following objective on infant mortality: — starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between “routine and manual” groups and the population as a whole. 11. Latest figures show that infant mortality rates have actually fallen in both the “routine and manual” group and the total population. However, despite this, the relative gap between the rates among the target group and the total population rose to 19% in 2001–03, compared with 13% in the baseline period of 1997–99. This is because the overall rate in the total population has fallen faster than the rate in the routine and manual group. 12. Health inequalities are stubborn, persistent and diYcult to change. The national strategy to tackle health inequalities (Tackling Health Inequalities: A Programme for Action (2003)) recognises that the first challenge would be to halt a long-term trend and stop the widening gap. 3178271171 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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13. The Programme for Action also highlights the time lag between policy implementation and the achievement of improved health outcomes. Recognising this, the Programme for Action specifies headline indicators to measure progress against long-term trends in reducing inequalities. 14. Tackling health inequalities: Status report on the Programme for Action (www.dh.gov.uk/Publications AndStatistics/Publications/PublicationsPolicyAndGuidance/Publications PolicyAndGuidanceArticle/fs/en?CONTENT—ID%4117696&chk%OXFbWI) was published in August and it reports primarily on data to 2003. This does not necessarily reflect the impact of current policies. However, it does indicate that some of the headline indicators like reducing child poverty and improving housing quality are moving in the right direction. 15. By 2006, we will have new data on smoking throughout pregnancy and breastfeeding initiation rates from the 2005 Infant Feeding Survey. These are proxy measures for maternal and infant health and risk factors for infant mortality. These new data will update information from the 2000 Infant Feeding Survey, and will give an early indication of progress in these important areas.
Table 6.3(b) DEATH RATESFROM ACCIDENTS— PROGRESS BY SELECTED AGE GROUPS
Death rate from accidents per Age group 100,000 population % change 1995–97 to 1995–97 2001–03 2001–03
Under 15 4.1 3.0 "26% 15 to 24 17.8 15.3 "14% 25 to 64 13.0 13.1 1% 65 and over 50.1 56.6 13% Source: Notes 1. Death rates are directly age–standardised rates for all persons, England 2. A % change less than 0 is a reduction, greater than 0 is an increase 3. 1995–97 data coded using ICD9 (codes E800-E928 exc E870-E879 used for accidents); 2001–03 data coded using ICD10 (codes V01-X59 used for accidents). Due to the change from ICD9 to ICD10 there are small discontinuities in the comparison between the two periods
Table 6.3(c) DEATH RATESFROM ACCIDENTSAMONG AGES65 AND OVER— CONTRIBUTION OF SELECTED ACCIDENT CATEGORIES
Accident category Death rate from accidents per 100,000 population Contribution to all accidents % change for ages 1995–97 2001–03 65 and over
Land transport accidents 7.8 7.0 "2% Falls 14.1 19.0 10% Drowning and submersion 0.4 0.4 0% Smoke, fire and flames 2.3 1.6 "1% Poisoning 1.1 0.9 0% Other and unspecified accidents 24.3 27.7 7% Total % change 13%
Source: ONS Notes: 1. Death rates are directly age-standardised rates for all persons, England 2. The contributions from each accident category are the impact of each category on the change for all accidents (not the % change in the death rate for each category) 3178271173 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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3. The contributions from each accident category sum to the % change for all accidents for ages 65 and over 4. A contribution to % change less than 0 is a reduction, greater than 0 is an increase 5. 1995–97 data coded using ICD9; 2001–03 data coded using ICD10. Due to the change from ICD9 to ICD10 there are small discontinuities in the comparison between the two periods.
Table 6.3(d) ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY—PROGRESS BY SELECTED AGE GROUPS
Admission rate for serious accidental injury per 100,000 population % change 1995–96 to Age group 1995–96 2002–03 2002–03
Under 5 131.7 97.2 "26% 5 to 14 120.8 84.1 "30% 15 to 64 221.2 223.3 1% 65 and over 1,280.2 1,442.5 13%
Source: Hospital Episode Statistics Notes 1. Admission rates are directly age-standardised rates for all persons, England. 2. A % change less than 0 is a reduction, greater than 0 is an increase. 3. ICD10 codes V01–X59, Y40–Y84 used for all accidents. 4. Figures for 1995–96 are estimates based on trend for subsequent years (due to data quality problems for some areas in 1995–96).
6.4 In respect of SR 2004 target 1, on what basis have the links between the sub targets and the specific life expectancy targets been established? How much control can the Department and frontline staV realistically be expected to have over life expectancy given the importance of external factors such as the overall state of the economy? Answer 1. The sub-targets in PSA target 1 will contribute to achievement of the overall life expectancy objective and to the life expectancy element of PSA target 2 on health inequalities. Other PSA targets will also support the life expectancy targets, particularly the PSA 3 sub-targets. On their own this suite of targets cannot achieve the life expectancy targets, but their impact is expected to be significant. It will be necessary for a wide range of other activity, by a range of organisations and individuals, to be taken to improve overall life expectancy and to narrow geographical health inequalities. For inequalities, the breadth of activity has been set out in Tackling health inequalities: A Programme for Action. 2. Because such a wide range of activity is needed, and because there is a large range of factors and interventions, which change over time and will impact on the target over diVerent timescales, and which are themselves inter-related (eg smoking impacts on cancer, heart disease and respiratory disease), it is not possible to determine precisely what the contribution of each PSA 1 sub-target will be, particularly in respect of the 2010 target date. However, between them they cover the big killers (cancer and cardiovascular disease (CVD)) and, in suicide, an important marker of eVective mental health services which impact on morbidity and mortality. These three causes of death combined are currently responsible for around 70% of all deaths under the age of 75 in England. 3. As far as control is concerned, improvements in life expectancy cannot be delivered solely through the action of the Department of Health and NHSfrontline sta V, but will depend also upon non-health sectors, including other Government departments and agencies, business and the community and voluntary sectors, as well as individuals, and also upon wider societal influences. However, DH and NHSsta V do have a major role to play, especially on the achievement of mortality targets where the 2010 time horizon means achievement will depend on delaying the premature mortality of those who already have disease or are at high risk of disease. Developing and communicating policy, implementing the National Service Frameworks, modifying risk factors such as smoking, providing treatment services, primary and secondary prevention are activities which will have high impact on reducing mortality quickly. The White Paper Choosing Health—Making healthy choices easier (2004) and its delivery plan (2005) set out a broad programme to make it easier for everyone to choose health, including giving priority to tackling health inequalities. 3178271175 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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6.5 In respect of SR 2004 target 3, is the sub target of halting the year-on-year rise in obesity among children under 11 by 2010 a suYciently challenging aim? At what point will the trend be reversed? Answer 1. Obesity in 2–10 year olds rose, on average, by 0.8% per year between 1995 and 2002. England is not the only country to experience a rapid increase in the prevalence of obesity. Although the rates diVer between countries, virtually all countries have shown an increase over the last two decades. Halting the rise in obesity by 2010 is indeed a challenge as no country has yet managed to neither halt nor reverse the trend. England is however acknowledged particularly in Europe as being ahead of the game with a clear strategy and focus to tackle obesity as set out in the Public Health White Paper. 2. Obesity is a complex multi-factorial condition with wide-ranging causes—social, cultural, behavioural factors requiring a multi-pronged approach. Several interventions are already well in train, and several more are in development and will come on stream over the 18 months including the Obesity Social Marketing campaign and the impact of restricting Food Promotion to children. 3. Central to tackling obesity is the National Healthy Schools Programme that has now been made more rigorous. From September, schools will be required to satisfy all the criteria under four core themes, which include “Healthy Eating” and “Physical Activity”. More funding has been provided this year to local programmes to strengthen delivery and we will ensure that programme staV are supported and resourced to eVectively promote and co-ordinate action on obesity. 4. We expect that the cumulative impact of the above multiple interventions to improve diet and increase physical activity would be significant. Many of the planned interventions aim to bring about a sustained change in behaviour to make healthy lifestyle a norm.
6.6 In respect of SR 2004 target 4, is the baseline for emergency bed days confirmed as being the expected 2003–04 number rather than the actual figure? Does this not create a situation in which a 5% reduction from the baseline could fall short of achieving the desired outcome? Answer 1. The baseline figure for emergency bed days is the actual figure taken from the Hospital Episodes Statistics (HES) data collection. 2. A subsequent refresh of the 2003–04 data is currently being undertaken as errors were found in data submissions from a small number of NHStrusts. We would expect the refresh t o show a minimal change in the baseline as only a small number of trusts were found to have deficiencies in their 2003–04 HESdata.
6.7 In respect of SR 2004 target 6, will the participation sub target be measured in absolute terms? Does this not ignore the potential for the population of problem drug users to grow, which could allow for the target of 100% increase in participation to be met alongside an increase in the number of problem drug users not participating in drug treatment programmes? Answer 1. There is currently no direct link between the numbers in treatment as we do not yet understand the relationship between successful prevention and treatment interventions, prevalence of drug use and the growth (or decline) of the problem drug user (PDU) population. Understanding this is a priority to future planning of drug strategy delivery and is currently being explored as part of a Prime Minister’s Delivery Unit/National Treatment Agency (NTA) review of treatment eVectiveness, which also involves oYcials from the Department of Health and the Home OYce. 2. We are currently working on an assumption that the number of PDU will remain constant at around 280,000 so that when we meet our PSA target to double the numbers in treatment by 2008, 60% of PDUs will enter treatment during the course of each year. 3. It should also be noted that increasing numbers of dependent users are now stabilised and rehabilitated, no longer oVending or experiencing significantly increased health harms but are receiving long-term methadone maintenance. At the moment they are still be regarded as PDUs, this may also need to be reviewed.
6.8 In respect of SR 2004 target 7, why is success defined merely as achieving increasingly positive national survey results under each patient dimension, rather than stipulating some magnitude of increase? Answer 1. Progress against the patient experience PSA target is measured via the national patient survey programme, which the Healthcare Commission is responsible for managing. The survey programme is one of (if not the) largest programmes in existence: surveys are setting-based (each trust and PCT is responsible for conducting their own survey in line with standardised guidance) and, since 2001, around a million patients have taken part in 13 surveys across seven care settings. 3178271175 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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2. The survey programme is designed to provide a robust and detailed measure of the experience of recent service users at a national and local level. While the PSA is reported at a national level, the “national average” is simply an aggregation of the results of all trusts participating in each survey wave. This means that each trust contributes towards the PSA target—positively (ie improved performance over time) or negatively (declining performance or no change). In this way, the PSA target relies on the continuous improvement of each trust in their performance on the surveys, as measured against their own baseline. 3. The survey programme is relatively young, and until analysts at both DH and the Healthcare Commission have the opportunity to fully inspect a run of time series data, then it is not possible to make a judgement on a pass/fail measure or indeed any other absolute figure for improvement. 4. The design of the current survey programme balances the desirability for frequent patient feedback with the financial costs involved for participating trusts and PCTs. On this basis, baseline data and repeat surveys are only now just becoming available. Research is ongoing during 2005–06 to assess the extent to which systematic diVerences in trust performance may be associated with diVerent organisational practices. Clearly, this information was not available when setting PSA targets for SR 2002 and SR 2004. However, this evidence base will inform decisions on future outcome measures.
6.9 In respect of SR 2004 target 7, does the sub target of ensuring that individuals are fully involved in decisions about their healthcare, including choice of provider, mean that survey results should show 100% agreement with this statement? Why is no timeframe set out for this sub target? Answer 1. The PSA for SR 2004 carries forward from SR2002, but now with explicit reference to involvement in decisions about healthcare. This acknowledges the top priority reported by the public and users in the national consultation Choice, Responsiveness and Equity. Choice of provider is explicit in the wording of the PSA to highlight what is a significant reform. 2. These elements are tested using the same vehicle as for the rest of the PSA ie through the national survey programme administered by the Healthcare Commission. We have not stipulated a timeframe as both elements are live and will be tested in relevant surveys during the full period of the PSA ie 2005–08. 3. All questionnaires test the theme of involvement. For example, patients are asked: “Were you involved as much as you wanted to be in decisions about your care and treatment?” They are invited to select one of the following response categories. This example shows results from the 2004 adult inpatient survey.
Were you involved as much as you wanted to be in decision about your care and treatment? In patient survey published August 2004
National average % Number
Yes, definitely 52% Yes, to some extent 36% No 11% Total specific responses 85,773 Missing responses 2,535
Answered by all 4. This shows that 88% of inpatients reported that they were involved. Whilst this is already a high figure the challenge is to move more respondents into the “yes, definitely” category, and to reduce the number who respond negatively. It is highly unlikely that any subjective questionnaire on public services would result in 100% of the sample reporting in the top response category. 5. For the choice of provider element of the PSA, we are working with the Healthcare Commission to ensure that survey design accurately captures the choice policy from December 2004.
6.10 In respect of SR 2004 target 8, the second sub target details a numerator of “those supported intensively to live at home” and a denominator of “those being supported at home or in residential care.” The technical note defines the denominator as the number of people being supported intensively to live at home plus the number of people in residential or nursing homes whose care is funded by the local councils. Why is the word “intensively” not used in the denominator of the target itself? Answer 1. When Department of Health oYcials wrote the technical guidance for this target they were keen to make the supporting technical note’s introductory headlines for each PSA target as readily understandable as possible. 3178271176 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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2. Although the wording of the headline subject—on page 18 of the guidance you refer to—did not make it clear that the denominator only includes people receiving intensive home care, the supporting technical note, on the same page, was clear that they were included. 3. The technical note is available on the DH website at the address below: www.dh.gov.uk/assetRoot/04/08/69/19/04086919.pdf
4. On reflection, we recognise that it may have been clearer to include the word¸ intensively¸ in the reference to the denominator in the measure’s headline introduction. We will ensure we do so in future references to this target.
6.11 In respect of the evolution of SR 2004 target 3 and SR 2002 target 9, on the under-18 conception rate, from SR 2000 target 2, why was the interim target of 15% reduction by 2004 dropped between the 2000 and 2002 reviews? Answer 1. This was done to simplify and focus the target. However, the 15% reduction by 2004 remains a target in the NHSplan and we believe that it is important to achieve this in order to reach 50% by 2010 (hence the comments concerning slippage in response to question 6.3).
6.12 SR 2004 target 2 is a slight (wording only) modification of SR 2002 target 11. The target 11 assessment in the DAR describes the infant mortality sub target as subject to slippage and the life expectancy sub target as being “challenging”, with the data showing that the relative gap in life expectancy between England and the lowest fifth of local authorities increased for both males and females. Given the divergence from target, does SR 2004 target 2 remain realistic? In terms of reporting, shouldn’t all targets be challenging? Answer 1. The SR2004 PSA target set gave a higher profile to health inequalities. In addition to retaining a target on narrowing the life expectancy gap across geographical areas and narrowing the infant mortality gap across socio-economic groups, the SR2002 targets on Cancer and Cardio Vascular Disease were revised to include new sub-targets to narrow the gap in mortality between the fifth of areas with the worst health and deprivation indicators and the population as a whole by 2010. In order to assist local delivery it was decided to base these new sub-targets and the inequalities life expectancy sub-target on the same geographical basis, keeping the same areas until the target delivery date (2010) and selecting the areas on the basis of the baseline date for the mortality targets (1995–97). The selection of areas with the worst health and deprivation indicators, or Spearhead Group, was based on factors relevant to all three sub-targets, and includes the areas which are in the bottom fifth for three or more of the following five factors: — Male life expectancy at birth — Female life expectancy at birth — Cancer mortality rate in under 75s — CVD mortality rate in under 75s — ODPM Index of Multiple Deprivation (2004), LA summary, average scores 2. The Spearhead Group was announced in November 2004 and consists of 70 local authorities which map across to 88 primary care trusts. 3. The 2002 PSA11 sub-target on inequalities in life expectancy was, in contrast, based upon the bottom quintile for life expectancy, with areas changing each year based upon the latest statistics, and with target achievement based on the baseline of 1997–99. 4. While all targets do need to be challenging, the Department has always acknowledged that the trends in health inequalities are stubborn, persistent and very resistant to change. Tackling Health Inequalities: Status Report on the Programme for Action (August 2005), overseen by the Department’s independent and advisory Scientific Reference Group on health inequalities, notes that the health inequalities gap continues to widen in line with the existing trend. This is as expected and explicitly was noted in the Programme for Action. It said that changes in the gap were unlikely to be seen until closer to the target date of 2010. It noted that the first challenge was to stop health inequalities widening further. The report said that there are, however, some encouraging signs, in particular in reductions in child poverty, improvements in housing and reduction in the inequalities in CVD and cancer death rates (in absolute terms). These—and other changes —will have an impact on the trend in the health gap over time. The report highlighted the overall challenge that remains in meeting the PSA target as well as other areas for action. Action to tackle health inequalities remains a priority, as set out in the White Paper Choosing Health—Making healthy choices easier (2004) and its delivery plan (2005). 3178271177 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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6.13 In respect of SR 2002 target 1, the number of outpatients waiting more than four months fell from 24,495 in December 2003 to 2,847 in March 2004, while the number of inpatients waiting more than nine months fell from 19,407 in February 2004 to 41 in March 2004. How were such substantial reductions achieved in such a short space of time? Has there been any external validation of the figures? Answer
1. The numbers quoted by the committee are provider-based statistics. The preferred measure for waiting times figures is commissioner based as this excludes Welsh patients not subject to the waiting times targets. The relevant figures are:
2. The number of outpatients waiting longer than 17 weeks (four months) was 21,076 in December 2003 and 378 in March 2004. The number of inpatients waiting more than nine months fell from 19,404 in February 2004 to 223 in March 2004.
3. The operational standard since 31 March 2004 has been 17 weeks for outpatient waits and nine months for inpatient waits. The new target to be delivered is 13 weeks for outpatients and six months for inpatients by the end of December 2005.
4. The key strategies for reducing waiting times included: — Clear and challenging, but achievable national targets and standards In 2000, the Department published the NHSPlan, which set out clear targets for improving access to NHSservices. This publication set out how, by the end of 2005, maximum wa iting times for a first outpatient appointment with a consultant would be reduced to 13 weeks (from over 26 weeks) to six months for inpatient treatment (surgery) from 18 months. In addition to this, the Department set targets for even shorter maximum waits for the priority conditions such as cancer and Coronary Heart Disease. The targets of 17 weeks and nine months were milestones designed to support delivery of the December 2005 targets. More recently, in the NHSImprovement Plan (2004) the Department has gone e ven further, and has set a target that, by the end of 2008, the maximum length of time any patient should have to wait will be just 18 weeks from General Practitioner referral to start of treatment. This includes all stages that lead up to the start of treatment including diagnostic tests. — National Orthopaedic Project We concluded that on the basis of existing strategies (NHStreatment centr es, independent sector treatment centres, choice at six months, CPaT (see below) and performance management) the NHSshould be able to deliver 13 weeks and six months for most specialities b ut that a particular focus was needed on orthopaedics. The National Orthopaedic Project was established in January 2004 to implement an integrated national strategy under four key workstreams: increasing the focus on orthopaedics to ensure awareness and ownership; maximising the impact of other initiatives; risk-based performance management; and a tailored support programme to support the NHS. A team was developed to co-ordinate the input from the NHS, the Department of Health, the Modernisation Agency, and professional bodies including the British Orthopaedic Association. Since the project’s inception, the number of patients waiting longer than six months for orthopaedic surgery has fallen from over 57,000 to 16,000, a reduction of 72%. The March 2005 milestone of an 80% reduction from the December 2002 baseline was met, and the latest weekly PTL data shows that the NHSis on track to deliver the December 2005 target. — Improved waiting list management We have developed a number of national tools to help NHSTrusts manage waiti ng lists eVectively. For example: Primary Targeting Lists (PTLs): In Summer 2001, the NHS Modernisation Agency released guidance to the NHScalled the “Primary Targeting Lists Approach” to assis t them to treat patients within the shorter maximum waiting times targets for 2001–02. This has since become the basis for the work done by the DH and SHAs to monitor progress towards waiting time targets and, where necessary, oVer support and intervention for challenged trusts or health economies. Clinically Prioritise and Treat (CPaT): In September 2003, the Modernisation Agency released guidance to the NHScalled Clinically Prioritise and Treat (CPaT) to assis t them to treat patients within the waiting time targets. The guidance makes it clear that patients with greater clinical need must be treated first and gives NHSorganisations the practical advice to treat patients in broad chronological order within the maximum waiting times targets. CPaT enables local clinicians to incorporate clinically agreed definitions of “priority” and “routine”patients into a robust mechanism for managing waiting lists. 3178271177 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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CPaT is a very simple approach, supported by a toolkit that does three things: (a) Provides Trusts with tools so that they can see and understand how they are managing their waiting lists; (b) OVers training techniques to promote shared understanding by clinicians, managers and administrative staV; and (c) Suggests ways to improve waiting list management and introduce transparent, systematic processes that are fairer to patients and reduce maximum waiting times.
Validation 5. Spot-checks on waiting lists and waiting times have been carried out for the last three years and have now covered all acute trusts. Responsibility for the spot-check programme fell to the Audit Commission for the first two years and then moved to the Healthcare Commission in April 2004, although the Audit Commission still operationally manage the process. Spot-checks are a quick way of establishing whether there is evidence of problems in a system, such as deliberate misreporting or inadvertent errors and they can highlight areas for improvement in the management systems. 6. The Audit Commission issued “Information and Data Quality in the NHS” on 31 March 2004. The report stated that national figures on waiting times and waiting lists are now reliable. Audit Commission Chairman James Strachan said: “The NHS has been working hard to improve the accuracy of its data. This is absolutely vital for building public confidence that healthcare services are getting better. Recent improvements in waiting times are real. They are the result of a greater focus on improving the experience of patients and not the result of misreporting or inadequate data”.
6.14 In response to question 6.1.3 in last year’s Public Expenditure Questionnaire,1 you claimed that, with respect to SR 2002 target 2, you were: “minded to develop a system that will enable the NHS to benchmark the proportion of patients seen in one hour or less, rather than setting a blanket national standard” and that you were intending to: “seek further views from stakeholder organisations before reaching a final decision on a way forward”. Have you now reached this decision? Answer 1. Yes. Following further discussions with stake-holders we have concluded that a blanket national standard would not be appropriate. The sharp diVerences in case mix, particularly between major departments and units seeing only minor injury or illness, mean that any blanket standard for the proportion of patients seen within an hour would risk compromising clinical care in departments seeing more complex cases. By contrast, there are no clinical reasons why any A&E department cannot meet the operational standard of at least 98% of patients spending no more than four hours in A&E. 2. We have, however, now made available to all trusts and PCTs a standard national tool that allows analysis of performance against a range of benchmarks for the time spent in A&E. Amongst other benefits, the tool allows trusts and PCTs to look at the proportion of patients discharged within given time-bands and compare performance with organisations that provide services with similar case-mix.
6.15 In respect of SR 2002 target 5, the summary includes no figures, but instead provides a link to detailed survey results. Why have no summary figures been produced? Can these be supplied now please. Answer 1. The Healthcare Commission publish the results of all surveys on their website ı this includes a summary report of national findings and “local benchmark reports” for each trust or PCT, which compare their performance with all other organisations for each survey question. 2. To date there have been 13 surveys carried out across seven NHSsettings. In order to summarise results we have agreed a metrics system with the Healthcare Commission. NAO is currently validating the methodology together with internal and external analysts. Table 6.15 presents the current set of scores by way of illustration only, since the validation work is still ongoing. (see table 6.15) 3. The metrics for measuring progress against the patient experience PSA were designed in collaboration with the Healthcare Commission, who also calculate the final results for the Department. The methodology is essentially based on the approach used in the Healthcare Commission’s annual performance assessment of NHSorganisations: the results for each trust or PCT on a number of perfor mance indicator questions are scored, and are then aggregated to produce an index score for each of five themes or dimensions that patients say are the most important for a good experience: — Access and waiting.
1 Public Expenditure on Health and Personal Social Services 2004: Memorandum received from the Department of Health containing replies to a Written Questionnaire from the Committee, HC 1113, Q6.1.3. 3178271177 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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— Safe, high quality and co-ordinated care. — Better information, more choice. — Building better relationships. — A clean, friendly and comfortable place to be. 4. A “national average” is then calculated for each dimension, representing a high-level summary of performance. The questions, which are used to construct these scores, are diVerent for each survey, so it is not appropriate to compare performance across settings. However, since the performance indicator questions, which are used in each separate survey, will not change, comparisons over time for the same survey setting can be made. 5. The PSA Technical Note for SR2004 summarised this methodology, and also presented index scores for the first series of baseline surveys (2001–02 and 2002–03). Since this was first published, the Healthcare Commission have made a number of technical adjustments to the methodology. The Department is working closely with the Healthcare Commission to review and validate this change. 3178271177 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 311 (6) health Mental services 2003–04 level summary ommission are (5) setting-based so e 2003–04 young rvey programme. rvey survey not successful, then this 2004–05 e survey instrument will be (2) ll future surveys and will not 2002–03 (3) 2004–05 (2) erent from those already published in the PSA technical notes. V 2002–03 (1) Survey setting (4) 2003–04 (2) res will be calculated soon afterwards. Please note that this survey is not 2002–03 res will be calculated soon afterwards. At present, DH and the Healthcare C Table 6.15 thodology—and so may be di of the five dimensions. The aggregate score presented here is by way of a high ealthcare Commission; this forms part of the discussions on the forward su d survey programme for 2005–06 and onwards. Results are not pesented for th (3) ill be constructed using a PCT diabetes survey. shed. e place to be” dimension. ment via the Quality Outcome Framework negotiations; if negotiations are hey will be repeated in the future. If they are repeated, it is likely that th core until it is possible to identify a set of questions that will be used in a 2003–04 (2) METRICS FOR SR 2002, PSA TARGET 7 Adult inpatient survey Primary care trust survey A&E survey Outpatient su 7. The PSA technical note specifies that the PSA will be reported at the level 6. A new survey for this setting will be published in September 2005—PSA sco 5. The timetable for repeating this survey has not yet been agreed with the H 4. A new survey for this setting will be published in September 2005—PSA sco 3. A repeat of this survey will be conducted in 2005–06. 2. Please note that the scores for these surveys are based on the “new” PSA me 1. As of writing, DH and the Healthcare Commission are finalising the forwar measure of performance across all of the dimensions for each survey only. does not include questions to measure the “Clean, friendly and comfortabl survey may be repeated in the future. Performance indicators for 2005-06 w working towards replacing this survey with a better and more robust instru be changed. Only in this way can a robust and reliable time series be establi significantly revised; on this basis, it is not possible to calculate a PSA s Aggregate index score (7) 74 75 77 78 74 76 77 77 74 inpatient or 2003–04 ambulance trust surveys since it is unclear whether t 4 Building better relationships5 Clean, friendly comfortable place to be 78 83 77 83 72 87 73 86 78 79 80 80 70 86 68 86 n/a 86 3 Better information, more choice 67 68 82 81 73 73 77 77 61 Index score for each dimension of experience 2001–02 2 Safe, high qulaity coordinated care 64 66 79 80 75 75 83 82 70 1 Access & waitingNotes 82 83 67 69 64 69 70 69 80 3178271179 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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6.16 In respect of SR 2002 target 7, progress towards the sub target on access to CAMHS is measured on the basis of annual year-on-year increases in the number of staV engaged on CAMHS work, annual year-on- year increases in the number of CAMHS cases seen and an assessment of comprehensiveness of the CAMHS services which are available. Why are no numerical targets provided? Answer 1. The CAMHSsub-target within SR2002 target 7 is amplified in the Technical Note which was published in July 2002 and updated earlier this year. The requirement is for a comprehensive CAMHSto be in place by December 2006. The definition of a comprehensive CAMHSwas ori ginally published in May 2003 and confirmed in the National Service Framework for Children, Young People and Maternity Services which was published in September 2004. 2. Pending publication of the Children’s NSF, for NHS planning purposes the target was articulated as, “All CAMHSshould provide a comprehensive service, including mental heal th promotion and early intervention, by 2006 (demonstrated by increased staYng, patient contacts and/or investment)”. This was the basis on which the NHSdrew up Local Delivery Plans for 2003–04—2005–06 and against which they will be performance managed. Following publication of the Children’s NSF the definition of a comprehensive CAMHSwhich it contained was adopted as the objective which must be achieve d by December 2006. As this is an absolute requirement, a numerical target would be inappropriate. 3. For the purposes of routine monitoring and performance management, three key elements of a comprehensive CAMHShave been identified as proxy measures. They are: — 24/7 cover — Services for children and young people with learning disabilities — Services for 16 and 17 year olds 4. Information on the arrangements for tracking achievement of the CAMHSs ub-target and performance management of the NHSwas set out in the letter which Duncan Sel bie sent to Chief Executives on 11 March 2005: http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/DearColleagueLetters/ DearColleagueLettersArticle/fs/en?CONTENT—ID%4106041&chk%sZQY5N
6.17 In respect of SR 2002 target 7, the CAMHS sub target is described as being in the early stages of delivery. Given that the target year is end 2006, when will a more comprehensive assessment be available? Answer 1. The description in the Departmental annual report of being in the early stages of delivery related to the crisis services sub-target and not to the CAMHSsub-target. The most up -to-date assessment of progress towards the CAMHSsub-project is in the Local Delivery Plan Returns for the quarter ending 31 March 2005. This shows that the percentage of PCTs reporting availability of key aspects of CAMHSis as follows: — 24/7 services 79% — CAMHSfor those with a learning disability 41% — Services for 16–17 year olds 72%
6.18 Can you provide the Committee with a copy of Figure 7.7, which appears to have been misprinted in the DAR. Why have unit costs in the hospital sector tended to increase in the last 10 years? In respect of SR 2002 target 12, when do you expect to be able to provide an assessment against the value for money target? Answer 1. The information requested is given in Figure 6.18. 2. Unit costs in the hospital sector will increase due to increases in input costs (eg staV, drugs and equipment) as well as increases in expenditure designed to improve the quality of NHScare, whether that be through new hospitals with en-suite rooms, better drugs, or improvements in the quality of hospital food.
3. DH reported in the 2005 Departmental Report that NHSvalue for money thro ugh cost eYciency has in 2003–04 improved by an estimated 2.1%. We plan to finalise details of our PSS cost eYciency measure in time for the Autumn Performance Report. 3178271179 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Figure 6.18: Average unit costs by category of care 1991-92 to 2002-03 (Index 1991-92 = 100)
900
800
700 Learning Disability (£237 per day) 600
500
400 Mental Health (£246 per day) 300 Maternity 200 (£2,152 per birth) Acute 100 (£1,295 per case) Geriatric 0 (£2,220 per case) 1991-92 1993-94 1995-96 1997-98 1999-00 2001-02
6.19 In respect of CSR 1998 target 4, the rate of hospital admissions for serious accidental injury has increased from the baseline. Does the target of reducing such admissions by 10% from the baseline by 2010 remain realistic? Answer 1. The response to this question is linked to the response to question 6.3 in relation to CSR 1998 target 4. 2. A key factor in the increase in the admission rate since the baseline is falls in older people. As noted in the response to question 6.3 we have put in place a number of measures to tackle falls in older people, and it is too early for the eVect of these to be reflected in currently available data. 3. For example, a Healthy Communities Collaborative sponsored by the National Primary Care Development Team reduced falls in older people by a third in its first year in disadvantaged areas of Easington, Gateshead and Northampton Primary Care Trusts. This indicates that appropriate interventions can have a large impact in a short time period. 4. Furthermore, good progress has been made in reducing the admission rate for serious accidental injury in younger age groups, with a 26% reduction in the rate in under fives and a 30% reduction in the rate among 5 to 14 year olds since the baseline. 5. Nevertheless, given that the rate of hospital admissions for serious accidental injury has increased since the baseline, the target presents a high degree of challenge.
Supplementary memorandum from the Department of Health In this memorandum the Q numbers refer to the oral evidence questions from Thursday 1 December Q1–Q261 and Tuesday 6 December Q262–Q370. The following issues(s) were raised by committee members at the oYcials hearing session held on 1 December and the session with the Secretary of State on 6 December.
Q (24) Provision of DH Gershon delivery plans
Answer
1. A consolidated delivery plan is attached. This document is published on the department’s website http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/ PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT–ID%4131575&chk%JxrzVU 3178271180 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Q (38) Provision of planning and priorities guidance used to set the three-year NHS forward plan (budget and targets)
Answer 1. National Standards, Local Action, the Health and Social Care Planning Framework, sets out what is expected of NHSand social care organisations for the financial years 2005– 06 to 2007–08. This document is published on the department’s website www.dh.gov.uk.
Q (44) Provision of comparative health inequality ratings with other European countries (eg Spain, Holland, Germany)
Answer 1. There is no single source of internationally comparable information on health inequalities. We are aware that the World Health Organisation (WHO) has produced an inequality index, but a number of leading academic researchers in the EU have expressed their reservations about this measure (see reference 1). 2. Another possible measure is morbidity rates. However, as these are generally self-reported, they are subject to cultural and other diVerences in interpretation between countries. 3. Mortality rates provide a more objective measure, which is therefore more likely to be comparable across countries. Table 1 following shows inequalities in mortality by socio-economic position in 21 European countries. It is taken from “Health Inequalities: Europe in Profile”, an independent, expert report commissioned by, and published under the auspices of, the UK Presidency of the EU (October 2005). The report was produced by an acknowledged expert in the field of health inequalities, Professor Johan Mackenbach of Erasmus University, Rotterdam, Netherlands (reference 2). 4. The table shows that mortality is always higher in the lower, than in the higher, socio-economic groups. This is indicated by the fact that all rate ratios (ie the ratio of the death rate in the lower as compared to the higher socio-economic groups) are clearly above 1. Many of the figures given in table 1 apply to middle-aged adults, and this implies that diVerences in mortality rates can be interpreted as diVerences in the risks of dying prematurely. 5. The rate ratios for England and Wales are around the middle of the distribution across the European countries shown in the table, for both men and women. However, these comparisons should be interpreted with caution, because of diVerences in data collection and classification between countries.
Health Inequalities in Europe:Overview of Patterns and Trends
Table 1 Inequalities in mortality by socio-economic position in 21 European countries. This table shows that mortality is always higher in the lower, than in the higher socio-economic groups.
Country Indictor of socio- Period Age- Rate Ratiob Source economic position group Men Women
Austria Education2 1991–92 45! 1.43* 1.32* National census-linked mortality follow-up Belgium Education2 1991–95 45! 1.34* 1.29* National census-linked Housing tenure1 1991–95 60–69 1.44* 1.43* mortality follow-up Czech Republic Education6 End 1990s 20–64 1.66* 1.09* Unlinked cross-sectional study Denmark Education1 1991–95 60–69 1.28* 1.26* National census-linked Housing tenure1 1991–95 60–69 1.64* 1.47* mortality follow-up Occupation3 1981–1990 45–59 1.33* na National census-linked mortality follow-up England/Wales Eduction2 1991–96 45! 1.35* 1.22* National census-linked Housing tenure1 1991–96 60–69 1.65* 1.58* mortality follow-up Occupation3 1981–89 45–59 1.61* na National census-linked mortality follow-up: representative sample Estonia Education11 2000 20! 2.38* 2.23* National cross-sectional study Edcuation6 1988 20–74 1.50* 1.31* National cross-sectional study Finland Education2 1991–95 45! 1.33* 1.24* National census-linked Housing tenure1 1991–95 60–69 1.90* 1.73* mortality follow-up 3178271180 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 315
Country Indictor of socio- Period Age- Rate Ratiob Source economic position group Men Women
France Education1 1990–94 60–69 1.31* 1.14 National census-linked Housing tenure1 1990–94 60–69 1.27* 1.25* mortality follow-up Occupation3 1980–89 45–59 2.15* na National census-linked mortality follow-up: representative sample Hungary Education9 2002 45–64 1.97* 1.58* Cross-sectional ecological analysis Occupation10 1984"85 45–64 1.61 1.33 National cross-sectional study Ireland Occupation3 1980–82 45–59 1.38* na National cross-sectional study Italy Education2 1991–96 45! 1.22* 1.20* Urban census-linked mortality Housing tenure1 1991–96 60–69 1.37* 1.33* follow-up (Turin) Education4 1981–82 18–54 1.85* na National census-linked mortality follow-up Occupation3 1981–82 45–59 1.35* na National census-linked mortality follow-up Latvia Education7 1988–89 1.50 1.20 National cross-sectional study Lithuania Education5 2001 25! 2.40* 2.90* Unlinked cross-sectional analysis Netherlands Education23 1991–97 25–74 1.92* 1.28 GLOBE Longitudinal study (Eindhoven) Norway Education2 1990–95 45! 1.36* 1.27* National census-linked Housing tenure1 1990–95 60–69 1.44* 1.36* mortality follow-up Occupation3 1980–1990 45–59 1.47* na National census-linked mortality follow-up Poland Education8 1988–89 50–64 2.24 1.78 National cross-sectional study Portugal Occupation3 1980–82 45–69 1.36* na National cross-sectional study Slovenia Education 1991 & 2002 25–64 2.44 2.66 Unlinked cross-sectional study Spain Education2 1992–96 45! 1.24* 1.27* Urban and regional census- linked mortality follow up (Barcelona and Madrid) Occupation3 1980–82 45–59 1.37* na National cross-sectional study Sweden Occupation3 1980–86 45–59 1.59* na National census-linked mortality follow-up Switzerland Education2 1991–95 45! 1.33* 1.27* National census-linked mortality follow-up Occupation3 1979–1982 45–59 1.37* na National cross-sectional study a Because of diVerences in data collection and classification, the magnitude of inequalities in health cannot always directly be compared between countries. b Rate Ratio: ratio of mortality rate in lower socio-economic groups as compared to that in higher socio-economic groups. Asterisk (*) indictes that diVerence in mortality between socio-economic groups is statistically significant. Notes refer to references given in back of this report. na indicates “not availabe”.
References (1) World Health Report 2000: inequality index and socioeconomic inequalities in mortality. Tanja A J Houweling, Anton E. Kunst, Johan P. Mackenbach. The Lancet Vol 357 May 26 2001. (2) “Health Inequalities: Europe in Profile”. Professor Johan P Mackenbach. An independent, expert report commissioned by, and published under the auspices of, the UK Presidency of the EU (October 2005). http:// www.fco.gov.uk/Files/kfile/HI—EU—Profile,0.pdf 3178271181 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 316 Health Committee: Evidence
Q (70) NHS deficit analysis Answer 1. An analysis is attached. 2. This is provisional analysis, but suggests there is no obvious relationship between performance indicators and deficits. 3. The analysis does demonstrate the ‘breakeven mentality’ of many NHStru sts, because their data clusters around the breakeven point. This also makes it more diYcult to identify relationships between financial and other aspects of performance.
2004-05 NHS Trust surplus / (deficit) against Reference Cost Index
160
140
120
100
80 Reference Cost Index 2004
60
40 (35) (30) (25) (20) (15) (10) (5) 0 5 10 15 20 2004-05 surplus / (deficit) £ms
2004-05 NHS Trust surplus / (deficit) against 4 Hour A&E Waiting Time Target
100
99
98
97
96
95 (%)
94
93
92
91 Proportion of patients waiting less than 4 hours
90 (35) (30) (25) (20) (15) (10) (5) 0 5 10 15 20 2004-05 Surplus / (deficit) £ms 3178271181 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 317
2004-05 NHS Trust surplus / (deficit) against 6 Month Inpatient Wait Target
100
98
96
94
92
90
months (%) months 88
86
84
Proportion of patients waiting less than six 82
80 (35) (30) (25) (20) (15) (10) (5) 0 5 10 15 20 2004-05 Surplus / (deficit) £ms
2004-05 NHS Trust surplus / (deficit) against 13 week Outpatient Wait Target
100
95
90
85
80 (%)
75
70
65 Proportion of patients waiting less than 13 weeks 60 (35) (30) (25) (20) (15) (10) (5) 0 5 10 15 20 2004-05 Surplus / (deficit) £ms 3178271181 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 318 Health Committee: Evidence
2004-05 Primary Care Trust Under / (over) spend against closing 2005-06 Distance From Target
40
30
20
10 2005-06 % DFT 0
-10
-20 (25) (20) (15) (10) (5) 0 5 10 15 2004-05 Under / (over) spend £ms
2004-05 Primary Care Trust Under / (over) spend against 4 Hour A&E Waiting time Target
100
99
98
97
96
95 (%)
94
93
92
91 Proportion of patients waiting less than 4 hours 90 (25) (20) (15) (10) (5) 0 5 10 15 2004-05 Under / (over) spend £ms 3178271181 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 319
2004-05 Primary Care Trust Under / (over) spend against 6 Month Inpatient Target
100
98
96
94
92
90 (%)
88
86
84
82 Proportion of patients waiting less than 6 months 80 (25) (20) (15) (10) (5) 0 5 10 15 2004-05 Under / (over) spend £ms
SHA Trust NHS Trust Name Surplus/ Reference Total 6 month 13 week Code Code (deficit) Costs Time in inpatient outpatient £ms Index A & E waits wait (4 hours)
Q01 RQQ HINCHINGBROOKE HEALTH CARE NHSTRUST (2) 87 98.3 96.1 81 Q01 RGQ IPSWICH HOSPITAL NHS TRUST (6) 90 94.3 94.9 78 Q01 RGP JAMESPAGET HEALTHCARE NHSTRUST 0 100 95.8 96.2 80 Q01 RM1 NORFOLK AND NORWICH UNI HOSP NHS TRUST 0 103 96.4 88.6 78 Q01 RCX THE QUEEN ELIZ HOSP KING’S LYNN NHS TR (8) 97 91.4 89.6 70 Q01 RGR WEST SUFFOLK HOSPITALS NHS TRUST (8) 86 96.3 81.6 78 Q02 RC1 BEDFORD HOSPITAL NHS TRUST (8) 98 96.6 96.6 85 Q02 RWH EAST AND NORTH HERTFORDSHIRE NHS TRUST (9) 106 94.9 93.8 78 Q02 RC9 LUTON AND DUNSTABLE HOSPITAL NHS TRUST 0 102 96.1 97.7 80 Q02 RWG WEST HERTFORDSHIRE HOSPITALS NHS TRUST (10) 99 95.2 89.1 81 Q03 RDE ESSEX RIVERS HEALTHCARE NHS TRUST 0 91 95.7 94.9 82 Q03 RQ8 MID ESSEX HOSPITAL SERVICES NHS TRUST (2) 98 96.3 97.8 82 Q03 RQW PRINCESS ALEXANDRA HOSPITAL NHS TRUST 0 99 98.1 95.9 78 Q03 RAJ SOUTHEND HOSPITAL NHS TRUST 0 94 94.7 99.0 84 Q04 RQM CHELSEA AND WESTMINSTER HEALTHCARE TRUST 0 96 96.0 97.5 88 Q04 RC3 EALING HOSPITAL NHS TRUST 0 93 97.2 95.8 78 Q04 RQN HAMMERSMITH HOSPITALS NHS TRUST (18) 99 94.9 97.1 83 Q04 RV8 NORTH WEST LONDON HOSPITALS NHS TRUST (12) 98 93.2 93.5 68 Q04 RT3 ROYAL BROMPTON AND HAREFIELD NHSTRUST (3) 93 0.0 97.5 97 Q04 RJ5 ST MARY’S NHS TRUST (3) 96 97.4 99.7 80 Q04 RAS THE HILLINGDON HOSPITAL NHS TRUST 0 104 93.5 99.1 88 Q04 RFW WEST MIDDLESEX UNIVERSITY HOSP NHS TRUST (4) 118 96.0 96.8 83 Q05 RVL BARNET AND CHASE FARM HOSPITALS NHS TR 0 102 91.2 86.6 76 Q05 RP4 GREAT ORMOND ST HOSP FOR CHILDREN NHS TR (1) 135 0.0 98.6 96 Q05 RAP NORTH MIDDLESEX UNIVERSITY HOSP NHS TR (4) 89 96.0 98.0 88 Q05 RAL ROYAL FREE HAMPSTEAD NHS TRUST (10) 95 95.2 95.2 81 Q05 RAN ROYAL NAT ORTHOPAEDIC HOSP NHS TRUST (4) 142 0.0 82.7 64 Q05 RKE THE WHITTINGTON HOSPITAL NHS TRUST 2 98 94.8 100.0 87 Q06 RF4 BARKING, HAVERING AND REDBRIDGE HOSP NH 0 97 92.5 94.0 69 Q06 RNJ BARTSAND THE LONDON NHSTRUST 0 96 94.8 96.7 75 Q06 RNH NEWHAM UNIVERSITY HOSPITAL NHS TRUST 0 103 93.5 98.6 79 Q06 RGC WHIPPS CROSS UNIVERSITY HOSP NHS TRUST 0 103 95.3 91.2 74 Q07 RG3 BROMLEY HOSPITALS NHS TRUST 11 114 96.2 95.3 84 Q07 RJZ KING’S COLLEGE HOSPITAL NHS TRUST (3) 99 96.2 97.3 92 Q07 RG2 QUEEN ELIZABETH HOSPITAL NHS TRUST (9) 102 95.8 99.0 93 Q07 RGZ QUEEN MARY’S SIDCUP NHS TRUST (5) 97 95.1 99.6 81 Q07 RJ2 THE LEWISHAM HOSPITAL NHS TRUST (8) 105 94.3 96.9 79 Q08 RVR EPSOM AND ST HELIER UNI HOSPS NHS TRUST 1 94 93.1 91.7 88 Q08 RAX KINGSTON HOSPITAL NHS TRUST 1 93 97.0 94.7 80 Q08 RJ6 MAYDAY HEALTHCARE NHSTRUST 0 93 93.0 95.3 81 Q08 RJ7 ST GEORGE’S HEALTHCARE NHS TRUST (22) 118 95.3 95.9 89 3178271182 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 320 Health Committee: Evidence
SHA Trust NHS Trust Name Surplus/ Reference Total 6 month 13 week Code Code (deficit) Costs Time in inpatient outpatient £ms Index A & E waits wait (4 hours)
Q09 RTD NEWCASTLE UPON TYNE HOSPITALS NHS TRUST 0 101 96.4 93.6 91 Q09 RTF NORTHUMBRIA HEALTH CARE NHSTRUST 0 98 94.7 98.6 96 Q10 RXP CO DURHAM & DARLINGTON ACUTE HOSP NHS TR 0 106 93.7 98.1 85 Q10 RVW NORTH TEESAND HARTLEPOOL NHSTRUST 0 101 97.1 90.2 86 Q10 RTR SOUTH TEES HOSPITALS NHS TRUST (9) 103 97.6 93.6 81 Q11 RWA HULL AND EAST YORKSHIRE HOSPITALS NHS TR (5) 106 94.9 90.1 74 Q11 RJL NORTH LINCOLNSHIRE AND GOOLE HOSPS NHS T 0 107 96.4 98.9 93 Q11 RCC SCARBOROUGH AND NE YORKS NHS TRUST (5) 95 96.2 98.2 91 Q11 RCB YORK HOSPITALS NHS TRUST 0 89 95.9 89.8 81 Q12 RCF AIREDALE NHSTRUST (3) 103 98.0 94.0 89 Q12 RWY CALDERDALE AND HUDDERSFIELD NHS TRUST 0 109 97.2 99.7 82 Q12 RR8 LEEDS TEACHING HOSPITALS NHS TRUST 0 115 92.3 88.9 71 Q12 RXF MID YORKSHIRE HOSPITALS NHS TRUST (20) 102 93.8 88.6 77 Q13 RXL BLACKPOOL, FYLDE AND WYRE HOSPS NHS TR 0 108 96.0 96.8 80 Q13 RXR EAST LANCASHIRE HOSPITALS NHS TRUST (4) 96 96.1 98.3 81 Q13 RXN LANCASHIRE TEACHING HOSP NHS FOUND TRUST (3) 99 97.2 98.4 80 Q13 RTX MORECAMBE BAY HOSPITALS NHS TRUST (2) 101 96.7 98.3 84 Q13 RNL NORTH CUMBRIA ACUTE HOSPITALS NHS TRUST 0 108 98.8 93.2 84 Q14 RMC BOLTON HOSPITALS NHS TRUST (3) 105 94.4 98.1 82 Q14 RW3 CENT MANCHESTER/ MANCHESTER CHILD NHS TR (8) 106 94.9 100.0 89 Q14 RBV CHRISTIE HOSPITAL NHS TRUST 0 122 0.0 100.0 100 Q14 RW6 PENNINE ACUTE HOSPITALS NHS TRUST 1 104 94.6 96.8 81 Q14 RM3 SALFORD ROYAL HOSPITALS NHS TRUST 0 101 98.4 100.0 85 Q14 RM2 SOUTH MANCHESTER UNIV HOSP NHS TRUST 0 103 96.7 100.0 96 Q14 RMP TAMESIDE AND GLOSSOP ACUTE SERVS NHS TR 0 107 98.4 100.0 81 Q14 RM4 TRAFFORD HEALTHCARE NHSTRUST (3) 104 97.2 100.0 83 Q14 RRF WRIGHTINGTON, WIGAN AND LEIGH NHSTRUST (1) 105 96.5 96.9 81 Q15 REM AINTREE HOSPITALS NHS TRUST 0 96 94.0 98.2 81 Q15 REN CLATTERBRIDGE CENTRE FOR ONCOLOGY TRUST 0 98 0.0 100.0 100 Q15 RJN EAST CHESHIRE NHS TRUST 0 102 95.0 88.3 83 Q15 REP LIVERPOOL WOMEN’SNHSFOUND TRUST 0 106 97.5 99.5 100 Q15 RWW NORTH CHESHIRE HOSPITALS NHS TRUST 0 96 95.4 84.4 90 Q15 RQ6 ROYAL LIVERPOOL BROADGREEN UNIV HOSP TR 0 108 97.0 90.3 74 Q15 RBSROYAL LIVERPOOL CHILDRENSNHSTRUST 0 132 97.9 100.0 80 Q15 RVY SOUTHPORT AND ORMSKIRK HOSPITAL NHS TR (1) 109 98.0 94.6 77 Q15 RBN ST HELENS AND KNOWSLEY HOSPITALS NHS TR 0 98 97.2 93.2 86 Q15 RBQ THE CARDIOTHORACIC CNTR—LIVERPOOL NHST 0 119 0.0 98.2 99 Q15 RBT THE MID CHESHIRE HOSPITALS NHS TRUST 0 96 95.9 93.1 83 Q15 RET WALTON NEUROLOGY CENTRE NHSTRUST 0 109 0.0 99.2 67 Q15 RBL WIRRAL HOSPITAL NHS TRUST 0 96 96.6 91.7 85 Q16 RXQ BUCKINGHAMSHIRE HOSPITALS NHS TRUST 3 98 97.2 97.3 87 Q16 RD7 HEATHERWOOD AND WEXHAM PARK HOSPS TRUST (4) 91 96.8 100.0 97 Q16 RD8 MILTON KEYNES GENERAL HOSPITAL NHS TRUST 1 93 96.4 95.1 89 Q16 RBF NUFFIELD ORTHOPAEDIC CENTRE NHSTRUST 0 123 0.0 96.9 58 Q16 RTH OXFORD RADCLIFFE HOSPITALS NHS TRUST 2 99 96.6 100.0 97 Q16 RHW ROYAL BERKSHIRE AND BATTLE HOSPS NHS TR 0 89 97.2 100.0 83 Q17 RR2 ISLE OF WIGHT HEALTHCARE NHS TRUST 0 107 96.0 94.8 82 Q17 RN5 NORTH HAMPSHIRE HOSPITALS NHS TRUST 0 103 96.3 94.8 81 Q17 RHU PORTSMOUTH HOSPITALS NHS TRUST 1 97 96.0 100.0 97 Q17 RHM SOUTHAMPTON UNIVERSITY HOSPS NHS TRUST (12) 95 96.4 85.3 78 Q17 RN1 WINCHESTER AND EASTLEIGH HLTHCRE NHS TR 0 98 96.8 91.4 79 Q18 RN7 DARTFORD AND GRAVESHAM NHS TRUST (1) 93 97.7 97.3 82 Q18 RVV EAST KENT HOSPITALS NHS TRUST 0 103 96.8 93.1 77 Q18 RWF MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 0 100 96.4 94.4 80 Q18 RPA MEDWAY NHSTRUST (0) 104 97.7 94.2 78 Q19 RTK ASHFORD AND ST PETER’S HOSPITALS NHS TR 0 94 95.9 97.0 90 Q19 RXH BRIGHTON AND SUSSEX UNIV HOSPS NHS TRUST (10) 113 95.8 90.5 80 Q19 RXC EAST SUSSEX HOSPITALS NHS TRUST (5) 112 94.9 91.5 72 Q19 RDU FRIMLEY PARK HOSPITAL NHS FOUND TRUST 0 83 96.0 99.1 84 Q19 RA2 ROYAL SURREY COUNTY HOSPITAL NHS TRUST 0 89 96.2 97.4 90 Q19 RPR ROYAL WEST SUSSEX NHS TRUST (15) 90 97.0 98.9 86 Q19 RTP SURREY AND SUSSEX HEALTHCARE NHS TRUST (31) 94 93.7 92.8 78 Q19 RPL WORTHING AND SOUTHLANDS HOSPITALS TRUST 0 94 96.8 95.5 76 Q20 RVJ NORTH BRISTOL NHS TRUST 2 109 91.8 88.8 80 Q20 RBB ROYAL NAT HOSP RHEUM DISEASE NHS FOUN TR 0 125 0.0 100.0 100 Q20 RD1 ROYAL UNITED HOSPITAL BATH NHS TRUST (1) 95 97.9 78.8 75 Q20 RNZ SALISBURY HEALTH CARE NHS TRUST 0 89 96.6 98.3 88 Q20 RN3 SWINDON AND MARLBOROUGH NHS TRUST 0 103 97.8 94.1 85 Q20 RA7 UNITED BRISTOL HEALTHCARE NHS TRUST 0 104 95.6 90.4 76 Q20 RA3 WESTON AREA HEALTH NHS TRUST (5) 82 98.8 94.5 87 Q21 RBZ NORTHERN DEVON HEALTHCARE NHSTRUST (1) 102 96.8 96.7 90 Q21 RK9 PLYMOUTH HOSPITALS NHS TRUST (8) 101 95.0 94.0 68 Q21 REF ROYAL CORNWALL HOSPITALS NHS TRUST 14 98 96.3 95.8 68 Q21 RA9 SOUTH DEVON HEALTH CARE NHS TRUST 0 101 96.5 97.4 96 3178271183 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 321
SHA Trust NHS Trust Name Surplus/ Reference Total 6 month 13 week Code Code (deficit) Costs Time in inpatient outpatient £ms Index A & E waits wait (4 hours)
Q22 RA4 EAST SOMERSET NHS TRUST 0 102 96.4 100.0 89 Q22 RD3 POOLE HOSPITAL NHS TRUST 0 89 95.2 100.0 93 Q22 RDZ ROYAL BRNMTH AND CHRISTCRCH FOUN TRUST (0) 93 97.5 100.0 89 Q22 RBA TAUNTON AND SOMERSET NHS TRUST 0 90 97.7 100.0 86 Q22 RBD WEST DORSET GENERAL HOSPITALS NHS TRUST (0) 90 96.7 100.0 85 Q23 RCU SHEFFIELD CHILDREN’S NHS TRUST 0 113 98.6 96.1 74 Q23 RFR THE ROTHERHAM NHSFOUNDATION TRUST 0 104 96.5 98.3 91 Q24 RCS NOTTINGHAM CITY HOSPITAL NHS TRUST 0 104 0.0 100.0 89 Q24 RFK QUEEN’S MEDICAL NOTTS UNI HOSP NHS TRUST 0 94 95.4 100.0 91 Q24 RK5 SHERWOOD FOREST HOSPITALS NHS TRUST 0 101 98.0 100.0 85 Q24 RWD UNITED LINCOLNSHIRE HOSPITALS NHS TRUST (5) 109 96.5 100.0 83 Q25 RNQ KETTERING GENERAL HOSPITAL NHS TRUST (2) 87 93.0 90.0 82 Q25 RNS NORTHAMPTON GENERAL HOSPITAL NHS TRUST 0 94 94.1 94.7 67 Q25 RWE UNIVERSITY HOSPITALS OF LEICESTER NHS TR 0 101 95.7 92.6 77 Q26 RJF BURTON HOSPITALS NHS TRUST (3) 102 95.0 88.5 78 Q26 RJD MID STAFFORDSHIRE GEN HOSPITALS TRUST (2) 97 94.7 96.6 66 Q26 RL1 ROB JONESAND A HUNT ORTHOPAEDIC NHSTR 0 127 100.0 80.9 62 Q26 RXW SHREWSBURY & TELFORD HOSPITAL NHS TRUST (10) 89 96.8 92.2 75 Q26 RJE UNIV HOSP NORTH STAFFORDSHIRE NHS TRUST 0 101 94.7 95.2 71 Q27 RQ3 BIRMINGHAM CHILDREN’S HOSPITAL NHS TRUST 0 147 96.0 99.9 93 Q27 RLU BIRMINGHAM WOMEN’SHEALTH CARE NHSTRUST (0) 102 0.0 100.0 100 Q27 RNA DUDLEY GROUP OF HOSPITALS NHS TRUST 2 106 96.0 100.0 94 Q27 RJH GOOD HOPE HOSPITAL NHS TRUST (4) 98 97.9 100.0 78 Q27 RR1 HEART OF ENGLAND NHSFOUNDATION TRUST 0 90 95.4 100.0 87 Q27 RRJ ROYAL ORTHOPAEDIC HOSPITAL NHS TRUST 1 110 0.0 100.0 100 Q27 RL4 ROYAL WOLVERHAMPTON HOSPITAL NHS TRUST (9) 105 96.3 100.0 94 Q27 RXK SANDWELL & WEST BIRMINGHAM HOSPS NHS TR (8) 95 96.6 99.6 88 Q27 RBK WALSALL HOSPITALS NHS TRUST (2) 102 97.7 100.0 90 Q28 RLT GEORGE ELIOT HOSPITAL NHS TRUST (1) 79 96.3 96.0 92 Q28 RLQ HEREFORD HOSPITALS NHS TRUST 0 100 96.7 87.6 83 Q28 RJC SOUTH WARWICKSHIRE GEN HOSPS NHS TRUST (9) 84 95.4 98.3 72 Q28 RKB UNIV HOSPS COVENTRY & WARWICKSHIRE NHSTR 0 104 95.8 100.0 80 Q28 RWP WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST 0 97 94.5 99.0 80 Q01 RT1 CAMBS& PETERBOROUGH MH PARTNERSHIPTR (0) 84 Q01 RMZ EAST ANGLIAN AMBULANCE NHS TRUST 1 128 12.0 Q01 RMY NORFOLK & WAVENEY MH PARTNERSHIP NHS TR 1 121 Q01 RT6 SUFFOLK MENTAL HEALTH PARTNERSHIP NHS TR 1 102 Q02 RV7 BEDFORDSHIRE & LUTON MH & SOC CAR NHS TR 1 98 Q02 RFU BEDSAND HERTSAMBULANCE AND PARAMEDIC T 0 98 Q02 RWR HERTFORDSHIRE PARTNERSHIP NHS TRUST 1 82 Q03 RB4 ESSEX AMBULANCE SERVICE NHS TRUST 0 93 Q03 RRD N ESSEX MENTAL HEALTH PARTNERSHIP NHS TR 1 93 Q03 RWN SOUTH ESSEX PARTNERSHIP NHS TRUST 0 96 Q04 RV3 CENTRAL AND NORTH WEST LONDON MH NHS TR 0 81 Q04 RKL WEST LONDON MENTAL HEALTH NHS TRUST 0 95 Q05 RRP BARNET, ENFIELD AND HARINGEY MH NHSTR 1 91 Q05 TAF CAMDEN & ISLINGTON MH & SOCIAL CARE TR 0 83 Q05 RNK TAVISTOCK AND PORTMAN NHS TRUST 0 42 Q06 RWK EAST LONDON AND THE CITY MH NHS TRUST 0 96 Q06 RAT NORTH EAST LONDON MENTAL HEALTH NHS TR 0 99 Q07 RPG OXLEASNHSTRUST 0 98 Q07 RV5 SOUTH LONDON AND MAUDSLEY NHS TRUST 0 107 Q08 RRU LONDON AMBULANCE SERVICE NHS TRUST 0 114 Q08 RQY SW LONDON AND ST GEORGE’S MENTAL HLTH TR 0 92 Q09 RNP NEWC, N TYNESIDE AND N’THUMBERLND MH NHS 2 99 Q09 RVK NORTH EAST AMBULANCE SERVICE NHS TRUST 0 89 Q09 RM6 NORTHGATE AND PRUDHOE NHSTRUST 0 132 Q09 RW9 SOUTH OF TYNE AND WEARSIDE MH NHS TRUST 0 106 Q10 RTC COUNTY DURHAM AND DARLINGTON PRIOR SRV T 0 107 Q10 RVX TEES AND NORTH EAST YORKSHIRE NHS TRUST 0 96 Q11 RV9 HUMBER MENTAL HEALTH TEACHING NHSTRUST 0 139 Q11 RV1 TEES EAST AND NTH YORKSHRE AMB SERV NHS 0 109 Q12 TAD BRADFORD DISTRICT CARE TRUST 0 110 Q12 RGD LEEDSMENTAL HEALTH TEACHING NHSTRUST 0 121 Q12 RXG SOUTH WEST YORKSHIRE MENTAL HEALTH NHSTR 0 99 Q12 RGH WEST YORKSHIRE AMBULANCE SERVICE TRUST 0 88 Q13 RJX CALDERSTONES NHS TRUST 0 109 Q13 RE6 CUMBRIA AMBULANCE SERVICE NHS TRUST 0 135 Q13 RMD LANCASHIRE AMBULANCE SERVICE NHS TRUST 0 78 Q13 RW5 LANCASHIRE CARE NHS TRUST 0 100 Q13 RNN NTH CUMBRIA MH AND LEARNING DISAB NHS TR 0 104 Q14 RXV BOLTON SALFORD AND TRAFFORD MH NHS TRUST 0 96 Q14 RMA GREATER MANCHESTER AMBULANCE NHS TRUST 0 77 Q14 TAE MANCHESTER MENTAL HLTH & SOCIAL CARE TR 0 94 3178271185 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 322 Health Committee: Evidence
SHA Trust NHS Trust Name Surplus/ Reference Total 6 month 13 week Code Code (deficit) Costs Time in inpatient outpatient £ms Index A & E waits wait (4 hours)
Q14 RT2 PENNINE CARE NHSTRUST 0 97 Q15 RTV 5 BOROUGHS PARTNERSHIP NHS TRUST 0 90 Q15 RXA CHESHIRE AND WIRRAL PARTNERSHIP NHS TR 0 84 Q15 RW4 MERSEY CARE NHS TRUST 0 123 Q15 RB6 MERSEY REGIONAL AMBULANCE SERVICE TRUST 0 93 Q16 RWX BERKSHIRE HEALTHCARE NHS TRUST 0 86 Q16 RWT BUCKINGHAMSHIRE MENTAL HEALTH NHS TRUST (1) 111 Q16 RHX OXFORD LEARNING DISABILITY NHS TRUST 0 - Q16 RNY OXFORDSHIRE AMBULANCE NHS TRUST 0 91 Q16 RNU OXFORDSHIRE MENTAL HEALTHCARE NHS TRUST 0 99 Q16 RH1 ROYAL BERKSHIRE AMBULANCE SERVICE TRUST 0 102 Q17 RKD HAMPSHIRE AMBULANCE SERVICE NHS TRUST (3) 104 Q17 RW1 HAMPSHIRE PARTNERSHIP NHS TRUST 0 92 Q18 RTM EAST KENT NHS AND SC PARTNERSHIP TRUST 0 98 Q18 RPH KENT AMBULANCE NHSTRUST 0 107 Q18 RXJ WEST KENT NHS AND SOCIAL CARE TRUST 0 102 Q19 RXD EAST SUSSEX COUNTY HEALTHCARE NHS TRUST 0 93 Q19 RW7 NORTH WEST SURREY MH NHS PARTNERSHIP TR 0 92 Q19 RDR SOUTH DOWNS HEALTH NHS TRUST 0 105 Q19 RPQ SURREY AMBULANCE SERVICE NHS TRUST 0 107 Q19 RTJ SURREY HAMPSHIRE BORDERS NHS TRUST 0 90 Q19 RTN SURREY OAKLANDS NHS TRUST 0 110 Q19 RQ2 SUSSEX AMBULANCE SERVICE NHS TRUST 0 104 Q19 RW8 WEST SUSSEX HEALTH AND SOCIAL CARE NHSTR 0 98 Q20 RB1 AVON AMBULANCE SERVICE NHS TRUST 0 81 Q20 RVN AVON AND WILTSHIRE MHP NHS TRUST 0 109 Q20 RB5 GLOUCESTERSHIRE AMBULANCE SERVICES NHST 0 134 Q20 RTQ GLOUCESTERSHIRE PARTNERSHIP NHS TRUST 0 109 Q20 RHR WILTSHIRE AMBULANCE SERVICE NHS TRUST 0 113 Q21 RJ8 CORNWALL PARTNERSHIP NHS TRUST 0 110 Q21 RWV DEVON PARTNERSHIP NHS TRUST (1) 108 Q21 RJ9 WESTCOUNTRY AMBULANCE SERVICES NHS TRUST 0 134 Q22 RHP DORSET AMBULANCE NHS TRUST 0 94 Q22 RDY DORSET HEALTHCARE NHS TRUST 0 92 Q22 RH5 SOMERSET PARTNERSHIP NHS AND SOC CARE TR 0 108 Q23 RXE DONCASTER & SOUTH HUMBER H’CARE NHS TR 0 100 Q23 RB8 SOUTH YORKSHIRE AMBULANCE SERVICE NHS TR 0 76 Q24 RXM DERBYSHIRE MENTAL HEALTH SERVICES NHS TR 0 106 Q24 RV6 EAST MIDLANDS AMBULANCE SERVCE NHS TRUST 0 94 Q24 RBX LINCOLNSHIRE AMBULANCE NHS TRUST 0 123 Q24 RP7 LINCOLNSHIRE PARTNERSHIP NHS TRUST 0 110 Q24 RHA NOTTINGHAMSHIRE HEALTHCARE NHS TRUST 0 109 Q24 TAH SHEFFIELD CARE TRUST 0 114 Q25 RT5 LEICESTERSHIRE PARTNERSHIP NHS TRUST 0 110 Q25 RP1 NORTHAMPTONSHIRE HEALTHCARE NHS TRUST 0 107 Q25 RHY TWO SHIRES AMBULANCE NHS TRUST 0 95 Q26 RLY NORTH STAFFS COMBINED HC NHS TRUST 0 106 Q26 RRE SOUTH STAFFORDSHIRE HEALTHCARE NHS TRUST 0 109 Q26 RB7 STAFFORDSHIRE AMBULANCE SERVICE TRUST 0 72 Q27 RXT BIRMINGHAM AND SOLIHULL MH NHS TRUST 0 94 Q27 TAJ SANDWELL MENTAL HEALTH NHS & SOCIAL CT 0 106 Q27 RKA WEST MIDLANDS AMBULANCE SERVICE NHS TR (0) 96 Q28 RL6 COVENTRY & WARWICKSHIRE AMBULANCE NHS TR 0 93 Q28 RL5 HEREFORD AND WORCESTER AMBULANCE NHS TR 0 125 Q28 RWQ WORCESTERSHIRE MH PARTNERSHIP NHS TRUST 0 99
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q01 5JL BROADLAND PCT (4) 2.4 96.4 89.2 Q01 5JH CAMBRIDGE CITY PCT (8) 16.6 96.7 92.4 Q01 5JT CENTRAL SUFFOLK PCT (4) "1.1 94.3 93.3 Q01 5JK EAST CAMBRIDGESHIRE AND FENLAND PCT 0 "5.5 95.0 92.1 Q01 5GT GREAT YARMOUTH PCT 1 "6.0 95.8 95.7 Q01 5GF HUNTINGDONSHIRE PCT (2) 1.9 98.3 95.1 Q01 5JQ IPSWICH PCT (10) "1.2 94.3 94.5 Q01 5JM NORTH NORFOLK PCT (5) "1.5 96.4 90.7 Q01 5AF NORTH PETERBOROUGH PCT 0 "5.8 98.0 97.9 3178271186 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 323
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q01 5A2 NORWICH PCT (0) "1.2 96.4 88.3 Q01 5JJ SOUTH CAMBRIDGESHIRE PCT (3) 7.8 96.7 91.9 Q01 5AG SOUTH PETERBOROUGH PCT 0 0.5 98.0 98.7 Q01 5G1 SOUTHERN NORFOLK PCT (7) "2.5 96.4 87.9 Q01 5JR SUFFOLK COASTAL PCT (6) 2.1 94.3 94.9 Q01 5JW SUFFOLK WEST PCT (13) 0.5 96.3 83.7 Q01 5JV WAVENEY PCT (2) "3.8 95.8 94.4 Q01 5CY WEST NORFOLK PCT (1) "5.6 91.4 89.8 Q02 5GD BEDFORD PCT 1 "3.8 96.6 95.7 Q02 5GE BEDFORDSHIRE HEARTLANDS PCT (15) "2.3 96.3 95.0 Q02 5GW DACORUM PCT (5) "1.5 95.4 90.1 Q02 5CP HERTSMERE PCT (5) 3.1 92.6 91.4 Q02 5GC LUTON PCT (6) "6.0 96.1 96.3 Q02 5GH NORTH HERTFORDSHIRE AND STEVENAGE PCT (4) "0.3 94.9 93.4 Q02 5GK ROYSTON BUNTNGFRD & BISHPS STRTFORD PCT 0 8.9 97.6 94.6 Q02 5GJ SOUTH EAST HERTFORDSHIRE PCT (0) "5.5 94.6 92.9 Q02 5GX ST ALBANS AND HARPENDEN PCT (2) 11.0 95.3 90.2 Q02 5GV WATFORD AND THREE RIVERSPCT (2) 7.9 95.2 93.5 Q02 5GG WELWYN HATFIELD PCT (0) "1.5 94.9 94.4 Q03 5GR BASILDON PCT 0 "6.0 94.0 99.2 Q03 5GP BILLERICAY, BRENTWOOD AND WICKFORD PCT (1) 3.7 93.6 97.9 Q03 5JP CASTLE POINT AND ROCHFORD PCT 0 "3.9 94.7 98.9 Q03 5JN CHELMSFORD PCT (7) 3.1 96.3 96.8 Q03 5GM COLCHESTER PCT (1) "4.4 95.7 94.9 Q03 5AJ EPPING FOREST PCT 0 1.3 98.1 95.4 Q03 5DC HARLOW PCT 0 1.6 98.1 96.0 Q03 5GL MALDON AND SOUTH CHELMSFORD PCT (1) "1.0 96.3 96.7 Q03 5AK SOUTHEND ON SEA PCT 0 0.7 94.7 98.8 Q03 5AH TENDRING PCT 0 "11.0 95.7 94.6 Q03 5GQ THURROCK PCT (1) "6.0 94.0 99.2 Q03 5GN UTTLESFORD PCT 0 5.7 96.9 93.3 Q03 TAG WITHAM, BRAINTREE AND HALSTEAD CARE TR (3) "6.0 96.3 96.4 Q04 5K5 BRENT TEACHING PCT 1 "1.2 94.1 94.9 Q04 5HX EALING PCT 0 4.4 96.8 95.8 Q04 5H1 HAMMERSMITH AND FULHAM PCT 1 10.0 95.1 96.9 Q04 5K6 HARROW PCT (1) 5.0 93.2 93.7 Q04 5AT HILLINGDON PCT (13) 4.5 93.5 95.3 Q04 5HY HOUNSLOW PCT (6) 1.4 95.8 96.6 Q04 5LA KENSINGTON AND CHELSEA PCT (19) 15.4 96.5 98.2 Q04 5LC WESTMINSTER PCT 0 29.9 97.4 98.4 Q05 5A9 BARNET PCT 1 7.3 92.7 93.2 Q05 5K7 CAMDEN PCT 0 7.4 94.5 95.7 Q05 5C1 ENFIELD PCT 0 "0.7 93.2 89.5 Q05 5C9 HARINGEY TEACHING PCT 0 "0.8 95.6 93.9 Q05 5K8 ISLINGTON PCT 0 8.3 94.4 97.2 Q06 5C2 BARKING AND DAGENHAM PCT 0 "10.7 92.5 94.2 Q06 5C3 CITY AND HACKNEY TEACHING PCT 0 "4.5 93.8 96.7 Q06 5A4 HAVERING PCT (3) 0.0 92.5 94.4 Q06 5C5 NEWHAM PCT 0 "6.0 93.5 94.9 Q06 5NA REDBRIDGE PCT 0 1.7 93.3 93.9 Q06 5C4 TOWER HAMLETSPCT 0 "6.0 94.8 96.6 Q06 5NC WALTHAM FOREST PCT (3) "1.9 95.3 91.4 Q07 TAK BEXLEY CARE TRUST (3) 0.8 95.1 98.9 Q07 5A7 BROMLEY PCT 0 4.1 96.2 95.1 Q07 5A8 GREENWICH TEACHING PCT 0 4.5 95.8 97.5 Q07 5LD LAMBETH PCT 1 6.4 96.1 95.4 Q07 5LF LEWISHAM PCT 0 6.4 94.3 96.0 Q07 5LE SOUTHWARK PCT 0 1.1 96.2 94.9 Q08 5K9 CROYDON PCT 0 0.2 93.0 94.6 Q08 5A5 KINGSTON PCT (2) 8.7 97.0 94.9 Q08 5M6 RICHMOND AND TWICKENHAM PCT 0 17.7 96.6 94.6 Q08 5M7 SUTTON AND MERTON PCT 0 5.5 93.8 93.6 Q08 5LG WANDSWORTH PCT (8) 13.4 95.3 95.7 Q09 5KF GATESHEAD PCT 0 "2.7 97.0 96.9 Q09 5D7 NEWCASTLE PCT 0 4.0 96.4 93.5 Q09 5D8 NORTH TYNESIDE PCT 0 "1.3 94.7 95.6 Q09 TAC NORTHUMBERLAND CARE TRUST 0 0.5 94.7 96.6 Q09 5KG SOUTH TYNESIDE PCT 0 "4.5 96.7 99.1 Q09 5KL SUNDERLAND TEACHING PCT 0 "1.6 97.1 99.6 Q10 5J9 DARLINGTON PCT 0 6.2 93.7 97.8 Q10 5KA DERWENTSIDE PCT 0 "4.1 93.7 97.5 Q10 5KC DURHAM AND CHESTER"LE"STREET PCT 0 1.3 93.7 97.8 3178271187 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 324 Health Committee: Evidence
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q10 5J8 DURHAM DALESPCT 0 0.8 93.7 95.9 Q10 5KD EASINGTON PCT 0 "16.2 97.1 95.0 Q10 5D9 HARTLEPOOL PCT 0 "1.6 97.1 92.6 Q10 5KN LANGBAURGH PCT 0 "0.7 97.6 92.2 Q10 5KM MIDDLESBROUGH PCT 0 "5.5 97.6 94.5 Q10 5E1 NORTH TEESPCT 0 "3.1 97.1 90.5 Q10 5KE SEDGEFIELD PCT 0 "2.4 93.7 93.3 Q11 5KJ CRAVEN, HARROGATE AND RURAL DISTRICT PCT 0 5.0 98.0 97.0 Q11 5E3 EAST YORKSHIRE PCT 0 6.6 94.9 91.9 Q11 5E5 EASTERN HULL PCT 0 "1.5 94.9 89.2 Q11 5KH HAMBLETON AND RICHMONDSHIRE PCT 0 8.4 97.6 94.6 Q11 5AN NORTH EAST LINCOLNSHIRE PCT 0 "2.0 96.4 97.9 Q11 5EF NORTH LINCOLNSHIRE PCT 0 0.7 96.4 98.1 Q11 5KK SCARBOROUGH, WHITBY AND RYEDALE PCT 0 "1.5 96.2 96.6 Q11 5E2 SELBY AND YORK PCT (7) 1.4 95.9 90.0 Q11 5E6 WEST HULL PCT 0 1.0 94.9 89.1 Q11 5E4 YORKSHIRE WOLDS AND COAST PCT (6) 2.7 94.9 93.6 Q12 5AW AIREDALE PCT 0 5.6 98.0 95.2 Q12 5CF BRADFORD CITY TEACHING PCT 0 "6.0 97.1 98.4 Q12 5CG BRADFORD SOUTH AND WEST PCT 0 "2.4 97.1 98.9 Q12 5J6 CALDERDALE PCT 0 2.4 97.2 99.1 Q12 5HK EAST LEEDS PCT 0 6.6 92.3 88.3 Q12 5E7 EASTERN WAKEFIELD PCT 2 "6.0 93.8 89.7 Q12 5LJ HUDDERSFIELD CENTRAL PCT 0 0.8 97.2 98.9 Q12 5HJ LEEDSNORTH EASTPCT 1 4.3 93.1 93.3 Q12 5HM LEEDSNORTH WESTPCT 0 1.0 92.3 87.3 Q12 5HH LEEDSWESTPCT 0 4.4 92.3 91.9 Q12 5CH NORTH BRADFORD PCT 0 0.2 97.1 98.7 Q12 5J7 NORTH KIRKLEESPCT 0 "4.4 93.8 88.7 Q12 5LK SOUTH HUDDERSFIELD PCT 0 3.4 97.2 98.6 Q12 5HL SOUTH LEEDS PCT 0 0.6 92.6 89.7 Q12 5E8 WAKEFIELD WEST PCT 0 0.3 93.8 88.2 Q13 5CC BLACKBURN WITH DARWEN PCT 0 "6.0 96.1 98.0 Q13 5HP BLACKPOOL PCT 1 "3.5 96.0 96.2 Q13 5G8 BURNLEY, PENDLE AND ROSSENDALE PCT 0 "4.7 96.1 97.6 Q13 5D4 CARLISLE AND DISTRICT PCT 0 0.1 98.8 93.1 Q13 5F2 CHORLEY AND SOUTH RIBBLE PCT 0 "1.4 97.2 98.4 Q13 5D5 EDEN VALLEY PCT 0 5.6 98.8 93.1 Q13 5HE FYLDE PCT 0 4.6 96.0 96.0 Q13 5G7 HYNDBURN AND RIBBLE VALLEY PCT 0 "4.8 96.1 98.1 Q13 5DD MORECAMBE BAY PCT 0 0.8 96.7 97.7 Q13 5HD PRESTON PCT 0 6.8 97.2 98.4 Q13 5D6 WEST CUMBRIA PCT 0 1.5 98.8 92.4 Q13 5F3 WEST LANCASHIRE PCT 0 "1.5 98.0 94.0 Q13 5HF WYRE PCT 1 0.1 96.0 97.0 Q14 5HG ASHTON, LEIGH AND WIGAN PCT 0 "3.1 96.5 99.4 Q14 5HQ BOLTON PCT 0 "4.7 94.4 98.2 Q14 5JX BURY PCT 0 "1.8 94.6 97.2 Q14 5CL CENTRAL MANCHESTER PCT 4 0.6 94.9 99.8 Q14 5F4 HEYWOOD AND MIDDLETON PCT 1 "4.8 94.6 97.5 Q14 5CR NORTH MANCHESTER PCT 1 0.1 94.6 97.7 Q14 5J5 OLDHAM PCT 0 "6.0 94.6 96.6 Q14 5JY ROCHDALE PCT 1 "3.8 94.6 97.8 Q14 5F5 SALFORD PCT 0 "1.0 98.4 99.5 Q14 5AA SOUTH MANCHESTER PCT 3 "3.3 96.7 99.8 Q14 5F7 STOCKPORT PCT 0 1.3 96.6 90.7 Q14 5LH TAMESIDE AND GLOSSOP PCT 0 "2.5 98.4 98.9 Q14 5F6 TRAFFORD NORTH PCT 0 1.1 97.2 100.0 Q14 5CX TRAFFORD SOUTH PCT 0 11.8 96.9 99.8 Q15 5F8 BEBINGTON AND WEST WIRRAL PCT 0 8.8 96.6 91.3 Q15 5H2 BIRKENHEAD AND WALLASEY PCT 0 "4.7 96.6 91.8 Q15 5H4 CENTRAL CHESHIRE PCT 0 "2.3 95.9 92.7 Q15 5HA CENTRAL LIVERPOOL PCT 0 "6.6 97.2 92.2 Q15 5H3 CHESHIRE WEST PCT (1) 0.7 93.2 89.3 Q15 5H5 EASTERN CHESHIRE PCT 0 9.2 95.0 90.8 Q15 5H6 ELLESMERE PORT AND NESTON PCT 0 2.5 94.0 88.9 Q15 5J1 HALTON PCT 0 "1.3 96.0 89.5 Q15 5J4 KNOWSLEY PCT 0 "10.9 96.1 95.3 Q15 5G9 NORTH LIVERPOOL PCT 0 "8.5 95.1 97.3 Q15 5HC SOUTH LIVERPOOL PCT 0 "2.5 97.2 91.5 Q15 5M5 SOUTH SEFTON PCT 0 "3.0 94.0 97.5 Q15 5F9 SOUTHPORT AND FORMBY PCT 0 2.5 98.0 94.2 3178271188 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 325
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q15 5J3 ST HELENS PCT 0 "6.0 97.2 93.8 Q15 5J2 WARRINGTON PCT 0 "0.4 95.4 84.9 Q16 5G2 BRACKNELL FOREST PCT 0 2.7 96.8 99.6 Q16 5DV CHERWELL VALE PCT (4) "3.1 96.6 99.7 Q16 5G4 CHILTERN AND SOUTH BUCKS PCT (1) 3.7 97.1 98.1 Q16 5CQ MILTON KEYNESPCT (5) "0.5 96.4 95.6 Q16 5DK NEWBURY AND COMMUNITY PCT (0) "2.1 97.2 98.7 Q16 5DT NORTH EAST OXFORDSHIRE PCT (2) "1.6 96.6 99.0 Q16 5DW OXFORD CITY PCT 1 13.4 96.6 98.8 Q16 5DL READING PCT 0 0.1 97.2 99.7 Q16 5DM SLOUGH PCT 0 "4.3 96.8 100.0 Q16 5DX SOUTH EAST OXFORDSHIRE PCT 0 "0.3 96.9 99.0 Q16 5DY SOUTH WEST OXFORDSHIRE PCT (5) 0.4 96.6 99.1 Q16 5DP VALE OF AYLESBURY PCT (5) "0.4 97.2 97.2 Q16 5G3 WINDSOR, ASCOT AND MAIDENHEAD PCT 0 6.8 96.8 99.7 Q16 5DN WOKINGHAM PCT 0 0.6 97.2 99.7 Q16 5G5 WYCOMBE PCT (0) 0.1 97.2 97.4 Q17 5G6 BLACKWATER VALLEY AND HART PCT (3) 0.3 96.0 98.4 Q17 5FD EAST HAMPSHIRE PCT (5) 1.6 96.0 99.3 Q17 5LY EASTLEIGH AND TEST VALLEY SOUTH PCT (1) 0.2 96.5 88.7 Q17 5LX FAREHAM AND GOSPORT PCT (7) 0.7 96.0 98.0 Q17 5DG ISLE OF WIGHT PCT (0) "1.2 96.0 94.4 Q17 5E9 MID"HAMPSHIRE PCT (1) 6.0 96.8 91.4 Q17 5A1 NEW FOREST PCT (9) 2.5 96.6 89.6 Q17 5DF NORTH HAMPSHIRE PCT (1) 6.4 96.3 94.8 Q17 5FE PORTSMOUTH CITY TEACHING PCT 0 "1.7 96.0 98.9 Q17 5L1 SOUTHAMPTON CITY PCT 0 "3.4 96.4 86.0 Q18 5LL ASHFORD PCT 0 0.2 96.8 93.9 Q18 5LM CANTERBURY AND COASTAL PCT (2) 1.3 96.8 93.2 Q18 5CM DARTFORD, GRAVESHAM AND SWANLEY PCT (1) 1.3 97.7 96.2 Q18 5LN EAST KENT COASTAL PCT 0 "2.4 96.8 92.7 Q18 5L2 MAIDSTONE WEALD PCT (4) 0.0 96.4 93.3 Q18 5L3 MEDWAY PCT (0) "3.8 97.7 95.3 Q18 5LP SHEPWAY PCT 0 "0.9 96.8 93.9 Q18 5FF SOUTH WEST KENT PCT 0 2.0 96.4 96.0 Q18 5L4 SWALE PCT (0) "5.4 97.7 93.9 Q19 5L8 ADUR, ARUN AND WORTHING PCT 4 "0.2 96.8 92.5 Q19 5FH BEXHILL AND ROTHER PCT 0 5.1 94.9 95.2 Q19 5LQ BRIGHTON AND HOVE CITY PCT 0 "0.2 95.8 88.4 Q19 5MA CRAWLEY PCT 0 "1.4 93.7 92.3 Q19 5KP EAST ELMBRIDGE AND MID SURREY PCT (3) 10.7 94.2 94.3 Q19 5KQ EAST SURREY PCT 0 5.6 93.7 93.5 Q19 5LR EASTBOURNE DOWNS PCT (1) 4.9 94.9 89.3 Q19 5L5 GUILDFORD AND WAVERLEY PCT (6) 8.0 96.2 98.0 Q19 5FJ HASTINGS AND ST LEONARDS PCT 1 "4.7 94.9 96.4 Q19 5MC HORSHAM AND CHANCTONBURY PCT 0 1.8 94.9 93.7 Q19 5FK MID"SUSSEX PCT 0 4.8 96.2 90.1 Q19 5L6 NORTH SURREY PCT 0 4.5 95.9 97.7 Q19 5L7 SURREY HEATH AND WOKING PCT 0 7.4 95.9 98.0 Q19 5LT SUSSEX DOWNS AND WEALD PCT (2) 0.4 95.7 91.5 Q19 5L9 WESTERN SUSSEX PCT 0 4.2 97.0 97.7 Q20 5FL BATH AND NORTH EAST SOMERSET PCT 0 0.5 97.9 81.2 Q20 5JF BRISTOL NORTH PCT 1 0.4 93.2 90.1 Q20 5JG BRISTOL SOUTH AND WEST PCT 0 3.4 95.6 89.0 Q20 5KW CHELTENHAM AND TEWKESBURY PCT 0 "3.1 97.4 98.2 Q20 5KY COTSWOLD AND VALE PCT (5) 7.3 97.4 96.4 Q20 5K4 KENNET AND NORTH WILTSHIRE PCT (10) 3.1 97.9 88.4 Q20 5M8 NORTH SOMERSET PCT (5) "5.8 97.2 90.5 Q20 5A3 SOUTH GLOUCESTERSHIRE PCT 1 0.1 92.4 88.4 Q20 5DJ SOUTH WILTSHIRE PCT (2) 4.2 96.6 97.0 Q20 5K3 SWINDON PCT 1 "0.5 97.8 94.5 Q20 5KX WEST GLOUCESTERSHIRE PCT (3) "0.5 97.4 97.3 Q20 5DH WEST WILTSHIRE PCT (3) "3.7 97.9 81.7 Q21 5KT CENTRAL CORNWALL PCT (5) 0.4 96.3 94.6 Q21 5FT EAST DEVON PCT 0 2.1 98.5 95.0 Q21 5FR EXETER PCT 0 0.5 98.5 95.5 Q21 5FV MID DEVON PCT 0 0.8 98.5 95.4 Q21 5KR NORTH AND EAST CORNWALL PCT (7) 0.8 95.4 94.8 Q21 5FQ NORTH DEVON PCT (5) 0.2 96.8 96.6 Q21 5F1 PLYMOUTH TEACHING PCT 0 2.1 95.0 94.0 Q21 5CV SOUTH HAMS AND WEST DEVON PCT 0 7.6 95.5 95.9 Q21 5FY TEIGNBRIDGE PCT 0 1.7 96.5 97.1 3178271189 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 326 Health Committee: Evidence
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q21 5CW TORBAY PCT 0 "4.0 96.5 96.7 Q21 5FM WEST OF CORNWALL PCT (6) "0.3 96.3 95.8 Q22 5CE BOURNEMOUTH TEACHING PCT 0 "0.5 97.0 98.8 Q22 5FX MENDIP PCT 0 "5.6 97.7 86.9 Q22 5CD NORTH DORSET PCT 1 4.6 96.6 98.5 Q22 5KV POOLE PCT 0 1.7 95.2 98.9 Q22 5FW SOMERSET COAST PCT 0 "6.0 97.9 98.7 Q22 5FN SOUTH AND EAST DORSET PCT (2) 1.1 96.0 99.0 Q22 5K1 SOUTH SOMERSET PCT 0 2.8 96.6 98.6 Q22 5FP SOUTH WEST DORSET PCT 1 "0.4 96.7 98.9 Q22 5K2 TAUNTON DEANE PCT 1 "1.1 97.7 99.2 Q23 5JE BARNSLEY PCT 0 "5.1 96.9 95.6 Q23 5CK DONCASTER CENTRAL PCT 1 "3.2 95.9 97.4 Q23 5EK DONCASTER EAST PCT 1 "1.1 95.9 98.3 Q23 5EL DONCASTER WEST PCT 0 "6.0 95.9 98.1 Q23 5EE NORTH SHEFFIELD PCT 0 "2.5 94.4 94.5 Q23 5H8 ROTHERHAM PCT 0 "2.5 96.5 97.3 Q23 5EP SHEFFIELD SOUTH WEST PCT 0 10.7 94.4 95.3 Q23 5EN SHEFFIELD WEST PCT 0 "0.3 94.4 94.5 Q23 5EQ SOUTH EAST SHEFFIELD PCT 0 3.2 94.4 94.4 Q24 5ED AMBER VALLEY PCT 0 "2.2 95.6 99.1 Q24 5FA ASHFIELD PCT 1 "8.8 98.0 100.0 Q24 5ET BASSETLAW PCT 0 "6.0 95.9 99.0 Q24 5EV BROXTOWE AND HUCKNALL PCT 0 0.7 95.4 100.0 Q24 5AL CENTRAL DERBY PCT 0 "0.4 95.6 98.4 Q24 5EA CHESTERFIELD PCT 0 "2.6 97.0 98.4 Q24 5H7 DERBYSHIRE DALES & SOUTH DERBYSHIRE PCT 0 "2.2 95.2 94.5 Q24 5H9 EAST LINCOLNSHIRE PCT (4) "3.0 96.5 99.4 Q24 5ER EREWASH PCT 0 "2.2 95.5 99.6 Q24 5EC GEDLING PCT 0 1.9 95.4 100.0 Q24 5EX GREATER DERBY PCT 0 "1.4 95.6 98.6 Q24 5HN HIGH PEAK AND DALESPCT 0 5.3 96.8 92.5 Q24 5D3 LINCOLNSHIRE SOUTH WEST TEACHING PCT 0 2.3 96.9 99.2 Q24 5AM MANSFIELD DISTRICT PCT 0 "6.0 98.0 99.9 Q24 5AP NEWARK AND SHERWOOD PCT 0 "4.1 98.0 99.9 Q24 5EG NORTH EASTERN DERBYSHIRE PCT 0 "6.0 97.2 98.8 Q24 5EM NOTTINGHAM CITY PCT 0 "1.9 95.4 100.0 Q24 5FC RUSHCLIFFE PCT 0 11.6 95.4 99.8 Q24 5D2 WEST LINCOLNSHIRE PCT 1 "2.6 96.5 99.5 Q25 5JC CHARNWOOD AND NW LEICESTERSHIRE PCT (1) 0.8 95.7 92.4 Q25 5AC DAVENTRY AND SOUTH NORTHAMPTONSHIRE PCT 0 0.5 94.1 95.7 Q25 5EY EASTERN LEICESTER PCT 0 "6.0 95.7 93.8 Q25 5JA HINCKLEY AND BOSWORTH PCT 0 "1.6 96.0 92.1 Q25 5EJ LEICESTER CITY WEST PCT (1) "1.7 95.7 93.3 Q25 5EH MELTON, RUTLAND AND HARBOROUGH PCT 0 3.6 95.7 93.0 Q25 5LW NORTHAMPTON PCT 0 "2.7 94.1 94.5 Q25 5LV NORTHAMPTONSHIRE HEARTLANDS PCT 0 "4.4 93.0 90.6 Q25 5JD SOUTH LEICESTERSHIRE PCT (1) 2.7 95.7 92.2 Q26 5DQ BURNTWOOD, LICHFIELD AND TAMWORTH PCT (2) "2.0 97.9 96.7 Q26 5MM CANNOCK CHASE PCT (1) "4.6 94.7 96.5 Q26 5ML EAST STAFFORDSHIRE PCT 0 "1.8 95.0 89.0 Q26 5HW NEWCASTLE"UNDER"LYME PCT (1) 0.3 94.7 95.9 Q26 5ME NORTH STOKE PCT (7) "3.4 94.7 96.0 Q26 5M2 SHROPSHIRE COUNTY PCT 1 0.0 97.0 93.7 Q26 5MF SOUTH STOKE PCT (2) "4.0 94.7 96.1 Q26 5MN SOUTH WESTERN STAFFORDSHIRE PCT (4) 2.3 94.7 97.0 Q26 5HR STAFFORDSHIRE MOORLANDS PCT (4) 1.6 94.7 91.4 Q26 5MK TELFORD AND WREKIN PCT 0 "6.0 96.8 91.9 Q27 5HV DUDLEY BEACON AND CASTLE PCT 3 "6.0 96.0 99.9 Q27 5HT DUDLEY SOUTH PCT 0 "2.0 96.0 100.0 Q27 5MY EASTERN BIRMINGHAM PCT 0 "6.0 95.7 100.0 Q27 5MX HEART OF BIRMINGHAM TEACHING PCT 9 "6.6 96.4 99.9 Q27 5MW NORTH BIRMINGHAM PCT (1) 4.8 97.9 100.0 Q27 5MG OLDBURY AND SMETHWICK PCT (0) "5.3 96.6 100.0 Q27 5MH ROWLEY REGISAND TIPTON PCT 0 "5.0 96.4 100.0 Q27 5D1 SOLIHULL PCT 0 2.2 95.4 99.9 Q27 5M1 SOUTH BIRMINGHAM PCT 0 1.5 96.7 100.0 Q27 5M3 WALSALL TEACHING PCT 2 "6.0 97.7 99.9 Q27 5MJ WEDNESBURY AND WEST BROMWICH PCT 1 "6.0 96.6 100.0 Q27 5MV WOLVERHAMPTON CITY PCT 0 "6.0 96.3 99.9 Q28 5MD COVENTRY TEACHING PCT 0 "4.8 95.8 99.0 Q28 5CN HEREFORDSHIRE PCT 0 "3.6 96.7 88.7 3178271190 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 327
SHA PCT PCT Name Under/(Over) 2005-06 Total 6 month Code Code spend against Closing Time in inpatient Revenue Resource DFT A & E (4 wait Limits hours) £ms
Q28 5MP NORTH WARWICKSHIRE PCT 0 "4.3 96.3 97.7 Q28 5MR REDDITCH AND BROMSGROVE PCT 0 "1.8 94.5 99.1 Q28 5M9 RUGBY PCT 0 8.7 95.8 98.7 Q28 5MQ SOUTH WARWICKSHIRE PCT 1 3.9 95.4 98.3 Q28 5MT SOUTH WORCESTERSHIRE PCT 0 "2.1 94.5 98.7 Q28 5DR WYRE FOREST PCT (2) "2.5 94.5 99.1 Totals (272)
Q (81) A list of those organisations that were in receipt of planned support to allow them to break-even at the end of 2004–05, include amounts. Historical context to see trend in planned support
Answer 1. A list is attached of organisations that recorded the receipt of planned support in their 2004–05 accounts. It shows that total planned support in 2004–05 was £603 million. 2. It is not possible to provide a historic trend for this data, because changes in reporting requirements means we do not have the data on a consistent basis.
NHS TRUSTS—FINANCIAL SUPPORT 2004–05
NHS Trusts £000s
RTV 5 BOROUGHS PARTNERSHIP NHS TRUST 1,153 REM AINTREE HOSPITALS NHS TRUST 3,200 RCF AIREDALE NHSTRUST 0 RTK ASHFORD AND ST PETER’S HOSPITALS NHS TRUST 13,000 RB1 AVON AMBULANCE SERVICE NHS TRUST 0 RVN AVON AND WILTSHIRE MHP NHS TRUST 1,200 RF4 BARKING, HAVERING AND REDBRIDGE HOSP NH” 0 RVL BARNET AND CHASE FARM HOSPITALS NHS TRUST 11,200 RRP BARNET, ENFIELD AND HARINGEY MH NHSTRUST” 4,100 RFF BARNSLEY HOSPITAL NHS FOUNDATION TRUST 0 RNJ BARTSAND THE LONDON NHSTRUST 0 RC1 BEDFORD HOSPITAL NHS TRUST 0 RV7 BEDFORDSHIRE & LUTON MH & SOC CARE NHS TRUST 0 RFU BEDSAND HERTSAMBULANCE AND PARAMEDIC TRUST 0 RWX BERKSHIRE HEALTHCARE NHS TRUST 0 RXT BIRMINGHAM AND SOLIHULL MH NHS TRUST 2,000 RQ3 BIRMINGHAM CHILDREN’S HOSPITAL NHS TRUST 0 RLU BIRMINGHAM WOMEN’SHEALTH CARE NHSTRUST 0 RXL BLACKPOOL, FYLDE AND WYRE HOSPS NHS TRUST” 0 RMC BOLTON HOSPITALS NHS TRUST 0 RXV BOLTON SALFORD AND TRAFFORD MH NHS TRUST 0 TAD BRADFORD DISTRICT CARE TRUST 0 RXH BRIGHTON AND SUSSEX UNIV HOSPS NHS TRUST 3,000 RG3 BROMLEY HOSPITALS NHS TRUST 0 RXQ BUCKINGHAMSHIRE HOSPITALS NHS TRUST 0 RWT BUCKINGHAMSHIRE MENTAL HEALTH NHS TRUST 1,700 RJF BURTON HOSPITALS NHS TRUST 0 RWY CALDERDALE AND HUDDERSFIELD NHS TRUST 209 RJX CALDERSTONES NHS TRUST 0 RGT CAMBRIDGE UNI HOSPITAL NHS FOUND TRUST 0 RT1 CAMBS & PETERBOROUGH MH PARTNERSHIP TRUST 0 TAF CAMDEN & ISLINGTON MH & SOCIAL CARE TRUST 1,000 RW3 CENT MANCHESTER/ MANCHESTER CHILD NHS TRUST 0 RV3 CENTRUSTAL AND NORTH WEST LONDON MH NHS TRUST 0 RQM CHELSEA AND WESTMINSTER HEALTHCARE TRUST 0 RXA CHESHIRE AND WIRRAL PARTNERSHIP NHS TRUST 0 RFS CHESTERFIELD ROYAL HOSPITAL NHS FOUND TRUST 0 RBV CHRISTIE HOSPITAL NHS TRUST 0 RLN CITY HOSPITALS SUNDERLAND NHS FOUND TRUST 0 REN CLATTERBRIDGE CENTRE FOR ONCOLOGY TRUST 0 3178271192 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 328 Health Committee: Evidence
NHS Trusts £000s
RXP CO DURHAM & DARLINGTON ACUTE HOSP NHS TRUST 0 RJ8 CORNWALL PARTNERSHIP NHS TRUST 0 RTC COUNTY DURHAM AND DARLINGTON PRIOR SRV T 0 RL6 COVENTRUSTY & WARWICKSHIRE AMBULANCE NHS TRUST 0 RE6 CUMBRIA AMBULANCE SERVICE NHS TRUST 0 RN7 DARTFORD AND GRAVESHAM NHS TRUST 0 RTG DERBY HOSPITALS NHS FOUNDATION TRUST 0 RXM DERBYSHIRE MENTAL HEALTH SERVICES NHS TRUST 0 RWV DEVON PARTNERSHIP NHS TRUST 0 RXE DONCASTER & SOUTH HUMBER H’CARE NHS TRUST 0 RHP DORSET AMBULANCE NHS TRUST 0 RDY DORSET HEALTHCARE NHS TRUST 0 RNA DUDLEY GROUP OF HOSPITALS NHS TRUST 0 RC3 EALING HOSPITAL NHS TRUST 0 RWH EAST AND NORTH HERTFORDSHIRE NHS TRUST 3,000 RMZ EAST ANGLIAN AMBULANCE NHS TRUST 0 RJN EAST CHESHIRE NHS TRUST 6,000 RVV EAST KENT HOSPITALS NHS TRUST 1,200 RTM EAST KENT NHS AND SC PARTNERSHIP TRUST 0 RXR EAST LANCASHIRE HOSPITALS NHS TRUST 5,000 RWK EAST LONDON AND THE CITY MH NHS TRUST 0 RV6 EAST MIDLANDS AMBULANCE SERVCE NHS TRUST 0 RA4 EAST SOMERSET NHS TRUST 0 RXD EAST SUSSEX COUNTY HEALTHCARE NHS TRUST 273 RXC EAST SUSSEX HOSPITALS NHS TRUST 0 RVR EPSOM AND ST HELIER UNI HOSPS NHS TRUST 4,600 RB4 ESSEX AMBULANCE SERVICE NHS TRUST 0 RDE ESSEX RIVERS HEALTHCARE NHS TRUST 13,972 RDU FRIMLEY PARK HOSPITAL NHS FOUND TRUST 0 RR7 GATESHEAD HEALTH NHS FOUNDATION TRUST 0 RLT GEORGE ELIOT HOSPITAL NHS TRUST 0 RB5 GLOUCESTERSHIRE AMBULANCE SERVICES NHST 0 RTE GLOUCESTERSHIRE HOSPITALS NHS FOUND TRUST 0 RTQ GLOUCESTERSHIRE PARTNERSHIP NHS TRUST 0 RJH GOOD HOPE HOSPITAL NHS TRUST 0 RP4 GREAT ORMOND ST HOSP FOR CHILDREN NHS TRUST 0 RMA GREATER MANCHESTER AMBULANCE NHS TRUST 0 RJ1 GUY’S AND ST THOMAS’ NHS FOUND TRUST 0 RQN HAMMERSMITH HOSPITALS NHS TRUST 0 RKD HAMPSHIRE AMBULANCE SERVICE NHS TRUST 2,000 RW1 HAMPSHIRE PARTNERSHIP NHS TRUST 0 RCD HARROGATE AND DISTRICT NHS FOUND TRUST 0 RR1 HEART OF ENGLAND NHSFOUNDATION TRUST 0 RD7 HEATHERWOOD AND WEXHAM PARK HOSPS TRUST 0 RL5 HEREFORD AND WORCESTER AMBULANCE NHS TRUST 0 RLQ HEREFORD HOSPITALS NHS TRUST 0 RWR HERTFORDSHIRE PARTNERSHIP NHS TRUST 0 RQQ HINCHINGBROOKE HEALTH CARE NHSTRUST 0 RWA HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST 2,000 RV9 HUMBER MENTAL HEALTH TEACHING NHSTRUST 0 RGQ IPSWICH HOSPITAL NHS TRUST 0 RR2 ISLE OF WIGHT HEALTHCARE NHS TRUST 5,400 RGP JAMESPAGET HEALTHCARE NHSTRUST 0 RPH KENT AMBULANCE NHSTRUST 0 RNQ KETTERING GENERAL HOSPITAL NHS TRUST 4,250 RJZ KING’S COLLEGE HOSPITAL NHS TRUST 0 RAX KINGSTON HOSPITAL NHS TRUST 0 RMD LANCASHIRE AMBULANCE SERVICE NHS TRUST 0 RW5 LANCASHIRE CARE NHS TRUST 0 RXN LANCASHIRE TEACHING HOSP NHS FOUND TRUST 1,500 RGD LEEDSMENTAL HEALTH TEACHING NHSTRUST 0 RR8 LEEDS TEACHING HOSPITALS NHS TRUST 8,800 RT5 LEICESTERSHIRE PARTNERSHIP NHS TRUST 0 RBX LINCOLNSHIRE AMBULANCE NHS TRUST 0 RP7 LINCOLNSHIRE PARTNERSHIP NHS TRUST 0 3178271193 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 329
NHS Trusts £000s
REP LIVERPOOL WOMEN’SNHSFOUND TRUST 0 RRU LONDON AMBULANCE SERVICE NHS TRUST 0 RC9 LUTON AND DUNSTABLE HOSPITAL NHS TRUST 0 RWF MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 9,700 TAE MANCHESTER MENTAL HLTH & SOCIAL CARE TRUST 6,322 RJ6 MAYDAY HEALTHCARE NHSTRUST 0 RPA MEDWAY NHSTRUST 0 RW4 MERSEY CARE NHS TRUST 0 RB6 MERSEY REGIONAL AMBULANCE SERVICE TRUST 0 RQ8 MID ESSEX HOSPITAL SERVICES NHS TRUST 1,000 RJD MID STAFFORDSHIRE GEN HOSPITALS TRUST 1,500 RXF MID YORKSHIRE HOSPITALS NHS TRUST 30,000 RD8 MILTON KEYNES GENERAL HOSPITAL NHS TRUST 2,900 RTX MORECAMBE BAY HOSPITALS NHS TRUST 0 RRD N ESSEX MENTAL HEALTH PARTNERSHIP NHS TRUST 0 RNP NEWC, N TYNESIDE AND N’THUMBERLND MH NHS TRUST 0 RTD NEWCASTLE UPON TYNE HOSPITALS NHS TRUST 3,000 RNH NEWHAM UNIVERSITY HOSPITAL NHS TRUST 0 RMY NORFOLK & WAVENEY MH PARTNERSHIP NHS TRUST 0 RM1 NORFOLK AND NORWICH UNI HOSP NHS TRUST 0 RVJ NORTH BRISTOL NHS TRUST 20,026 RWW NORTH CHESHIRE HOSPITALS NHS TRUST 7,931 RNL NORTH CUMBRIA ACUTE HOSPITALS NHS TRUST 3,829 RVK NORTH EAST AMBULANCE SERVICE NHS TRUST 0 RAT NORTH EAST LONDON MENTAL HEALTH NHS TRUST 2,700 RN5 NORTH HAMPSHIRE HOSPITALS NHS TRUST 2,575 RJL NORTH LINCOLNSHIRE AND GOOLE HOSPS NHS TRUST 0 RAP NORTH MIDDLESEX UNIVERSITY HOSP NHS TR 1,000 RLY NORTH STAFFS COMBINED HC NHS TRUST 0 RVW NORTH TEESAND HARTLEPOOL NHSTRUST 6,500 RV8 NORTH WEST LONDON HOSPITALS NHS TRUST 0 RW7 NORTH WEST SURREY MH NHS PARTNERSHIP TRUST 1,614 RNS NORTHAMPTON GENERAL HOSPITAL NHS TRUST 0 RP1 NORTHAMPTONSHIRE HEALTHCARE NHS TRUST 0 RBZ NORTHERN DEVON HEALTHCARE NHSTRUST 0 RM6 NORTHGATE AND PRUDHOE NHSTRUST 0 RTF NORTHUMBRIA HEALTH CARE NHSTRUST 0 RCS NOTTINGHAM CITY HOSPITAL NHS TRUST 0 RHA NOTTINGHAMSHIRE HEALTHCARE NHS TRUST 0 RNN NTH CUMBRIA MH AND LEARNING DISAB NHS TRUST 0 RBF NUFFIELD ORTHOPAEDIC CENTRE NHSTRUST 0 RHX OXFORD LEARNING DISABILITY NHS TRUST 0 RTH OXFORD RADCLIFFE HOSPITALS NHS TRUST 18,700 RNY OXFORDSHIRE AMBULANCE NHS TRUST 0 RNU OXFORDSHIRE MENTAL HEALTHCARE NHS TRUST 0 RPG OXLEASNHSTRUST 0 RGM PAPWORTH HOSPITAL NHS FOUNDATION TRUST 0 RW6 PENNINE ACUTE HOSPITALS NHS TRUST 3,500 RT2 PENNINE CARE NHSTRUST 0 RK9 PLYMOUTH HOSPITALS NHS TRUST 6,000 RD3 POOLE HOSPITAL NHS TRUST 0 RHU PORTSMOUTH HOSPITALS NHS TRUST 1,000 RQW PRINCESS ALEXANDRA HOSPITAL NHS TRUST 3,970 RG2 QUEEN ELIZABETH HOSPITAL NHS TRUST 4,473 RGZ QUEEN MARY’S SIDCUP NHS TRUST 0 RPC QUEEN VICTORIA HOSPITAL NHS FOUND TRUST 0 RFK QUEEN’S MEDICAL NOTTS UNI HOSP NHS TRUST 0 RL1 ROB JONESAND A HUNT ORTHOPAEDIC NHSTRUST 5,581 RH1 ROYAL BERKSHIRE AMBULANCE SERVICE TRUST 0 RHW ROYAL BERKSHIRE AND BATTLE HOSPS NHS TRUST 0 RDZ ROYAL BRNMTH AND CHRISTCRCH FOUN TRUST 0 RT3 ROYAL BROMPTON AND HAREFIELD NHSTRUST 0 REF ROYAL CORNWALL HOSPITALS NHS TRUST 26,377 RAL ROYAL FREE HAMPSTEAD NHS TRUST 7,000 RQ6 ROYAL LIVERPOOL BROADGREEN UNIV HOSP TRUST 2,643 3178271194 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 330 Health Committee: Evidence
NHS Trusts £000s
RBSROYAL LIVERPOOL CHILDRENSNHSTRUST 0 RBB ROYAL NAT HOSP RHEUM DISEASE NHS FOUN TRUST 0 RAN ROYAL NAT ORTHOPAEDIC HOSP NHS TRUST 0 RRJ ROYAL ORTHOPAEDIC HOSPITAL NHS TRUST 0 RA2 ROYAL SURREY COUNTY HOSPITAL NHS TRUST 6,540 RD1 ROYAL UNITED HOSPITAL BATH NHS TRUST 9,379 RPR ROYAL WEST SUSSEX NHS TRUST 0 RL4 ROYAL WOLVERHAMPTON HOSPITAL NHS TRUST 0 RM3 SALFORD ROYAL HOSPITALS NHS TRUST 0 RNZ SALISBURY HEALTH CARE NHS TRUST 0 RXK SANDWELL & WEST BIRMINGHAM HOSPS NHS TRUST 0 TAJ SANDWELL MENTAL HEALTH NHS & SOCIAL CARE NHS TRUST 0 RCC SCARBOROUGH AND NE YORKS NHS TRUST 1,800 TAH SHEFFIELD CARE TRUST 0 RCU SHEFFIELD CHILDREN’S NHS TRUST 0 RHQ SHEFFIELD TEACHING HOSP NHS FOUND TRUST 0 RK5 SHERWOOD FOREST HOSPITALS NHS TRUST 0 RXW SHREWSBURY & TELFORD HOSPITAL NHS TRUST 9,157 RH5 SOMERSET PARTNERSHIP NHS AND SOCIAL CARE TRUST 0 RA9 SOUTH DEVON HEALTH CARE NHS TRUST 0 RDR SOUTH DOWNS HEALTH NHS TRUST 0 RWN SOUTH ESSEX PARTNERSHIP NHS TRUST 0 RV5 SOUTH LONDON AND MAUDSLEY NHS TRUST 0 RM2 SOUTH MANCHESTER UNIV HOSP NHS TRUST 0 RW9 SOUTH OF TYNE AND WEARSIDE MH NHS TRUST 0 RRE SOUTH STAFFORDSHIRE HEALTHCARE NHS TRUST 0 RTR SOUTH TEES HOSPITALS NHS TRUST 12,000 RE9 SOUTH TYNESIDE NHS FOUNDATION TRUST 0 RJC SOUTH WARWICKSHIRE GEN HOSPS NHS TRUST 2,827 RXG SOUTH WEST YORKSHIRE MENTAL HEALTH NHS TRUST 0 RB8 SOUTH YORKSHIRE AMBULANCE SERVICE NHS TRUST 0 RHM SOUTHAMPTON UNIVERSITY HOSPS NHS TRUST 6,900 RAJ SOUTHEND HOSPITAL NHS TRUST 0 RVY SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST 9,372 RJ7 ST GEORGE’S HEALTHCARE NHS TRUST 0 RBN ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST 12,000 RJ5 ST MARY’S NHS TRUST 0 RB7 STAFFORDSHIRE AMBULANCE SERVICE TRUST 0 RT6 SUFFOLK MENTAL HEALTH PARTNERSHIP NHS TRUST 0 RPQ SURREY AMBULANCE SERVICE NHS TRUST 0 RTP SURREY AND SUSSEX HEALTHCARE NHS TRUST 1,719 RTJ SURREY HAMPSHIRE BORDERS NHS TRUST 0 RTN SURREYOAKLANDSNHSTRUST 700 RQ2 SUSSEX AMBULANCE SERVICE NHS TRUST 0 RQY SW LONDON AND ST GEORGE’S MENTAL HLTH TRUST 0 RN3 SWINDON AND MARLBOROUGH NHS TRUST 0 RMP TAMESIDE AND GLOSSOP ACUTE SERVS NHS TRUST 0 RBA TAUNTON AND SOMERSET NHS TRUST 0 RNK TAVISTOCK AND PORTMAN NHS TRUST 0 RVX TEES AND NORTH EAST YORKSHIRE NHS TRUST 0 RV1 TEES EAST AND NTH YORKSHRE AMB SERV NHS TRUST 2,600 RBQ THE CARDIOTHORACIC CNTR—LIVERPOOL NHST 0 RAS THE HILLINGDON HOSPITAL NHS TRUST 0 RJ2 THE LEWISHAM HOSPITAL NHS TRUST 0 RBT THE MID CHESHIRE HOSPITALS NHS TRUST 2,100 RCX THE QUEEN ELIZ HOSP KING’S LYNN NHS TRUST 0 RFR THE ROTHERHAM NHSFOUNDATION TRUST 0 RKE THE WHITTINGTON HOSPITAL NHS TRUST 6,000 RM4 TRAFFORD HEALTHCARE NHSTRUST 2,989 RHY TWO SHIRES AMBULANCE NHS TRUST 0 RRV UNI COLL LONDON HOSP NHS FOUND TRUST 0 RRK UNI HOSPITAL BIRMINGHAM NHS FOUND TRUST 0 RA7 UNITED BRISTOL HEALTHCARE NHS TRUST 0 RWD UNITED LINCOLNSHIRE HOSPITALS NHS TRUST 5,650 RJE UNIV HOSP NORTH STAFFORDSHIRE NHS TRUST 0 3178271195 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 331
NHS Trusts £000s
RWE UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST 0 RKB UNIVERSITY HOSPSITALS COVENTRY & WARWICKSHIRE NHS TRUST 0 RBK WALSALL HOSPITALS NHS TRUST 0 RET WALTON NEUROLOGY CENTRE NHSTRUST 0 RBD WEST DORSET GENERAL HOSPITALS NHS TRUST 0 RWG WEST HERTFORDSHIRE HOSPITALS NHS TRUST 0 RXJ WEST KENT NHS AND SOCIAL CARE TRUST 0 RKL WEST LONDON MENTAL HEALTH NHS TRUST 0 RFW WEST MIDDLESEX UNIVERSITY HOSP NHS TRUST 0 RKA WEST MIDLANDS AMBULANCE SERVICE NHS TRUST 0 RGR WEST SUFFOLK HOSPITALS NHS TRUST 0 RW8 WEST SUSSEX HEALTH AND SOCIAL CARE NHS TRUST 0 RGH WEST YORKSHIRE AMBULANCE SERVICE TRUST 4,127 RJ9 WESTCOUNTRY AMBULANCE SERVICES NHS TRUST 468 RA3 WESTON AREA HEALTH NHS TRUST 0 RGC WHIPPS CROSS UNIVERSITY HOSP NHS TRUST 568 RHR WILTSHIRE AMBULANCE SERVICE NHS TRUST 0 RN1 WINCHESTER AND EASTLEIGH HLTHCRE NHS TRUST 2,678 RBL WIRRAL HOSPITAL NHS TRUST 5,400 RWP WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST 5,000 RWQ WORCESTERSHIRE MH PARTNERSHIP NHS TRUST 1,450 RPL WORTHING AND SOUTHLANDS HOSPITALS TRUST 2,000 RRF WRIGHTINGTON, WIGAN AND LEIGH NHSTRUST 0 RCB YORK HOSPITALS NHS TRUST 0 Totals (England) 393,022
Source: Audited NHSTrust summarisation schedules 2004–05.
Notes: 1. Figures from NHSfoundation trusts are not included.
PRIMARY CARE TRUSTS—FINANCIAL SUPPORT 2004–05
Primary Care Trust £000s
5L8 ADUR, ARUN AND WORTHING PCT 0 5AW AIREDALE PCT 0 5ED AMBER VALLEY PCT 0 5FA ASHFIELD PCT 0 5LL ASHFORD PCT 0 5HG ASHTON, LEIGH AND WIGAN PCT 0 5C2 BARKING AND DAGENHAM PCT 0 5A9 BARNET PCT 0 5JE BARNSLEY PCT 6,150 5GR BASILDON PCT 843 5ET BASSETLAW PCT 0 5FL BATH AND NORTH EAST SOMERSET PCT 0 5F8 BEBINGTON AND WEST WIRRAL PCT 0 5GD BEDFORD PCT 0 5GE BEDFORDSHIRE HEARTLANDS PCT 0 5FH BEXHILL AND ROTHER PCT 0 TAK BEXLEY CARE TRUST 5GP BILLERICAY, BRENTWOOD AND WICKFORD PCT 0 5H2 BIRKENHEAD AND WALLASEY PCT 600 5CC BLACKBURN WITH DARWEN PCT 0 5HP BLACKPOOL PCT 0 5G6 BLACKWATER VALLEY AND HART PCT 1,000 5HQ BOLTON PCT 0 5CE BOURNEMOUTH TEACHING PCT 0 5G2 BRACKNELL FOREST PCT 0 5CF BRADFORD CITY TEACHING PCT 0 5CG BRADFORD SOUTH AND WEST PCT 0 5K5 BRENT TEACHING PCT 0 5LQ BRIGHTON AND HOVE CITY PCT 0 3178271196 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 332 Health Committee: Evidence
Primary Care Trust £000s
5JF BRISTOL NORTH PCT 0 5JG BRISTOL SOUTH AND WEST PCT 3,875 5JL BROADLAND PCT 1,756 5A7 BROMLEY PCT 0 5EV BROXTOWE AND HUCKNALL PCT 0 5G8 BURNLEY, PENDLE AND ROSSENDALE PCT 650 5DQ BURNTWOOD, LICHFIELD AND TAMWORTH PCT 0 5JX BURY PCT 0 5J6 CALDERDALE PCT 500 5JH CAMBRIDGE CITY PCT 0 5K7 CAMDEN PCT 0 5MM CANNOCK CHASE PCT 800 5LM CANTERBURY AND COASTAL PCT 0 5D4 CARLISLE AND DISTRICT PCT 14,951 5JP CASTLE POINT AND ROCHFORD PCT 0 5H4 CENTRAL CHESHIRE PCT 0 5KT CENTRAL CORNWALL PCT 1,518 5AL CENTRAL DERBY PCT 0 5HA CENTRAL LIVERPOOL PCT 0 5CL CENTRAL MANCHESTER PCT 0 5JT CENTRAL SUFFOLK PCT 1,000 5JC CHARNWOOD AND NW LEICESTERSHIRE PCT 750 5JN CHELMSFORD PCT 4,065 5KW CHELTENHAM AND TEWKESBURY PCT 0 5DV CHERWELL VALE PCT 0 5H3 CHESHIRE WEST PCT 3,513 5EA CHESTERFIELD PCT 0 5G4 CHILTERN AND SOUTH BUCKS PCT 0 5F2 CHORLEY AND SOUTH RIBBLE PCT 0 5C3 CITY AND HACKNEY TEACHING PCT 0 5GM COLCHESTER PCT 0 5KY COTSWOLD AND VALE PCT 0 5MD COVENTRY TEACHING PCT 0 5KJ CRAVEN, HARROGATE AND RURAL DISTRICT PCT 0 5MA CRAWLEY PCT 247 5K9 CROYDON PCT 0 5GW DACORUM PCT 0 5J9 DARLINGTON PCT 0 5CM DARTFORD, GRAVESHAM AND SWANLEY PCT 0 5AC DAVENTRY AND SOUTH NORTHAMPTONSHIRE PCT 500 5H7 DERBYSHIRE DALES & SOUTH DERBYSHIRE PCT 0 5KA DERWENTSIDE PCT 0 5CK DONCASTER CENTRAL PCT 0 5EK DONCASTER EAST PCT 0 5EL DONCASTER WEST PCT 0 5HV DUDLEY BEACON AND CASTLE PCT 1,347 5HT DUDLEY SOUTH PCT 827 5KC DURHAM AND CHESTER-LE-STREET PCT 0 5J8 DURHAM DALESPCT 0 5HX EALING PCT 0 5KD EASINGTON PCT 0 5JK EAST CAMBRIDGESHIRE AND FENLAND PCT 0 5FT EAST DEVON PCT 0 5KP EAST ELMBRIDGE AND MID SURREY PCT 0 5FD EAST HAMPSHIRE PCT 1,250 5LN EAST KENT COASTAL PCT 0 5HK EAST LEEDS PCT 0 5H9 EAST LINCOLNSHIRE PCT 4,500 5ML EAST STAFFORDSHIRE PCT 0 5KQ EAST SURREY PCT 0 5E3 EAST YORKSHIRE PCT 0 5LR EASTBOURNE DOWNS PCT 0 5MY EASTERN BIRMINGHAM PCT 0 5H5 EASTERN CHESHIRE PCT 0 5E5 EASTERN HULL PCT 0 3178271197 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 333
Primary Care Trust £000s
5EY EASTERN LEICESTER PCT 0 5E7 EASTERN WAKEFIELD PCT 3,150 5LY EASTLEIGH AND TEST VALLEY SOUTH PCT 1,000 5D5 EDEN VALLEY PCT 5,838 5H6 ELLESMERE PORT AND NESTON PCT 2,700 5C1 ENFIELD PCT 0 5AJ EPPING FOREST PCT 0 5ER EREWASH PCT 0 5FR EXETER PCT 0 5LX FAREHAM AND GOSPORT PCT 1,250 5HE FYLDE PCT 0 5KF GATESHEAD PCT 0 5EC GEDLING PCT 0 5GT GREAT YARMOUTH PCT 901 5EX GREATER DERBY PCT 0 5A8 GREENWICH TEACHING PCT 0 5L5 GUILDFORD AND WAVERLEY PCT 0 5J1 HALTON PCT 1,300 5KH HAMBLETON AND RICHMONDSHIRE PCT 0 5H1 HAMMERSMITH AND FULHAM PCT 0 5C9 HARINGEY TEACHING PCT 0 5DC HARLOW PCT 0 5K6 HARROW PCT 0 5D9 HARTLEPOOL PCT 4,300 5FJ HASTINGS AND ST LEONARDS PCT 0 5A4 HAVERING PCT 0 5MX HEART OF BIRMINGHAM TEACHING PCT 0 5CN HEREFORDSHIRE PCT 0 5CP HERTSMERE PCT 0 5F4 HEYWOOD AND MIDDLETON PCT 0 5HN HIGH PEAK AND DALESPCT 1,795 5AT HILLINGDON PCT 0 5JA HINCKLEY AND BOSWORTH PCT 0 5MC HORSHAM AND CHANCTONBURY PCT 469 5HY HOUNSLOW PCT 0 5LJ HUDDERSFIELD CENTRAL PCT 1,250 5GF HUNTINGDONSHIRE PCT 0 5G7 HYNDBURN AND RIBBLE VALLEY PCT 0 5JQ IPSWICH PCT 2,184 5DG ISLE OF WIGHT PCT 1,000 5K8 ISLINGTON PCT 0 5K4 KENNET AND NORTH WILTSHIRE PCT 2,875 5LA KENSINGTON AND CHELSEA PCT 0 5A5 KINGSTON PCT 0 5J4 KNOWSLEY PCT 0 5LD LAMBETH PCT 0 5KN LANGBAURGH PCT 0 5HJ LEEDSNORTH EASTPCT 1,300 5HM LEEDSNORTH WESTPCT 0 5HH LEEDSWESTPCT 0 5EJ LEICESTER CITY WEST PCT 0 5LF LEWISHAM PCT 0 5D3 LINCOLNSHIRE SOUTH WEST TEACHING PCT 0 5GC LUTON PCT 0 5L2 MAIDSTONE WEALD PCT 0 5GL MALDON AND SOUTH CHELMSFORD PCT 1,705 5AM MANSFIELD DISTRICT PCT 0 5L3 MEDWAY PCT 0 5EH MELTON, RUTLAND AND HARBOROUGH PCT 0 5FX MENDIP PCT 2,700 5FV MID DEVON PCT 0 5KM MIDDLESBROUGH PCT 0 5E9 MID-HAMPSHIRE PCT 1,500 5FK MID-SUSSEX PCT 0 5CQ MILTON KEYNESPCT 2,000 3178271199 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 334 Health Committee: Evidence
Primary Care Trust £000s
5DD MORECAMBE BAY PCT 14,000 5A1 NEW FOREST PCT 3,500 5AP NEWARK AND SHERWOOD PCT 0 5DK NEWBURY AND COMMUNITY PCT 0 5D7 NEWCASTLE PCT 0 5HW NEWCASTLE-UNDER-LYME PCT 0 5C5 NEWHAM PCT 0 5KR NORTH AND EAST CORNWALL PCT 1,198 5MW NORTH BIRMINGHAM PCT 0 5CH NORTH BRADFORD PCT 0 5FQ NORTH DEVON PCT 0 5CD NORTH DORSET PCT 0 5AN NORTH EAST LINCOLNSHIRE PCT 0 5DT NORTH EAST OXFORDSHIRE PCT 0 5EG NORTH EASTERN DERBYSHIRE PCT 0 5DF NORTH HAMPSHIRE PCT 2,306 5GH NORTH HERTFORDSHIRE AND STEVENAGE PCT 0 5J7 NORTH KIRKLEESPCT 0 5EF NORTH LINCOLNSHIRE PCT 1,500 5G9 NORTH LIVERPOOL PCT 0 5CR NORTH MANCHESTER PCT 0 5JM NORTH NORFOLK PCT 1,685 5AF NORTH PETERBOROUGH PCT 0 5EE NORTH SHEFFIELD PCT 6,300 5M8 NORTH SOMERSET PCT 0 5ME NORTH STOKE PCT 0 5L6 NORTH SURREY PCT 0 5E1 NORTH TEESPCT 1,000 5D8 NORTH TYNESIDE PCT 2,300 5MP NORTH WARWICKSHIRE PCT 0 5LW NORTHAMPTON PCT 0 5LV NORTHAMPTONSHIRE HEARTLANDS PCT 0 TAC NORTHUMBERLAND CARE TRUST 4,500 5A2 NORWICH PCT 3,862 5EM NOTTINGHAM CITY PCT 0 5MG OLDBURY AND SMETHWICK PCT 0 5J5 OLDHAM PCT 0 5DW OXFORD CITY PCT 0 5F1 PLYMOUTH TEACHING PCT 0 5KV POOLE PCT 0 5FE PORTSMOUTH CITY TEACHING PCT 500 5HD PRESTON PCT 0 5DL READING PCT 0 5NA REDBRIDGE PCT 3,500 5MR REDDITCH AND BROMSGROVE PCT 0 5M6 RICHMOND AND TWICKENHAM PCT 0 5JY ROCHDALE PCT 0 5H8 ROTHERHAM PCT 1,150 5MH ROWLEY REGISAND TIPTON PCT 0 5GK ROYSTON BUNTNGFRD & BISHPS STRTFORD PCT 0 5M9 RUGBY PCT 0 5FC RUSHCLIFFE PCT 0 5F5 SALFORD PCT 0 5KK SCARBOROUGH, WHITBY AND RYEDALE PCT 0 5KE SEDGEFIELD PCT 0 5E2 SELBY AND YORK PCT 0 5EP SHEFFIELD SOUTH WEST PCT 2,900 5EN SHEFFIELD WEST PCT 3,900 5LP SHEPWAY PCT 0 5M2 SHROPSHIRE COUNTY PCT 0 5DM SLOUGH PCT 0 5D1 SOLIHULL PCT 500 5FW SOMERSET COAST PCT 0 5FN SOUTH AND EAST DORSET PCT 0 5M1 SOUTH BIRMINGHAM PCT 0 3178271200 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 335
Primary Care Trust £000s
5JJ SOUTH CAMBRIDGESHIRE PCT 0 5GJ SOUTH EAST HERTFORDSHIRE PCT 0 5DX SOUTH EAST OXFORDSHIRE PCT 0 5EQ SOUTH EAST SHEFFIELD PCT 7,700 5A3 SOUTH GLOUCESTERSHIRE PCT 1,135 5CV SOUTH HAMS AND WEST DEVON PCT 0 5LK SOUTH HUDDERSFIELD PCT 1,400 5HL SOUTH LEEDS PCT 0 5JD SOUTH LEICESTERSHIRE PCT 500 5HC SOUTH LIVERPOOL PCT 2,898 5AA SOUTH MANCHESTER PCT 9,986 5AG SOUTH PETERBOROUGH PCT 0 5M5 SOUTH SEFTON PCT 0 5K1 SOUTH SOMERSET PCT 0 5MF SOUTH STOKE PCT 0 5KG SOUTH TYNESIDE PCT 0 5MQ SOUTH WARWICKSHIRE PCT 0 5FP SOUTH WEST DORSET PCT 0 5FF SOUTH WEST KENT PCT 0 5DY SOUTH WEST OXFORDSHIRE PCT 0 5MN SOUTH WESTERN STAFFORDSHIRE PCT 700 5DJ SOUTH WILTSHIRE PCT 0 5MT SOUTH WORCESTERSHIRE PCT 4,414 5L1 SOUTHAMPTON CITY PCT 1,500 5AK SOUTHEND ON SEA PCT 0 5G1 SOUTHERN NORFOLK PCT 2,622 5F9 SOUTHPORT AND FORMBY PCT 0 5LE SOUTHWARK PCT 0 5GX ST ALBANS AND HARPENDEN PCT 0 5J3 ST HELENS PCT 0 5HR STAFFORDSHIRE MOORLANDS PCT 0 5F7 STOCKPORT PCT 1,019 5JR SUFFOLK COASTAL PCT 1,700 5JW SUFFOLK WEST PCT 0 5KL SUNDERLAND TEACHING PCT 0 5L7 SURREY HEATH AND WOKING PCT 0 5LT SUSSEX DOWNS AND WEALD PCT 0 5M7 SUTTON AND MERTON PCT 0 5L4 SWALE PCT 0 5K3 SWINDON PCT 3,901 5LH TAMESIDE AND GLOSSOP PCT 0 5K2 TAUNTON DEANE PCT 0 5FY TEIGNBRIDGE PCT 0 5MK TELFORD AND WREKIN PCT 0 5AH TENDRING PCT 0 5GQ THURROCK PCT 0 5CW TORBAY PCT 0 5C4 TOWER HAMLETSPCT 0 5F6 TRAFFORD NORTH PCT 0 5CX TRAFFORD SOUTH PCT 0 5GN UTTLESFORD PCT 0 5DP VALE OF AYLESBURY PCT 0 5E8 WAKEFIELD WEST PCT 500 5M3 WALSALL TEACHING PCT 0 5NC WALTHAM FOREST PCT 0 5LG WANDSWORTH PCT 0 5J2 WARRINGTON PCT 0 5GV WATFORD AND THREE RIVERSPCT 0 5JV WAVENEY PCT 1,000 5MJ WEDNESBURY AND WEST BROMWICH PCT 0 5GG WELWYN HATFIELD PCT 0 5D6 WEST CUMBRIA PCT 11,919 5KX WEST GLOUCESTERSHIRE PCT 0 5E6 WEST HULL PCT 0 5F3 WEST LANCASHIRE PCT 0 3178271201 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Primary Care Trust £000s
5D2 WEST LINCOLNSHIRE PCT 0 5CY WEST NORFOLK PCT 813 5FM WEST OF CORNWALL PCT 1,284 5DH WEST WILTSHIRE PCT 1,809 5L9 WESTERN SUSSEX PCT 0 5LC WESTMINSTER PCT 0 5G3 WINDSOR, ASCOT AND MAIDENHEAD PCT 0 TAG WITHAM, BRAINTRUSTEE AND HALSTEAD CARE TRUST 2,270 5DN WOKINGHAM PCT 0 5MV WOLVERHAMPTON CITY PCT 0 5G5 WYCOMBE PCT 0 5DR WYRE FOREST PCT 0 5HF WYRE PCT 0 5E4 YORKSHIRE WOLDS AND COAST PCT 0 Total (England) 203,530
Source: Audited Primary Care Trust Summarisation schedules 2004–05
STRATEGIC HEALTH AUTHORITIES—FINANCIAL SUPPORT 2004–05
Strategic Health Authority £000s
AVON, GLOUCESTERSHIRE AND WILTSHIRE SHA 0 BEDFORDSHIRE AND HERTFORDSHIRE SHA 0 BIRMINGHAM AND THE BLACK COUNTRY SHA 0 CHESHIRE & MERSEYSIDE STRATEGIC HA 0 COUNTY DURHAM AND TEESVALLEY SHA 0 CUMBRIA AND LANCASHIRE STRATEGIC HA 0 DORSET AND SOMERSET STRATEGIC HA 0 ESSEX STRATEGIC HA 636 GREATER MANCHESTER STRATEGIC HA 0 HAMPSHIRE AND ISLE OF WIGHT STRATEGIC HA 0 KENT AND MEDWAY STRATEGIC HA 0 LEICS, NORTHANTS AND RUTLAND SHA 0 NORFOLK, SUFFOLK AND CAMBRIDGESHIRE SHA 0 NORTH & EAST YORKSHIRE & N LINCS SHA 0 NORTH CENTRAL LONDON STRATEGIC HA 0 NORTH EAST LONDON STRATEGIC HA 0 NORTH WEST LONDON STRATEGIC HA 0 NORTHUMBERLAND, TYNE & WEAR STRATEGIC HA 0 SHROPSHIRE AND STAFFORDSHIRE SHA 0 SOUTH EAST LONDON STRATEGIC HA 0 SOUTH WEST LONDON STRATEGIC HA 2,284 SOUTH WEST PENINSULA STRATEGIC HA 0 SOUTH YORKSHIRE STRATEGIC HA 0 SURREY AND SUSSEX STRATEGIC HA 0 THAMESVALLEY STRATEGICHA 0 TRENT STRATEGIC HA 0 WEST MIDLANDS SOUTH STRATEGIC HA 3,900 WEST YORKSHIRE STRATEGIC HA 0 Total 6,820
Source: Audited strategic health authority summarisation forms 2004–05.
Q (84) A note of how the 2004-05 £250 million net deficit was covered by DH—a list of the major items was requested
Answer 1. One major saving was used to balance the 2004–05 DH overall revenue financial position (central and NHS). The NHS Litigation Authority (NHSLA) declared a £375 million saving on provisions for clinical negligence. The NHSLA is funded from a central budget. This saving contributed to a circa £200 million overall central underspend. At provisional outturn (based on Month 12 financial monitoring data) this 3178271203 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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central underspend oVset the NHSdeficit of £140 million and gave an overall 2004–05 DH revenue underspend of circa £60 million. In addition to this underspend, there was a further £1.4 billion reduction to the NHSLA position resulting from an accounting change to the calculation of provisions. This was a technical adjustment and was not available for spending on patient care. 2. The additional £110 million NHSdeficit in final accounts indicates that w e owe resources to HM Treasury in 2006–07 based on current arrangements for End Year Flexibility (EYF) and after an adjustment for the NHSLA accounting change. This will be funded by the recovery (in 2006–07) of the £110m additional deficit from the NHS. Nevertheless, we did not exceed our financial controls in 2004–05, ie the Parliamentary Estimates and HMT DEL.
Q (87) Q 3.8.11
Answer 1. The data requested is shown in the accompanying table and charts.
TRENDS IN KEY ACTIVITY AND WAITING FIGURES—PROVIDER BASED
1988–89 1998–99 2004–05 (000s) (000s) (000s) Decisions to admit 2,783 4,189 3,788 Number on waiting list 923 1,298 822 Total admissions 2,632 3,827 3,391 Ordinary admissions 1,880 1,370 1,226 Day case admissions 752 2,457 2,165 Outpatient 1st attendances 8,389 11,778 13,370 Outpatient total attendances 36,118 42,154 44,748 Procedures in Outpatients n/a n/a 2,073 Procedures in Primary Care n/a n/a 638 Removals from list 201 672 612 Self deferrals 49 379 259
Trend in key waiting list figures - 1988 to present
4,500
4,000
3,500
3,000
2,500
2,000 No of patients No of
1,500
1,000
500
0 1988/89 (000s) 1998/99 (000s) 2004/05 (000s) Year
Decisions to admit Number on waiting list Total admissions Removals from list Self deferrals 3178271203 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Inpatient waiting times by timeband (commissioner-based), March 2000 - present
350,000 Target: No one Target: No one Target: No one Target: No one waiting more than waiting more than waiting more than waiting more than 15 months at Mar 12 months at Mar 9 months at Mar 6 months by Dec 2002 2003 2004 2005 300,000
250,000
200,000
150,000 Number of patients of patients Number
100,000
50,000
0 Mar-00 Mar-01 Mar-02 Mar-03 Mar-04 Mar-05 Dec-05
People waiting 6 months or more People waiting 9 months or more
People waiting 12 months or more People waiting 15 months or more
Inpatient waiting list 1997-present
1400000
1300000
1200000
1100000
1000000 No on waiting list on waiting No 900000
800000
700000
600000
99 02 001 0 1999 2000 2002 2002 2004 2004 v v y 2003 v 2003 v v 2005 o ov 2000 ug 2 o eb 2003 ug 2003o o Mar 1997Dec 1997May 1998Aug 1998Nov 1998Feb 19May 1999Aug 1999N Feb 2000May Aug 2000N Feb 2001May 2001A Nov 2001Feb May 2 Aug 2002N F Ma A N Feb 2004May Aug 2004No Feb 2005May 2005Aug 2005N Month
2. In brief the charts and table show that: all the measures of inpatient waiting and activity showed a sharp increase between 1988 and 1998, followed by a steady fall to the year 2005. All these measures are consistent with each other; the number on the waiting list peaked at 1,313,000 in April 1998 before falling to 822,000 in March 2005; the number of decisions to admit for inpatient treatment per year rose from around 2.8 million in 1988 to 4.2 million in 1998, before falling back to 3.8 million in 2005. The recent fall reflects the fact that more patients are now treated in an outpatient setting, rather than being admitted as inpatients (see table); the number of admissions from the waiting list rose in line with decisions to admit, before falling back in line with the decrease in patients being added to the list; the number of removals from the list increased sharply up to 672,000 in 1998 before falling to 612,000 in 2005. The rise in the number of removals reflects improved NHSlis t management. This has now steadied, and the number of removals has fallen in line with the list size and number of decisions to admit; and similarly, the number of self-deferrals increased to 1998 and subsequently fell steadily to 2005. 3178271205 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Q (99); (276) and (283) NICE
Answer 1. The information requested is shown in Table 3.5.2(a) and 3.5.2(b). Table 3.5.2(a) shows Technology Appraisals and 3.5.2(b) published Clinical Guidelines.
Technology Appraisals 2. Technology appraisal guidance is guidance on specific health interventions, including pharmaceuticals and devices. 3. The estimated full-year costs of all NICE appraisal guidance issued so far amount to some £759 million for England & Wales. 4. In some cases the financial impact on the NHSmay build up gradually over a n umber of years, for instance where infrastructure changes are needed to put the recommendations into full eVect. 5. In addition, there will be some costs arising out of appraisals due to be completed during the current year. 6. There are a number of Technology Appraisals for which there are a range of costs. For the purposes of the schedule a mid point has been taken.
Clinical Guidelines 7. Clinical guidelines is guidance on the management of particular clinical conditions, which can be the overall care pathway for a condition/disease, or a specific care pathway for a subgroup of patients within a disease group 8. Work on developing robust costings for clinical guidelines began in 2004 and is still under development.
Topic Selection Process 9. We recognise that the current process for topic selection is too long. It has grown up over time and we are currently reviewing its working especially the time taken to refer topics to NICE and the involvement of the NHS. 10. The proposals we are currently discussing should give us a faster referral process and facilitate better engagement of the NHSin generating ideas for referral. It will also cover p ublic health. 11. Typically, the timescale for referral of appraisal topics to NICE for consultation on their remit and scope is in the region of nine to 12 months from consideration by the Advisory Committee on Topic Selection (ACTS). 12. For example in the 11th Wave, which represents a typical Wave, the average time from consideration to referral was a little over nine months. The Wave consisted of eight technology appraisals with four being referred to NICE, for them to begin preliminary work, within four months of being considered by ACTS. Full details for the 11th Wave are in the table below:
Referral to NICE for Considered Considered preliminary Topic by ACTS by JPGwork Comments Gemcitabine 28/01/04 30/06/04 25/08/04 Stapled haemorrhoidectomy 28/01/04 30/06/04 25/08/04 Docetaxal and paclitaxel 14/04/04 30/06/04 25/08/04 Rituximab 14/04/04 30/06/04 25/08/04 Cincacalcet 14/04/04 30/06/04 25/08/04 Drugs for pulmonary arterial hypertension 14/04/04 30/06/04 25/08/04 Ezetimibe 23/01/02 30/06/04 25/08/04 Place in treatment pathway initially unclear and referral was not considered appropriate. Scoping of the 8th Wave statins appraisal identified the need to appraise ezetimibe 3178271205 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Referral to NICE for Considered Considered preliminary Topic by ACTS by JPGwork Comments Erlotinib 02/04/03 25/11/03 and 25/08/04 Delays in licensing application 30/06/04 resulted in reconsideration.
13. The 12th Wave was not typical in that it contained of the outputs of four rather than two ACTS meetings and therefore the period between consideration and referral was generally longer—the average time was slightly over 14 months. Full details are shown in the table below:
Referral to NICE for Considered Considered preliminary Topic by ACTS by JPGwork Comments Herceptin 29/06/05 20/07/05 Considered directly by JPG Velcade 02/04/03 and 29/06/05 20/07/05 Reconsidered in light of 13/10/04 representations from manufacturer and patient group. Ruboxistaurin (LY333531) 02/09/03 25/11/03 and Delays in licensing 28/07/05 application resulted in reconsideration. Neuro-imaging in the 1st onset atypical psychosis 14/07/04 28/07/05 28/11/05 Cochlear implants 14/07/04 28/07/05 28/11/05 Rituximab and abatacept for refractory rheumatoid arthritis 14/07/04 28/07/05 28/11/05 New drugs for irritable bowel syndrome 14/07/04 28/07/05 28/11/05 Autologous tumour vaccine 13/10/04 28/07/05 28/11/05 Idaraparinux sodium for prevention of stroke 13/10/04 28/07/05 28/11/05 Idaraparinux sodium for recurrent venous 28/11/05 thromboembolism 13/10/04 28/07/05 28/11/05 Recumbinant factor Vlla 13/10/04 28/07/05 28/11/05 Rimonabant 13/10/04 28/07/05 28/11/05 Certolizumab pegol & natalizumab 13/10/04 28/07/05 28/11/05 Adalimumab and lefluomide 13/10/04 28/07/05 28/11/05 Sleep Apnoea 12/01/05 28/07/05 28/11/05 Varenicline 13/04/05 28/07/05 28/11/05 Alteplase 21/10/03 and 28/07/05 28/11/05 Initially deferred. 13/04/05
Funding for NICE Approved Treatments 14. PCTs are obliged to provide funding for any treatment that is recommended by NICE within three months of publication of the guidance (as per directions issued to the NHS). This applies to all recommendations. The diVerence between routine and selective approvals is that in the former, NICE will have recommended the treatment for use within the licensed indications the appraisal has considered, whereas in the latter NICE will only have recommended the treatment be used under certain conditions. However, should a patient fall into one of those certain conditions where the recommendations of NICE apply, then the PCT would have to provide funding for the treatment to be used. 15. It is important to note that Clinicians have to make an independent clinical judgement, taking due account of NICE’s advice and the strength of evidence which lies behind it. They may depart from the advice if in their view the circumstances of the individual patient justify doing so. But they will be held accountable (through clinical governance arrangements) for their clinical decisions. 3178271206 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Table 3.5.2(a)
ESTIMATED COSTS OF NICE GUIDANCE—TECHNOLOGY APPRAISALS (AS AT JULY 2005)
Routine/ Estimate full- selective/ year costs No. Title of guidance Date of Issue research(3) (England, £m) Comments
1 Wisdom Teeth March 2000 Selective "5.0 2 Hip Replacement April 2000 Selective "8.0 3 Taxanes for Ovarian May 2000 Selective 7.0 Cancer 4 Coronary Artery Stents May 2000 Selective 0.0 5 Liquid Based Cytology— June 2000 Research 0.0 cervical screening 6 Taxanes for Breast Cancer June 2000 Selective 16.0 7 Proton Pump Inhibitors July 2000 Selective "45.0 8 Hearing Aids July 2000 Selective 0.0 9 Rosiglitazone for Type 2 August 2000 Selective 0.0 Original estimate was 14.5, Diabetes but this was in eVect superseded by the later estimate for the two glitazones together in the pioglitazone appraisal. 10 Inhaler systems for under August 2000 Routine 0.0 5s 11 Implantable cardioverter September 2000 Selective 30.0 This assumes anoVset of defibrillators £15–20 million to gross costs of £45 million. 12 Glycoprotein IIb/IIIa September 2000 Routine 30.2 inhibitors 13 Methylphenidate for October 2000 Routine 44.0 NICE made separate ADHD estimates of the year 1 drug and associated running costs, and of the cost of initial assessment of potentially eligible patients. 14 Ribavirin and Interferon October 2000 Selective 17.3 £55 million spread over Alpha for Hepatitis C three years to clear the prevalent cases, then reducing to £5 million pa. 15 Zanamivir for Influenza November 2000 Selective 6.6 16 Autologous Cartilage December 2000 Research 0.0 transplantation in Knee Joints 17 Laparoscopic surgery for January 2001 Research 0.0 Colorectal Cancer 18 Laparoscopic surgery for December 2000 Selective 0.0 Inguinal Hernia 19 Donepezil, Rivastigmine January 2001 Selective 42.0 This is the long-run annual and Galantamine for cost—NICE expected a slow Alzheimer’s build-up over several years. 20 Riluzole for Motor January 2001 Routine 5.0 Neurone Disease 21 Pioglitazone for Type 2 March 2001 Selective "11.3 See comment on Diabetes rosiglitazone above. 22 Orlistat for Obesity March 2001 Selective 9.0 £6 million for drug costs and £3–4 million for overheads. 23 Temozolomide for Brain April 2001 Selective 1.0 Cancer 24 DiYcult to heal surgical April 2001 Routine 0.9 wounds 25 Gemcitabine for Pancreatic May 2001 Selective 1.8 cancer 26 Non-small cell lung cancer June 2001 Routine 9.0 These are the short-run costs⁄NICE comment that take-up may increase in the longer term. 27 Cox II for Osteoarthritis July 2001 Selective 25.0 3178271207 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Routine/ Estimate full- selective/ year costs No. Title of guidance Date of Issue research(3) (England, £m) Comments
and Rheumatoid Arthritis 28 Topetecan for advanced August 2001 Selective 7.0 Ovarian Cancer 29 Fludarabine for B-cell September 2001 Routine 0.0 Estimated to be broadly cost chronic lymphocytic neutral—no detailed leukaemia costings given. 30 Taxanes for Breast September 2001 Selective 0.0 Earlier guidance unchanged. Cancer—review 31 Sibutramine for Obesity in October 2001 Routine 19.2 Year 3 figure adults 32 Beta interferon and January 2002 Research 0.0 glatiramer 33 Colorectal Cancer March 2002 Selective 41.0 NICE estimate £21 million for 1st line and £20 million for 2nd line use. They indicate that costs in 2nd line use could be “considerably lower”, but do not give a lower bound. 34 Tratuzumab breast cancer March 2002 Selective 17.0 35 Enteracept juvenile arthritis March 2002 Selective 3.0 36 Enteracept and infliximab March 2002 Selective 59.0 rheumatoid arthritis 37 Rituximab lymphoma March 2002 Selective 1.2 NICE do not attempt a quantative estimate, but information in the guidance suggests a figure of around £1.2 million. 38 Inhalers 5- 15 March 2002 Routine 0.9 39 Zyban and NRT March 2002 Routine 38.7 40 Infliximab Crohn’s disease May 2002 Selective 2.5 NICE estimated £2.5 million for the first year costs. They expected lower costs in subsequent years but did not quantify. 41 Routine anti D rhesus May 2002 Routine 4.0 negative women 42 Human growth hormone May 2002 Routine 34.7 children 43 Atypical antipsychotics June 2002 Routine 104.8 44 Metal on Metal June 2002 Selective 1.9 NICE say cost is more likely to be at lower end of range. 45 PLDH (Caelyx) for ovarian July 2002 Selective 3.1 cancer 46 Surgery for morbid obesity July 2002 Selective 21.0 Initial costs will be lower, but will build as service provision increases. 47 Glycoproteins (review) September 2002 Routine 0.0 Replacement of the September 2000 guidance with this revised guidance is not expected to increase costs to the NHS. 48 Home vs hospital September 2002 Selective 0.0 haemodialysis 49 Ultrasonic locating devices September 2002 Routine 0.9 200,000 procedures x “less for pacing central venous than £10” per procedure. lines Number of additional machines w £7–15K not quantified.” 50 Imatinib for CML October 2002 Routine 13.8 Estimated increase in the first year is between £11.8 million and £5.8 million for England and Wales. 51 Computerised Cognitive October 2002 Research 0.0 Further research behavioural therapy recommended. 52 Thrombolysis October 2002 Routine 33.5 3178271209 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 343
Routine/ Estimate full- selective/ year costs No. Title of guidance Date of Issue research(3) (England, £m) Comments
53 Long acting insulin December 2002 Selective 16.0 Estimate on the high side— analogues (glargine) based on all potentially eligible patients switching to this treatment—actual costs will be proportionately less depending on uptake. 54 Vinorelbine for breast December 2002 Selective 6.5 cancer 55 Paclitaxel—oarian cancer January 2003 Routine 0.0 Unlikely that additional costs to the NHSwill result from this review. 56 Tension free vaginal tape February 2003 Routine 0.0 Further research recommended. 57 Subcutaneous insulin February 2003 Selective 5.3 NICE suggest costs will be infusion (insulin pumps) at the bottom end of the range. 58 Zanamivir oseltamivir February 2003 Routine and 0.0 Cost impact depends on the amantidine treatment of flu no—hence severity of an outbreak in tabled as any given year. No selective anticipated increase over previous estimated figures— as savings/pressures balance out between the three drugs. 59 ECT April 2003 Selective 0.0 Guidance recommends the use of ECT only in certain restricted circumstances. 60 Patient education models April 2003 Routine 10.3 160 centres for England each diabetes with running costs of £64,500 pa %10.3 million. 61 Capecitabine and tegafur May 2003 Routine "11.2 Assumes 3,500 each use with uracil for metastatic capecitabine or tegafur colorectal cancer uracil in preference to existing treatment options. 62 Capecitabine for locally May 2003 Routine "1.2 Saving is for combination advance breast cancer capecitabine/docetaxel relative to docetaxel monotherapy. 63 Glitazones for type 2 August 2003 Selective "16.0 Revision to previous diabetes (review) guidance reduces by about 30% the previous estimated saving of £12 million pa. 64 Human Growth Hormone August 2003 Selective 0.0 Cost saving—but no figures in adults estimated. 65 Rituximab for aggressive September 2003 Selective 13.2 NICE say incidence is rising non Hodgkin’s lymphoma by 4% pa and quote an upper limit of £27.3 for 2007 but basis is not clear. 66 Olanzapine and valporate September 2003 Routine 0.0 Unlikely to be net costs or semisodium for bipolar 1 savings. disorder 67 Oseltamivir and amantidine September 2003 Routine and 10.0 Costs will vary with severity for prophylaxis of flu no—hence of influenza outbreak. tabled as selective 68 PDT for macular September 2003 Selective 8.3 degeneration 69 Use of liquid-based October 2003 Routine 10.2 Running costs are likely to cytology for cervical be similar with some screening possible (unquantified) time savings in diagnosis. Running costs are likely to be similar to the start-up costs. 70 Use of imatanib for October 2003 Selective 5.0 Steady-state (year 5) costs. chronic myeloid leukaemia 3178271211 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Routine/ Estimate full- selective/ year costs No. Title of guidance Date of Issue research(3) (England, £m) Comments
71 Use of coronary artery October 2003 Selective 6.6 This is the net cost of using stents drug-eluting stents vs bare metal stents. NICE estimate a possible £4 million oVsetting saving from reducing the restenosis rate. "4.0 72 Rheumatoid arthritis— November 2003 Research "0.1 anakinra 73 Myocardial perfusion November 2003 Selective 27.0 scintigraphy for the diagnosis and management of angina and myocardial infarction 74 Pre-hospital initiation of January 2004 Selective 0.0 fluid replacement therapy in trauma 75 Hepatitis C—pegylated January 2004 Selective 10.5 interferons, ribavarin and alfa interferon 76 Newer drugs for epilepsy March 2004 Selective 0.0 NICE quote a range of in adults "£29 to "£32 million. However it is unlikely that such savings would be realised. 77 Newer hypnotic drugs for April 2004 Selective 0.0 Cost neutral insomnia 78 Fluid-filled thermal April 2004 Selective "14.2 balloon and microwave endometrial ablation techniques for heavy menstrual bleeding 79 Newer drugs for epilepsy April 2004 Selective 0.0 in children 80 Acute coronary July 2004 Routine 26.5 syndromes—clopidogrel 81 Atopic dermatitis August 2004 Selective "31.5 Cost saving (eczema)—topical steroids 82 Atopic dermatitis August 2004 Selective 2.9 Possible range of cost (eczema)—pimecrolimus extremely variable, but as and tacrolimus NICE’s recommendation was not positive it is likely that costs will trend towards the lower end”. 83 Hernia—laparoscopic September 2004 Selective 1.0 surgery (review) 84 Sepsis (severe)— September 2004 Routine 15.0 drotrecogin 85 Renal transplantation— September 2004 Selective 0.0 immuno-suppressive regimens (adults) 86 Gastro-intestinal stromal October 2004 Selective 4.7 tumours (GIST)—imatinib 87 Secondary osteoporosis January 2005 Selective 36.5 88 Dual-chamber pacemakers February 2005 Selective 9.0 for the treatment of symptomatic bradycardia 89 Cartilage injury— May 2005 Research 0.0 May be small expenditure to autologous chondrocyte fund research. implantation (ACI) (review) (No. 89) 3178271212 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Routine/ Estimate full- selective/ year costs No. Title of guidance Date of Issue research(3) (England, £m) Comments
90 Vascular disease— May 2005 Selective 27.4 clopidogrel and dipyridamole 91 Ovarian cancer May 2005 Selective 2.3 (advanced)—paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan (review) 92 Tooth Decay—Healozone July 2005 Research 0.0 Total Cost Totals Total number of appraisals Selective 56 758.63 Routine 28 Total number of researchable topics Research 8
Notes: 1. All estimates are based on figures published in NICE’s appraisal guidance. 2. NICE estimates are given on an England and Wales basis. 3. Routine % NICE has approved the use of a technology, Selective % NICE has approved technology, but only for use under specific conditions, Research % NICE has not approved the technology and recommends that further research on eVectiveness is needed. 4. There are a number of TA’s for which there are a range of costs. For the purposes of this table, we have taken the mid point where appropriate.
TABLE 3.5.2(b)—ALL PUBLISHED CLINICAL GUIDELINES INCLUDED INHERITED GUIDELINESAND CANCER SERVICEGUIDANCE DECEMBER 2005
Ref Title Wave Publication Review CG6 Antenatal care 6 Oct 2003 Oct 2007 CG22 Anxiety 6th wave Dec 2004 Dec 2008 CSG Breast (CSG) Inherited Aug 2002 CG13 Caesarean section 2nd programme Apr 2004 Apr 2008 CSG Children and young people with cancer Inherited Aug 2005 CG5 Chronic heart failure 2nd Programme Jul 2003 Jul 2007 CG12 Chronic obstructive pulmonary disease 6th Wave Feb 2004 Feb 2008 CSG Colorectal (CSG) Inherited Jun 2004 CG19 Dental recall 7th wave Oct 2004 Oct 2008 CG23 Depression 2nd programme Dec 2004 Dec 2008 CG28 Depression in children and young people 7th wave Sep 2005 Sep 2009 CG17 Dyspepsia 1st programme Aug 2004 Aug 2008 CG9 Eating disorders 2nd programme Jan 2004 Jan 2008 C Electronic fetal monitoring Inherited May 2001 May 2005 CG20 Epilepsy 6th wave Oct 2004 Oct 2008 CG21 Falls 6th wave Nov 2004 Nov 2008 Familial breast cancer 6th wave May 2004 May 2008 CG11 Fertility 6th wave Feb 2004 Feb 2008 CSG Haemato-oncology (CSG) Inherited Oct 2003 Head and neck (CSG) CG4 Head injury 2nd programme Jun 2003 Jun 2007 CG18 Hypertension 1st programme Aug 2004 Aug 2008 D Induction of labour Inherited Jun 2001 Jun 2005 CG2 Infection control 2nd programme Jun 2003 Jun 2007 CG30 Long-acting reversible contraception 7th wave Oct 2005 Oct 2009 CG24 Lung cancer 6th wave Feb 2005 Feb 2009 CG8 Multiple sclerosis 1st Programme Nov 2003 Nov 2007 CG31 Obsessive-compulsive disorder 6th wave Nov 2005 Nov 2009 A Post MI Inherited Apr 2001 Apr 2003 3178271213 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Ref Title Wave Publication Review CG26 Post-traumatic stress disorder (PTSD) 6th wave Mar 2005 Mar 2009 CG3 Preoperative tests 1st programme Jun 2003 Jun 2007 CG7 Pressure relieving devices 6th wave Oct 2003 Oct 2007 CG29 Pressure ulcer management 6th wave Sep 2005 Sep 2009 B Pressure ulcers Inherited Apr 2001 Apr 2005 CG27 Referral for suspected cancer 7th wave Jun 2005 Jun 2009 CG1 Schizophrenia 1st programme Dec 2002 Dec 2006 CG16 Self-harm 6th wave Jul 2004 Jul 2008 CSG Supportive and palliative care (CSG) Inherited Mar 2004 CG15 Type 1 diabetes 2nd programme Jul 2004 Jul 2008 G Type 2 diabetes—blood glucose Inherited Sep 2002 Sep 2005 CG10 Type 2 diabetes—footcare 1st update Jan 2004 Jan 2008 H Type 2 diabetes—management of blood Oct 2002 Oct 2005 pressure and blood lipids Inherited F Type 2 diabetes—renal disease Inherited Feb 2002 Mar 2005 E Type 2 diabetes—retinopathy Inherited Feb 2002 Mar 2005 CSG Urological (CSG) Inherited Sep 2002 CG25 Violence 6th wave Feb 2005 Feb 2009
Q (124) Out of hours funding. Analysis behind the amount made available (£316 million) to fund OOH services
Answer 2004–05 1. In 2004–05, the Department of Health supported out-of-hours services through greatly increased funding which was allocated directly to the PCTs who commission out-of-hours services. Some £316 million was available to help fund PCT provision of out-of-hours services. This included: — a sum of £180 million is available, in money which previously was given to practices to pay for out- of-hours services, which under the new contract, goes to the PCTs. It was agreed as part of the new contract arrangements that the income of GPs that opted out of providing out-of-hours services should be reduced by an average of £6,000 per annum—If every practice in the country opted-out, this would amount to £180 million. — doubling the out-of-hours development fund from this year, to £92 million. The primary use of the development fund is to support improvements in out-of-hours services. A centrally allocated OOH Development Fund (set up in 1995) provides money to PCTs for the development of services and infrastructure. The development fund has been instrumental in improving GP out-of-hours services to patients. — additional resources of £14 million to assist PCTs in very rural and urban areas; In order to target both rural and urban areas equitably, it was decided to split the additional support equally, between an allocation based on the unified budget allocation formula, and an allocation to the 50 most rural PCTs according to the Carr-Hill rurality adjustment, aggregated to SHA level.
Rurality Calculation. The methodology is drawn from the GP Contract and allocates money based upon the Carr-Hill rurality index. The index uses two indicators, the average population density of wards from which GP practices draw their patients and the average distance that a patient needs to travel to their practice. PCT (Av. Distance to practice∧0.05) % Rural IndexPCT Practice Population* (Av. Population density∧0.06) This was used to identify the 50 PCTs with the highest index. The 50 most rural PCTs were then allocated money based on the formula below (so the most rural according to Carr-Hill didn’t necessarily get the most money). PCT Population (Top 50 only) % PCT Budget Total Allocation* Total Population (Top 50 only) — plus, £30 million was available (100k for every PCT) in capital incentives (2 phases) to reward PCTs for having robust arrangements in place for OOH services 3178271214 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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First Phase All SHAs informed DH of the number of PCTs who were eligible for the first 50k capital incentive when they demonstrated a state of readiness to take over out-of-hours responsibilities.
Second phase
The second payment was given to PCTs, who demonstrated that they are delivering a sustainable high quality service, since assuming responsibility for out-of-hours services,
PCT Unified Budget
In addition to this, PCTs could also use some of their unified budgets amounting to a national total of £49.3 billion to support out-of-hours services.
2005–06
This financial year the Department has continued to support PCTs who commission and in some cases provide out-of-hours services by making available £322 million nationally. This included: — a sum of £180 million is available, in money which previously was given to practices to pay for out- of-hours services, which under the new contract, goes to the PCTs; — recurrent development fund of £92 million; — £2.5 million to cover deficit caused by new allocation formula; — additional resources of £11.5 million to assist PCTs in very rural and urban areas; — plus, £33.4 million to support the development of urgent care services; — plus, £3 million to support the out-of-hours exemplar programme. In addition to this, PCTs can also use some of their unified budgets amounting to a national total of £53.9 billion to support out-of-hours services.
Q (146) Tabulation of midwifery and radiographer vacancy and staV numbers data
Answer
1. Please see information in attached spreadsheet.
NHS HOSPITAL AND COMMUNITY HEALTH SERVICES (HCHS): QUALIFIED RADIOGRAPHERSEMPLOYED IN THE NHSASAT 30 SEPTEMBEREACH YEAR
All radiographers Diagnostic Therapeutic Whole-time Whole-time Whole-time Headcount equivalents Headcount equivalents Headcount equivalents
1997 11,771 9,901 10,364 8,626 1,407 1,275 1998 12,118 10,193 10,645 8,860 1,473 1,333 1999 12,330 10,368 10,839 9,009 1,491 1,358 2000 12,489 10,478 11,036 9,169 1,453 1,309 2001 12,706 10,655 11,163 9,264 1,543 1,391 2002 13,031 10,863 11,489 9,489 1,542 1,374 2003 13,344 11,111 11,687 9,642 1,657 1,469 2004 13,900 11,560 12,147 10,015 1,753 1,545 Increase in numbers from 1997 to 2004 2,129 1,659 1,783 1,389 346 270 Growth from 1997 to 2004 18.1% 16.8% 17.2% 16.1% 24.6% 21.2%
Source: Department of Health Non-Medical Workforce Census 3178271214 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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NHS HOSPITAL AND COMMUNITY HEALTH SERVICES (HCHS): REGISTERED MIDWIVES IN ENGLAND AS AT 30 SEPTEMBER EACH YEAR
Whole-time equivalent Headcount 1995(1) 18,034 22,022 1996 18,262 22,595 1997 18,053 22,385 1998 18,168 22,841 1999 17,876 22,799 2000 17,662 22,572 2001 18,048 23,075 2002 18,119 23,249 2003 18,444 23,941 2004 18,854 24,844 Increase in numbers from 1995 to 2004 820 2,822 Growth from 1995 to 2004 4.5% 12.8% Source: Department of Health Non-Medical Workforce CensusHealth and Personal Social Services Statistics for England (HPSSS) Notes: 1. A new system of occupation coding for NHSnon-medical sta V was introduced in 1995. The new codes classify staV according to what they do rather than the terms and conditions under which they are employed ie national payscales. Figures based on new occupation codes are not directly comparable with those basedon the old payscale classification. Therefore figures since 1995 are not comparable with earlier years. Figures are rounded to the nearest whole number All figures exclude learners and agency staV
Vacancy Rates
Radiographers—three month vacancy rate
1999 2000 2001 2002 2003 2004 2005 Diagnostic radiography rates 3.6% 4.4% 5.5% 6.1% 4.8% 3.4% Number of vacancies 330 420 530 599 488 398 Therapeutic radiography rates 7.1% 8.0% 8.8% 10.7% 8.8% 6.0% Number of vacancies 100 110 130 168 144 98
Source: NHS vacancy survey Notes: Vacancy rates rounded to one decimal place three month vacancies are posts that have been vacant for three months or more as at 30 March that Trusts are actively trying to fill. three month vacancy rates are three month vacancies as a percentage of vacancies plus staV in post. 3178271214 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Midwives—three month vacancy rates
1999 2000 2001 2002 2003 2004 2005
Vacancy Rate 2.1% 2.8% 2.6% 2.8% 3.1% 3.3% 1.8% Number of vacancies 400 510 470 530 572 619 348 Source: NHS Vacancy Survey Notes: Vacancy rates rounded to one decimal place. Number of vacancies rounded to the nearest 10. Three month vacancies are posts that have been vacant for three months or more as at 30 March that Trusts are actively trying to fill. Three month vacancy rates are three month vacancies as a percentage of vacancies plus staV in post.
Radiography — Compared to 1997 the number of diagnostic and therapeutic radiographers working in the NHS has increased by 17% and 25% respectively. At March 2005 the percentage of diagnostic radiographer posts that had been vacant for 3 months or more had fallen to 3.4% from a high of 6.1% in 2003. Vacancies for therapeutic radiographer posts are currently at 6%, down from 10.7% in 2003. The number of students entering training for both branches of the profession has increased year on year.
Midwifery — Nationally the supply and demand for midwives is approaching balance. However there are problems in some areas. The rate of vacancies lasting three months or more for midwives was 1.8% in March 2005, down from a high of 3.3% in 2004. This fall comes at the same time as increases in both the number of midwives employed in the NHSand students entering mid wifery training.
Q (151) A note to be provided on the Electronic StaV Record
Answer 1. The Electronic StaV Record (ESR) Project will replace the current 29 payroll and 38 HR systems with a single, national, integrated solution which will be used throughout the NHSin England and Wales. The ESR project is DH sponsored and endorsed by Andrew Foster. ESR is an integrated solution for the NHS oVering a wide range of functionality including self-service. At full capacity the system will hold over 1.2 million records, covering all NHSemployees. 2. ESR is currently live in around 39 NHS pilot sites and will continue to be rolled out in a series of waves. Implementation of ESR in the pilot sites has taken three years, mainly due to the complexity of the build. The pilot phase has now been signed oV and the standard product can be rolled out to the remainder of the Service, reaching full capacity by 2008. 3. The ESR project team has provided significant on-site support throughout the implementation, guiding Trusts through the prerequisite stage and supporting the implementation phase. 4. Monthly data downloads will be made available to selected users, via a Data Warehouse. The design of the Warehouse was determined mainly by central reporting requirements (DH and HSCIC) and requirements of other organisations (SHAs, Deaneries). Over time the Warehouse should help reduce the burden on the NHSas manual collections will decrease, however, the full be nefit will only be realised when ESR is rolled out nationally. 5. As at 30 September 2005 (census day), 22 organisations were live on ESR. Early indications of data extracted from the Warehouse show that there are some data quality issues to be resolved, but broadly, data appears to be fit for purpose in terms of recording workforce census information. The HSCIC have various plans for addressing data quality issues, such as sharing the data with the respective Trusts to ask them to validate. This process may become less intensive as data quality improves within ESR and confidence levels are raised. 6. DiVerences in data from ESR and that previously collected by disparate systems may occur. This could be a result of a more consistent approach being employed via a single, integrated system. Timeseries data could be aVected by these results and will need to be clearly footnoted. 3178271216 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 350 Health Committee: Evidence
7. SHAs will be able to report on data to make informed business decisions relating to staYng and service provision. Deaneries will use the warehouse for reporting on medical staV within their region. The warehouse will not be used for local reporting, or available to Trusts. Local reporting is incorporated into the ESR application. 8. National reporting using ESR data will not be feasible until full capacity is reached. A mixture of current data collections (via disparate systems) and data extracted from ESR will be the scenario until then. 9. Real time or instant reporting will not be possible as there is month’s delay between the data present in ESR being uploaded to the warehouse (to give the NHS organisations time to ensure the data is as accurate as possible).
Q (156) A note on the issue of the provision of performance data on ISTCs eg Alliance Medical. Review in light of the Freedom of Information Act powers
Answer 1. The Central Clinical Procurement Programme Team is currently working up the details to adopt a publication scheme under the Freedom of Information Act to extend the amount and detail of information readily available and accessible to the public with regard to centrally procured healthcare contracts.
Q (157) A note on the provision of information on NHS prescriptions and classes of drug. Committee believe this is restricted under “commercial-in-confidence” grounds
Answer 1. There is a considerable amount of information available on drugs prescribed and dispensed in the community and in hospitals.
Prescriptions dispensed in primary care 2. Information on prescribing in primary care comes from systems administered for the reimbursement of dispensing contractors by the Prescription Pricing Authority. The data covers all prescriptions dispensed in the community, ie by community pharmacists and appliance contractors, dispensing doctors and prescriptions submitted by prescribing doctors for items personally administered in England. Information is available at individual drug level and can be easily grouped into therapeutic classes. Data is available at national level, and sub-nationally (SHA and PCT). 3. Annual data at national level both for individual drugs and as aggregated data are published. These can be accessed from the Department of Health’s website and are also available in the House of Commons library. Requests for data are dealt with by the Health and Social Care Information Centre: (MBPrescriptionStatisticswdh.gsi.gov.uk)
Prescriptions dispensed in secondary care 4. Information on hospital prescribing is collected by the commercial organisation IMSHealth and is made available to DH and the Health & Social Care Information Centre under a contract with that organisation. The IMSdata is based on information collected from most acu te hospitals in England. Summary figures on hospital prescribing were published for the first time in September 2005. The publication describes prescribing taking place within hospitals in England, at both national and Strategic Health Authority level and is available electronically on the Health and Social Care Information Centre’s website. 5. The agreement with IMSallows for four types of use of the data besides int ernal management purposes: (a) National data can be published annually or six monthly, with a six months’ delay. (b) Requests for national data can be met on a quarterly basis, with a six months delay, except for information about drugs recommended by NICE, where the information can be provided immediately. (c) Requests for information at SHA level (or, for oncology drugs, cancer network level) can be met similarly but, apart from drugs recommended by NICE, no information which identifies a single manufacturer can be provided (eg information on the usage of a single in-patent drug could not be given—it would have to be combined with at least one other). (d) SHAs, Cancer Networks, the Healthcare Commission and NICE may receive data at SHA/Cancer Network level as soon as the data are available for internal management purposes. 3178271217 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Index to Tables
Table Description 1. Number and total net ingredient cost (NIC) of prescription items, average NIC per prescription item and average number of prescription items per head of population, 1994–2004 2. Number of prescription items and percentage of total items dispensed in the community by charged prescriptions and those categories where no prescription charge is made, 1994–2004 3. Number of exempt prescription items and percentage of total items dispensed in the community by category of exemption, 2003 and 2004. 4. Number of prescription items and percentage of total items dispensed by community pharmacists and appliance contractors and dispensing doctors, by charged and non-charged categories, 2004. 5. Average number of prescription items dispensed in the community per head of population by broad age group, 1994–2004 6. Number, net ingredient cost (NIC) and average NIC per prescription item by class of preparation, 1994–2004 7. Generic prescribing and dispensing, 1994–2004: all items excluding dressings and appliances. 8. Generic prescribing and dispensing, based on items, by British National Formulary chapters, 2003 and 2004 9. Number, net ingredient cost (NIC) and average NIC per prescription item by British National Formulary chapters, 2003 and 2004 10. Number and net ingredient cost (NIC) in 2003 and 2004 for the 20 British National Formulary sections which had the greatest increase in NIC between 2003 and 2004 11. Number, net ingredient cost (NIC) and average NIC per item in 2003 and 2004 for the 20 British National Formulary sections which had the greatest NIC in 2004
Table 1
NUMBER AND TOTAL NET INGREDIENT COST (NIC) OF PRESCRIPTION ITEMS, AVERAGE NIC PER PRESCRIPTION ITEM AND AVERAGE NUMBER OF PRESCRIPTION ITEMSPER HEAD OF POPULATION, 1994–2004
England
Average NIC Average number of Number Total NIC per prescription item prescription items per Year (million) (£ million) (£) head of population
Actual At 1994 prices Actual At 1994 prices 1994 456.1 3,405.2 3,405.2 7.47 7.47 9.5 1995 473.3 3,680.6 3,576.5 7.78 7.56 9.8 1996 484.9 4,007.0 3,763.7 8.26 7.76 10.0 1997 500.2 4,367.5 4,000.9 8.73 8.00 10.3 1998 513.2 4,701.5 4,186.2 9.16 8.16 10.5 1999 529.8 5,291.2 4,609.2 9.99 8.70 10.8 2000 551.8 5,584.6 4,802.6 10.12 8.70 11.2 2001 587.0 6,116.6 5,125.7 10.42 8.73 11.9 2002 617.0 6,846.7 5,549.4 11.10 8.99 12.4 2003 649.7 7,510.1 5,922.0 11.56 9.11 13.0 2004 686.1 8,079.6 6,227.3 11.78 9.08 13.7
Average annual increase (%)
1994 to 1995 3.8 8.1 5.0 4.1 1.2 3.5 1995 to 1996 2.4 8.9 5.2 6.3 2.7 2.2 1996 to 1997 3.1 9.0 6.3 5.7 3.1 2.8 1997 to 1998 2.6 7.6 4.6 4.9 2.0 2.3 1998 to 1999 3.2 12.5 10.1 9.0 6.7 2.8 1999 to 2000 4.2 5.5 4.2 1.3 0.0 3.7 2000 to 2001 6.4 9.5 6.7 3.0 0.3 5.9 2001 to 2002 5.1 11.9 8.3 6.5 3.0 4.7 3178271218 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 352 Health Committee: Evidence
Average NIC Average number of Number Total NIC per prescription item prescription items per Year (million) (£ million) (£) head of population
Actual At 1994 prices Actual At 1994 prices 2002 to 2003 5.3 9.7 6.7 4.2 1.3 4.9 2003 to 2004 5.3 7.6 5.2 1.9 "0.4 5.2
1994 to 2004 4.0 9.2 6.4 5.0 2.3 3.6
Notes: 1. The data are from the PCA system and cover prescription items dispensed by community pharmacists, appliance contractors, dispensing doctors and items personally administered. 2. Figures at 1994 prices are calculated using the GDP Deflator (see paragraph 39). 3. Revised ONSmid-year resident population estimates for 1994 to 2003 and mid-year resident projections for 2004, based on the 2001 Census, have been used. 3178271219 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 353 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 414.1 430.6 441.0 454.3 467.1 481.9 500.5 533.1 686.1 587.0 617.0 649.7 3,115.0 3,362.0 100.0 3,653.8 3,975.8 4,285.1 8,079.6 7,510.2 6,846.7 6,116.6 5,097.7 4,835.7 5,591.9 77.4 78.4 80.5 80.3 80.4 84.0 83.1 82.1 81.5 80.7 80.4 81.2 82.7 83.8 85.6 85.4 85.4 85.1 85.1 85.3 86.9 85.4 85.7 86.2 342.4 360.8 377.6 388.2 399.1 410.3 426.0 454.8 596.1 501.6 528.6 560.2 2,409.9 2,635.9 2,940.8 3,191.1 3,445.1 6,790.8 6,239.3 5,620.4 4,986.0 4,114.7 3,888.8 4,543.1 4.9 3.7 3.0 3.3 3.3 1.1 1.1 1.1 1.2 1.6 2.2 1.2 5.0 3.9 3.2 3.4 3.5 2.2 1.6 1.2 1.0 1.1 1.1 1.0 8.0 6.2 7.0 6.6 6.6 6.7 89.1 80.1 74.1 70.4 81.9 66.5 20.9 16.9 14.0 15.4 16.2 10.8 151.9 123.5 109.9 130.8 142.2 104.2 1994—2004 Number % Number % Number % 2.8 2.7 2.8 3.0 2.5 2.7 2.5 2.5 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 17.0 15.8 15.6 16.2 224.8 204.2 190.1 180.6 1.4 1.5 1.3 1.0 0.9 0.9 1.0 0.8 1.6 0.8 0.8 0.8 0.9 0.9 1.5 1.4 1.4 1.4 1.6 1.5 1.2 1.4 1.3 1.3 6.3 6.7 6.8 6.5 6.4 6.6 7.9 7.8 8.2 8.4 8.3 8.3 43.8 43.2 36.5 36.7 37.8 49.0 40.5 62.1 59.7 57.5 54.3 51.3 13.7 12.6 14.0 14.3 14.4 14.0 15.0 12.5 13.1 11.8 11.6 11.6 11.5 12.3 15.4 15.3 14.8 13.8 13.2 12.8 11.8 11.9 11.9 11.9 9.0 HS LIS No charge Personally Other Total Free Grand Total Free Prescriptions 56.8 64.7 67.8 69.6 66.5 66.0 68.3 81.3 70.1 73.3 77.2 392.9 470.8 523.7 573.6 601.2 638.1 633.7 951.2 871.2 791.5 704.3 686.5 6.6 8.3 8.2 7.7 6.4 6.7 7.5 8.7 8.3 9.6 9.3 9.1 8.9 9.2 5.9 5.2 5.7 6 6.3 6.5 6.8 7.3 6.7 6.8 7.1 27.2 27.5 26.1 23.4 26.8 30.4 32.4 36.5 50.1 39.1 42.2 45.9 Medical contraceptives administered 257.2 275.2 280.9 267.1 321.9 441.1 402.6 775.8 696.8 621.4 543.5 517.2 Table 2 9.1 8.3 7.9 6.0 7.6 7.7 7.3 7.0 6.6 5.6 6.0 4.4 4.5 4.7 5.1 5.3 7.5 6.9 6.5 11.4 11.8 11.3 10.9 10.0 47.0 51.0 50.0 49.4 46.7 43.7 41.6 42.1 41.1 44.2 42.8 42.4 237.6 259.5 266.2 277.0 281.9 283.6 288.0 353.7 338.8 325.1 312.6 298.1 44.5 42.6 43.5 45.0 47.2 47.9 48.1 51.4 50.0 53.6 53.1 52.0 51.0 52.3 48.3 49.3 50.1 52.3 54.0 55.1 57.0 54.1 55.0 55.9 184.2 193.9 212.9 223.9 234.0 252.2 270.2 293.8 391.4 317.5 339.7 363.5 72.9% 1,326.4 1,723.6 1,905.9 2,060.1 2,621.0 2,419.6 4,334.0 3,988.5 3,560.7 3,120.3 2,923.5 AND PERCENTAGE OF TOTAL ITEMS DISPENSED IN THE COMMUNITY BY CHARGED (1) 17.3 16.2 14.4 14.6 14.6 14.9 14.9 14.7 13.1 22.6 19.5 19.7 19.6 19.3 19.6 16.0 16.9 17.9 18.5 18.8 14.6 14.3 13.8 8.4 71.7 69.8 63.4 66.1 68.0 71.6 74.6 90.0 85.5 88.4 89.5 705.2 726.1 21.6 1,463.8 713.1 784.7 840.0 983.0 946.9 1,288.8 1,270.9 1,226.2 1,130.6 1,048.8 5.2 7.0 6.9 5.0 6.0 6.1 5.9 5.9 5.8 5.9 6.1 6.1 6.1 6.0 4.3 4.3 4.2 4.2 4.3 4.7 4.6 4.7 4.7 4.57 21.4 21.6 18.8 19.4 19.4 20.1 21.6 23.8 32.2 26.7 28.8 30.6 217.1 233.2 220.5 243.9 254.2 300.6 280.9 479.9 454.7 415.0 370.7 336.3 8.4 9.7 9.1 12.1 11.2 10.1 10.3 10.4 10.7 10.6 10.2 15.7 14.7 13.5 13.6 13.7 13.8 10.0 10.9 11.8 12.4 12.7 10.0 PRESCRIPTIONS AND THOSE CATEGORIES WHERE NO PRESCRIPTION CHARGE IS MADE, 682.4 13.4 Charged Prescriptions of dispensing certificate Number % Number % Number % Number % Number % Number % Number % Number % Number % NUMBER OF PRESCRIPTION ITEMS ngland E 1994 50.2 Year Charge at point Pre-payment Total Charged Elderly Young Maternity/ N Number of prescription items (millions) Community pharmacists and appliance contractors only 1995 48.2 1996 44.6 1997 46.7 1998 48.6 1999 51.4 2000 53.0 2001 54.6 2001(a) 58.8 All dispensed items 2002(a) 59.6 2003(a) 58.9 2004 57.8 Community pharmacists and appliance contractors only 1994 488.1 1995 492.9 Net ingredient cost (£millions) 1996 492.5 1997 540.7 1998 585.8 1999 666.0 2004 808.9 2003(a) 816.2 2002(a) 811.2 2001(a) 759.9 2001 712.5 2000 All dispensed items 3178271220 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 354 Health Committee: Evidence ng 56 10 ing doctors. 1994—2004 Number % Number % Number % nd women aged 60 years and over. pharmacists and appliance contractors only. Items dispensed by dispensi ing doctors and items personally administered by prescribing and dispens HS LIS No charge Personally Other Total Free Grand Total Free Prescriptions Medical contraceptives administered Table 2(continued) ver and women aged 60 and over. After this date Elderly people includes men a nt “no charge contraceptives” and for items personally administered. lly administered items. 1 in 20 sample of all exempt prescriptions submitted to the PPA by community ee items. ecific. AND PERCENTAGE OF TOTAL ITEMS DISPENSED IN THE COMMUNITY BY CHARGED r 2001(a)–2003(a) also includes prescription items dispensed by dispens (1) PRESCRIPTIONS AND THOSE CATEGORIES WHERE NO PRESCRIPTION CHARGE IS MADE, Charged Prescriptions of dispensing certificate Number % Number % Number % Number % Number % Number % Number % Number % Number % NUMBER OF PRESCRIPTION ITEMS : ngland otes 2004 14.00 14.89 14.32 11.07 8.61 15.47 11.70 7.56 13.22 12.69 11.39 11.78 8. “Free prescriptions” here includes both those to exempt patients and fr 2003(a) 13.86 14.86 14.20 10.97 7.99 15.19 11.28 7.21 12.61 11.86 11.14 11. 7. “n/a”: not appropriate—only GP practices can be reimbursed for persona 2002(a) 13.60 14.41 13.87 10.48 7.59 14.71 10.79 6.91 12.18 11.25 10.63 11. 2001(a) 12.93 13.88 13.23 9.83 7.07 13.92 10.05 6.49 11.44 10.63 9.94 10.42 All dispensed items 6. See paragraphs 51 and 52 for explanation of the change of procedure to cou 2001 13.06 14.13 13.38 9.95 7.08 14.16 10.05 6.59 n/a 10.67 9.99 10.49 5. See paragraph 52 for full explanation of categories. 2000 12.88 13.91 13.18 9.70 6.82 13.61 9.67 6.21 n/a 10.26 9.66 10.18 3. NHSLIS:NHSLow Income Scheme. 4. “Other” includes war pensioners and no declaration/declaration not sp 1999 12.95 13.96 13.23 9.59 6.59 13.23 9.53 6.14 n/a 9.66 9.48 10.04 1998 12.07 13.07 12.35 8.80 6.04 11.99 8.72 5.87 n/a 8.80 8.63 9.17 2. Prior to 20 October 1995 “Elderly people” includes men aged 65 years and o Personally administered items are free of charge. 1997 11.57 12.57 11.86 8.51 5.61 11.39 8.24 5.68 n/a 8.48 8.22 8.75 1996 11.04 11.75 11.25 8.10 5.33 10.74 7.73 5.35 n/a 7.85 7.79 8.28 doctors and personal administration prescriptions are excluded. Data fo E 1995 10.23 10.79 10.40 7.55 5.09 10.00 7.28 6.40 n/a 7.30 7.31 7.81 1994 9.71 10.12 9.84 7.20 5.05 9.45 6.92 6.92 n/a 7.28 7.04 7.52 Community pharmacists and appliance contractors only Year Charge at point Pre-payment Total Charged Elderly Young Maternity/ N 1. The analysis of 1993 to 2001 data for non-charged categories is based on a Average net ingredient cost per prescription item (£) N 3178271221 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
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Table 3
NUMBER OF EXEMPT PRESCRIPTION ITEMS AND PERCENTAGE OF TOTAL ITEMS DISPENSED IN THE COMMUNITY BY CATEGORY OF EXEMPTION, 2003 AND 2004
England 2003 2004 Number % Number % Number of prescription items (millions) 535.7 82.5 570.9 83.2
Children under 16 37.0 5.7 35.7 5.2 Young people 16, 17 or 18 in full time education 5.4 0.8 5.4 0.8 Elderly people 363.5 55.9 391.4 57.0 Maternity exemption 5.0 0.8 5.0 0.7 Medical exemption 40.8 6.3 45.1 6.6 Income support 54.5 8.4 54.8 8.0 Working Families’ Tax Credit/Working Tax Credit 10.8 1.7 14.7 2.1 Minimum Income Guarantee/Pension Credit 0.1 0.0 0.5 0.1 Disabled Person’s Tax Credit/Disability working allowance 1.3 0.2 0.0 0.0 Holders of an HC2 certificate 3.9 0.6 3.9 0.6 Income based Jobseekers allowance 6.7 1.0 7.3 1.1 War pension 0.6 0.1 0.6 0.1 No declaration/declaration not specific 6.1 0.9 6.4 0.9
Net ingredient cost (£millions) 5,975.4 79.6 6,503.7 80.5
Children under 16 281.5 3.7 293.8 3.6 Young people 16,17 or 18 in full time education 57.2 0.8 59.9 0.7 Elderly people 3,988.5 53.1 4,334.0 53.6 Maternity exemption 40.8 0.5 41.1 0.5 Medical exemption 656.0 8.7 734.7 9.1 Income support 631.3 8.4 660.2 8.2 Working Families’ Tax Credit/Working Tax Credit 106.3 1.4 158.7 2.0 Minimum Income Guarantee/Pension Credit 1.3 0.0 5.5 0.1 Disabled Person’s Tax Credit/Disability working allowance 19.6 0.3 0.5 0.0 Holders of an HC2 certificate 48.0 0.6 50.3 0.6 Income based Jobseekers allowance 64.7 0.9 76.0 0.9 War pension 9.5 0.1 10.1 0.1 No declaration/declaration not specific 70.5 0.9 78.8 1.0
Average net ingredient cost per prescription item 11.15 11.4
Children under 16 7.61 8.22 Young people 16, 17 or 18 in full time education 10.56 11.19 Elderly people 10.97 11.07 Maternity exemption 8.11 8.19 Medical exemption 16.06 16.28 Income support 11.59 12.05 Working Families’ Tax Credit/Working Tax Credit/Family Credit 9.88 10.76 Minimum Income Guarantee/Pension Credit 11.62 12.11 Disabled Person’s Tax Credit/Disability working allowance 14.61 15.86 Holders of an HC2 certificate 12.32 12.80 Income based Jobseekers allowance 9.72 10.40 War pension 15.45 15.69 No declaration/declaration not specific 11.50 12.38
Notes: 1. The analysis of 2003 and 2004 data for non-charged categories is based on a 1 in 20 sample of all exempt prescriptions submitted to the PPA by dispensing doctors as well as chemists and appliance contractors. Contraceptives and items personally administered by prescribing and dispensing doctors are free and are not shown in the table but are included in the totals used to calculate percentages. 2. See paragraph 51 for definition of exemption categories. 3. Information for Medical and Maternity exemption categories is shown separately. A very small number of items was recorded on “old” forms under the HA exemption category which included both medical and maternity exemption.These have been pro-rated to the Medical and Maternity categories. 3178271222 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 356 Health Committee: Evidence
Table 4
NUMBER OF PRESCRIPTION ITEMS(1) AND PERCENTAGE OF TOTAL ITEMS DISPENSED BY COMMUNITY PHARMACISTS AND APPLIANCE CONTRACTORS AND DISPENSING DOCTORS, BY CHARGED AND NON-CHARGED CATEGORIES, 2004
England
Total 2004 Community Dispensing pharmacists doctors and appliance contractors Number % Number % Number % Number of prescription items (millions):
Charged at point of dispensing 57.8 8.6 53.8 8.6 4.0 8.6 Pre-payment certificates 32.2 4.6 28.5 4.6 3.7 8.0 No charge contraceptives 8.2 1.2 7.6 1.2 0.6 1.2 Exempt prescription items 570.9 85.6 532.6 85.6 38.3 82.1 Of Which: Children under 16 35.7 5.3 34.0 5.5 1.7 3.7 Young people 16, 17 or 18 in full time education 5.4 0.8 5.0 0.8 0.3 0.7 Elderly people 391.4 58.5 361.5 58.1 29.9 64.1 Maternity exemption 5.0 0.7 4.7 0.8 0.3 0.6 Medical exemption 45.1 6.7 42.0 6.7 3.1 6.7 Income support 54.8 8.2 53.6 8.6 1.2 2.7 Working Families’ Tax Credit/Working Tax Credit 14.7 2.2 14.1 2.3 0.6 1.3 Minimum Income Guarantee/Pension Credit 0.5 0.1 0.4 0.1 0.0 0.0 Disabled Person’s Tax Credit 0.0 0.0 0.0 0.0 0.0 0.0 Holders of an HC2 certificate 3.9 0.6 3.8 0.6 0.1 0.3 Income based Jobseekers allowance 7.3 1.1 7.2 1.2 0.2 0.3 War pension 0.6 0.1 0.6 0.1 0.0 0.1 No declaration/declaration not specific 6.4 1.0 5.6 0.9 0.7 1.6
Net ingredient cost (£millions):
Charged at point of dispensing 808.9 10.3 761.9 10.3 47.0 10.3 Pre-payment certificates 479.9 6.1 434.7 5.9 45.3 9.9 No charge contraceptives 62.1 0.8 58.5 0.8 3.6 0.8 Exempt prescription items 6,503.7 82.8 6,144.3 83.0 359.4 79.0 Of Which: Children under 16 293.8 3.7 281.1 3.8 12.7 2.8 Young people 16, 17 or 18 in full time education 59.9 0.8 56.7 0.8 3.2 0.7 Elderly people 4,334.0 55.2 4,060.0 54.9 274.0 60.2 Maternity exemption 41.1 0.5 39.1 0.5 2.0 0.4 Medical exemption 734.7 9.4 699.7 9.5 35.0 7.7 Income support 660.2 8.4 645.6 8.7 14.7 3.2 Working Families’ Tax Credit/Working Tax Credit 158.7 2.0 152.2 2.1 6.5 1.4 Minimum Income Guarantee/Pension Credit 5.5 0.1 5.3 0.1 0.2 0.0 Disabled Person’s Tax Credit 0.5 0.0 0.5 0.0 0.0 0.0 Holders of an HC2 certificate 50.3 0.6 48.6 0.7 1.7 0.4 Income based Jobseekers allowance 76.0 1.0 74.4 1.0 1.6 0.4 War pension 10.1 0.1 9.6 0.1 0.5 0.1 No declaration/declaration not specific 78.8 1.0 71.6 1.0 7.2 1.6
Average net ingredient cost per prescription item (£):
Charged at point of dispensing 14.0 14.211.67 Pre-payment certificates 14.9 15.3 12.07 No charge contraceptives 7.6 7.7 6.19 Exempt prescription items 11.4 11.5 9.39 Of Which: Children under 16 8.22 8.26 7.38 Young people 16, 17 or 18 in full time education 11.19 11.26 10.07 Elderly people 11.07 11.23 9.17 Maternity exemption 8.19 8.24 7.40 Medical exemption 16.28 16.66 11.23 Income support 12.05 12.05 11.76 Working Families’ Tax Credit/Working Tax Credit 10.76 10.77 10.58 Minimum Income Guarantee/Pension Credit 12.11 12.17 10.59 Disabled Person’s Tax Credit 15.86 15.97 9.19 Holders of an HC2 certificate 12.80 12.84 11.89 3178271222 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 357
Total 2004 Community Dispensing pharmacists doctors and appliance contractors Number % Number % Number % Income based Jobseekers allowance 10.40 10.39 10.79 War pension 15.69 15.91 12.52 No declaration/declaration not specific 12.38 12.71 9.89
Notes: 1. Personally administered items are excluded from this analysis. 2. The analysis of 2004 data for non-charged categories is based on a 1 in 20 sample of all exempt prescriptions submitted to the PPA by community pharmacists and appliance contractors and dispensing doctors. 3. See paragraph 51 for definition of exemption categories. 4. Information for Medical and Maternity exemption categories is shown separately. A very small number of items was recorded on “old” forms under the HA exemption category which included both medical and maternity exemption. These have been pro-rated to the Medical and Maternity categories.
Table 5
AVERAGE NUMBER OF PRESCRIPTION ITEMS DISPENSED IN THE COMMUNITY PER HEAD OF POPULATION BY BROAD AGE GROUP, 1994–2004
England Year Children aged 0–15 Others aged 16–59/64 Elderly people All ages years years Community pharmacists and appliance contractors only(1)
1994 5.0 6.3 20.8 9.5 1995 5.4 6.4 21.8 9.8 1996 5.3 6.1 21.2 10.0 1997 5.3 6.2 22.3 10.3 1998 5.0 6.4 23.2 10.5 1999 4.6 6.3 24.8 10.8 2000 4.4 6.4 26.5 11.2 2001 4.5 6.5 29.6 11.9
All dispensed items
2001(a) 4.8 6.9 32.0 11.9 2002(a) 4.6 7.2 34.1 12.4 2003(a) 4.6 7.4 36.2 13.0 2004(a) 4.5 7.8 37.2 13.7
Notes : 1. The analysis of 1993 to 2001 data for non-charged categories is based on a 1 in 20 sample of all exempt prescriptions submitted to the PPA by community pharmacists and appliance contractors only. Items dispensed by dispensing doctors and personal administration prescriptions are excluded. Data for 2001(a) to 2004(a) also includes prescription items dispensed by dispensing doctors. Items personally administered by prescribing and dispensing doctors are not included in the broad age groups, but are included in the “All ages” group. 2. The calculation of the average number of prescriptions per head for children includes prescriptions of persons under 19 in full time education, although the population figure used is for children and young people aged 15 years and under only. 3. All no charge contraceptives items have been included under “others aged 16–59/64 years”. 4. Prior to 20 October 1995 “Elderly people” includes men aged 65 years and over and women aged 60 and over. After this date “Elderly people” includes men and women aged 60 and over. The population figures used from 1993 to 1995 are for men aged 65 years and over and women aged 60 and over. 5. Revised ONSmid-year resident population estimates for 1994 to 2003 and mid-year resident projections for 2004, based on the 2001 Census, have been used. 6. Prescription items per head for all dispensers from 1994 to 2004 is shown on Table 1. 3178271224 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 358 Health Committee: Evidence
Table 6
NUMBER, NET INGREDIENT COST (NIC) AND AVERAGE NIC PER PRESCRIPTION ITEM BY CLASS OF PREPARATION, 1994–2004
England Class of preparation
Prescribed generically, Prescribed and dispensed and Prescribed and dispensed reimbursed as dispensed as Dressings and generically(2) proprietary(3) proprietary appliances Year (class 1) (class 2) (class 3) (class 4) All classes Number of prescription items (million) 1994 180.3 47.4 214.1 14.3 456.1 1995 198.4 55.7 204.8 14.5 473.3 1996 210.2 60.4 199.6 14.7 484.9 1997 226.6 65.8 192.9 14.9 500.2 1998 237.9 75.7 184.7 14.9 513.2 1999 248.4 90.9 175.4 15.1 529.8 2000 277.6 103.2 155.4 15.5 551.8 2001 297.5 125.1 147.8 16.6 587.0 2002 317.9 138.1 144.0 17.0 617.0 2003 350.1 141.5 140.1 17.9 649.7 2004 385.6 142.3 139.6 18.5 686.1
Net ingredient cost (£million) 1994 381.2 804.2 2,016.6 201.7 3,405.2 1995 445.6 996.3 2,025.4 213.3 3,680.6 1996 500.2 1,161.0 2,119.5 226.3 4,007.0 1997 624.1 1,319.9 2,186.7 236.8 4,367.5 1998 685.1 1,547.5 2,221.3 247.5 4,701.5 1999 917.1 1,937.3 2,171.9 264.9 5,291.2 2000 1,143.0 2,167.0 1,990.1 284.5 5,584.6 2001 1,035.4 2,747.6 2,021.4 312.3 6,116.6 2002 1,297.0 3,132.5 2,079.9 337.2 6,846.7 2003 1,694.6 3,325.2 2,119.6 370.6 7,510.1 2004 2,021.8 3,435.2 2,220.6 402.0 8,079.6
Average net ingredient cost per prescription item (£) 1994 2.11 16.96 9.42 14.15 7.47 1995 2.25 17.90 9.89 14.72 7.78 1996 2.38 19.21 10.62 15.39 8.26 1997 2.75 20.07 11.34 15.94 8.73 1998 2.88 20.45 12.02 16.58 9.16 1999 3.69 21.32 12.38 17.52 9.99 2000 4.12 20.99 12.80 18.31 10.12 2001 3.48 21.96 13.67 18.83 10.42 2002 4.08 22.69 14.44 19.83 11.10 2003 4.84 23.50 15.13 20.67 11.56 2004 5.24 24.13 15.91 21.67 11.78
Notes: 1. The data are from the PCA system and cover prescription items dispensed by community pharmacists, appliance contractors, dispensing doctors and items personally administered. 2. Prescriptions which were written generically, are available generically and reimbursed at the Drug TariV or generic price. 3. Drug is not available generically. 4. Preparation classes are defined in paragraph 46. 5. Some drugs were incorrectly allocated to OWC2 in the years 2000 and 2001. As a result figures for 2000 are unreliable for classes 2 and 3; figures for 2001 have been corrected. 3178271225 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 359
Table 7
GENERIC PRESCRIBING AND DISPENSING, 1994–2004: ALL ITEMS EXCLUDING DRESSINGS AND APPLIANCES
England All items excluding dressings and appliances Prescribed generically, Prescribed and dispensed and Prescribed dispensed reimbursed as generically generically(2) proprietary(3) Year (class 1 and 2) (class 1) (class 2) Total Prescription items Millions
1994 51.5% 40.8% 10.7% 441.8 1995 55.4% 43.2% 12.1% 458.9 1996 57.5% 44.7% 12.9% 470.2 1997 60.3% 46.7% 13.6% 485.3 1998 62.9% 47.7% 15.2% 498.3 1999 65.9% 48.3% 17.7% 514.7 2000 71.0% 51.8% 19.2% 536.3 2001 74.1% 52.2% 21.9% 570.5 2002 76.0% 53.0% 23.0% 600.0 2003 77.8% 55.4% 22.4% 631.8 2004 79.1% 57.8% 21.3% 667.6
Net ingredient cost £ millions
1994 37.0% 11.9% 25.1% 3,203.4 1995 41.6% 12.9% 28.7% 3,467.4 1996 43.9% 13.2% 30.7% 3,780.6 1997 47.1% 15.1% 32.0% 4,130.7 1998 50.1% 15.4% 34.7% 4,454.0 1999 56.8% 18.2% 38.5% 5,026.4 2000 62.5% 21.6% 40.9% 5,300.1 2001 65.2% 17.8% 47.3% 5,804.3 2002 68.0% 19.9% 48.1% 6,509.4 2003 70.3% 23.7% 46.6% 7,139.5 2004 71.1% 26.3% 44.7% 7,677.6
Notes: 1. The data are from the PCA system and cover prescription items dispensed by community pharmacists, appliance contractors, dispensing doctors and items personally administered. 2. Prescriptions which were written generically, are available generically and reimbursed at the Drug TariV or generic price. 3. Drug is not available generically. 4. Some drugs were incorrectly allocated to “Of Which Class 2” in the years 2000 and 2001. As a result “prescribed generically” figures for 2000 are unreliable; figures for 2001 have been corrected.
Table 8
GENERIC PRESCRIBING AND DISPENSING, BASED ON ITEMS, BY BRITISH NATIONAL FORMULARY CHAPTERS, 2003 AND 2004
England
Prescribed generically Dispensed generically(5) BNF chapter 2003 2004 2003 2004 1: Gastro-intestinal system 74.5% 76.3% 42.7% 42.7% 2: Cardiovascular system 90.9% 91.8% 61.4% 68.4% 3: Respiratory system 71.1% 71.7% 46.0% 46.0% 3178271226 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 360 Health Committee: Evidence
Prescribed generically Dispensed generically(5) BNF chapter 2003 2004 2003 2004 4: Central nervous system 89.7% 90.1% 71.9% 72.5% 5: Infections 95.2% 95.9% 87.3% 88.1% 6: Endocrine system 69.9% 73.4% 57.2% 58.3% 7: Obstetrics, gynaecology, and urinary-tract 37.6% 40.4% 6.3% 6.2% disorders 8: Malignant disease and immunosuppression 83.5% 84.0% 61.8% 60.5% 9: Nutrition and blood 54.6% 53.3% 45.5% 46.5% 10: Musculoskeletal and joint diseases 78.5% 80.8% 49.3% 49.2% 11: Eye 63.0% 64.7% 36.0% 35.2% 12: Ear, nose and oropharynx 51.6% 52.1% 23.8% 22.4% 13: Skin 41.5% 43.4% 21.4% 21.9% 14: Immunological products and vaccines 21.9% 19.5% 21.4% 18.9% 15: Anaesthesia 50.3% 50.5% 47.5% 47.2%
Other 26.8% 26.2% 26.5% 26.0% Total (excluding dressings and appliances) 77.8% 79.0% 55.4% 57.7%
Notes: 1. BNF chapters are based on the British National Formulary (September 2003). See paragraph 41. 2. The data are from the PCA system and cover all prescription items dispensed by community pharmacists and appliance contractors, dispensing doctors and personal administration. 3. The table covers BNF chapters 1 to 15 and “others”—see note 4 below. Dressings and appliances are excluded. 4. The “Other” category covers drugs contained in pseudo British National Formulary chapters used by the Prescription Pricing Authority, eg homeopathic preparations. 5. Prescriptions which were written generically, are available generically and reimbursed at the Drug TariV or generic price.
Table 9 NUMBER, NET INGREDIENT COST (NIC) AND AVERAGE NIC PER PRESCRIPTION ITEM BY BRITISH NATIONAL FORMULARY CHAPTERS, 2003 AND 2004
England Prescription items Net ingredient cost (£millions) Average net ingredient cost (millions) per prescription item (£)
BNF Chapter 2003 2004 % Change 2003 2004 % Change Increase 2003 2004 % Change 1: Gastro-intestinal system 48.8 51.1 4.8 636.8 647.7 1.7 10.9 13.05 12.66 "3.0 2: Cardiovascular system 179.9 200.6 11.5 2,010.7 2,151.1 7.0 139.8 11.18 10.72 "4.1 3: Respiratory system 50.2 50.8 1.2 715.7 772.9 8.0 57.3 14.26 15.22 6.7 4: Central nervous system 117.8 121.9 3.5 1,310.3 1,431.6 9.3 121.3 11.13 11.74 5.5 5: Infections 42.4 41.5 "2.1 235.2 240.2 2.1 4.9 5.55 5.79 4.3 6: Endocrine system 50.5 54.2 7.4 705.0 772.2 9.6 67.8 13.96 14.25 2.1 7: Obstetrics, gynaecology 15.5 16.2 4.5 205.2 230.4 12.3 25.2 13.26 14.25 7.5 and urinary-tract disorders 8: Malignant disease and 3.8 4.0 4.8 268.4 292.1 8.8 23.7 70.48 73.19 3.8 immunosuppression 9: Nutrition and blood 19.0 21.2 11.5 265.4 294.4 10.9 28.9 13.96 13.89 "0.5 10: Musculoskeletal and joint 29.2 29.6 1.5 285.0 305.0 7.0 20.0 9.76 10.29 5.4 diseases 11: Eye 15.1 15.8 5.0 103.7 113.0 9.0 9.3 6.89 7.14 3.7 12: Ear, nose and oropharynx 9.6 9.5 "1.9 56.6 59.0 4.2 2.4 5.87 6.24 6.2 13: Skin 34.7 35.0 0.8 201.3 210.3 4.5 9.0 5.79 6.00 3.6 14: Immunological products 13.1 13.8 5.3 115.4 126.0 9.1 10.6 8.83 9.15 3.7 and vaccines 15: Anaesthesia 0.8 0.8 1.5 3.2 3.6 12.0 0.4 3.94 4.35 10.3
Other 1.4 1.5 9.1 21.6 28.1 30.3 6.5 15.41 18.40 19.4 Dressings and appliances 17.9 18.5 3.5 370.6 402.0 8.5 31.4 20.67 21.67 4.8 Overall Total 649.7 686.1 5.6 7,510.1 8,079.6 7.6 569.4 11.56 11.78 1.9
Notes: 1. Therapeutic classes are based on the British National Formulary (September 2003). See paragraph 41. 2. The data are from the PCA system and cover all prescription items dispensed by community pharmacists and appliance contractors, dispensing doctors, and personal administration. 3. The “Other” category covers drugs contained in pseudo British National Formulary chapters used by the Prescription Pricing Authority, eg homeopathic preparations. 3178271228 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 361 8 9 3 1.4 3.8 to 15, are % of the overall items personally .1 4.1 7.5 3.5 8.6 2.1 1.6 ONAL FORMULARY SECTIONS Table 10 3). See paragraph 41. Only those therapeutic areas in the BNF, ie Chapters 1 y community pharmacists, appliance contractors, dispensing doctors and PA pseudo classifications are excluded. Prescription items (millions) Net ingredient cost (£millions) WHICH HAD THE GREATEST INCREASE IN NIC BETWEEN 2003 AND 2004 ecting The Immune Response 0.9 1.0 5.7 81.3 88.8 7.5 9.2 1.4 ecting Bone Metabolism 2.9 3.8 32.1 97.8 125.5 27.7 28.3 5.2 V V NUMBER AND NET INGREDIENT COST (NIC) IN 2003 AND 2004 FOR THE 20 BRITISH NATI : otes ngland 8.2 : Drugs A 4.9 : Drugs Used In Park’ism/Related Disorders 2.8 2.9 1.4 79.1 86.6 7.5 9.5 3.1 : Bronchodilators 24.6 24.8 0.6 245.6 253.6 8.0 3.3 1.5 2.6 : ”Nit,Calc Blockers & Potassium Activators” 29.2 30.7 5.3 403.9 412.4 9.4 : Oral Nutrition 3.7 4.0 7.6 148.6 163.4 14.8 9.9 2.8 8.3 : Sex Hormones & Antag In Malig Disease 2.0 2.0 1.7 181.1 196.0 15.0 8.3 2. 7.4 : Drugs For Genito-Urinary Disorders 5.3 6.0 11.8 137.9 158.3 20.4 14.8 4.2 : Drugs Used In Psychoses & Rel.Disorders 6.4 6.6 3.8 197.3 219.2 21.8 11 4.7 : Analgesics 45.8 46.6 1.7 273.9 298.7 24.8 9.1 4.7 4.8 : Antiepileptics 8.1 8.6 6.5 165.8 192.1 26.3 15.9 4.9 6.6 : Drugs A 2.9 : Antiplatelet Drugs 24.4 27.4 12.0 110.8 144.8 34.1 30.7 6.4 2.5 : Antihypertensive Therapy 33.8 38.6 14.2 575.8 610.0 34.3 6.0 6.4 3.2 : Corticosteroids (Respiratory) 12.9 13.5 4.4 363.2 410.7 47.5 13.1 8. 6.1 : Drugs Used In Diabetes 22.3 24.5 9.8 390.6 450.6 60.0 15.4 11.3 14.4 : Vaccines And Antisera 13.1 13.8 5.3 111.9 122.7 10.8 9.7 2.0 4.11 : Drugs for Dementia 0.4 0.5 40.0 31.3 42.8 11.4 36.4 2.1 4.10 : Drugs Used In Substance Dependence 3.4 4.2 25.7 54.1 71.9 17.8 32.9 3. 10.1 : Drugs Used In Rheumatic Diseases & Gout 23.9 24.4 1.9 247.1 265.6 18.4 included in the analysis. Dressings and appliances and other items in the P E 2.12 : Lipid-Regulating Drugs 22.7 29.4 30.0 715.0 769.2 54.2 7.6 10.2 administered. 2. BNF sections are based on the British National Formulary (September 200 BNF Section 2003 2004 % Change 2003 2004 Increase % Change increase in 2004 N 1. The data are from the PCA system and cover prescription items dispensed b 3178271229 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 362 Health Committee: Evidence 3.3 1.5 7.2 3.1 8.1 17.2 " " " " " " to 15, are .7 6.5 .5 8.3 items personally 26.5 2.7 .0 33.2 7.0 0.3 10.9 5.4 .1 13.9 13.4 OR THE 20 BRITISH 16.5 21.3 21.0 " Net ingredient cost Average net ingredient cost Table 11 3). See paragraph 41. Only those therapeutic areas in the BNF, ie Chapters 1 y community pharmacists, appliance contractors, dispensing doctors and PA pseudo classifications are excluded. Prescription items (millions) (£millions) per item (£) NATIONAL FORMULARY SECTIONS WHICH HAD THE GREATEST NIC IN 2004 NUMBER, NET INGREDIENT COST (NIC) AND AVERAGE NIC PER ITEM IN 2003 AND 2004 F ecting Bone Metabolism 2.9 3.8 32.1 97.8 125.5 28.3 33.7 32.7 -2.9 V : otes ngland 6.4 : Sex Hormones 6.5 5.5 0.0 137.7 114.9 6.6 : Drugs A 2.9 : Antiplatelet Drugs 24.4 27.4 12.0 110.8 144.8 30.7 4.5 5.3 16.8 7.4 : Drugs For Genito-Urinary Disorders 5.3 6.0 11.8 137.9 158.3 14.8 25.8 9.4 : Oral Nutrition 3.7 4.0 7.6 148.6 163.4 9.9 40.5 41.4 2.2 5.1 : Antibacterial Drugs 37.6 36.5 -3.0 168.8 170.9 1.3 4.5 4.7 4.4 4.8 : Antiepileptics 8.1 8.6 6.5 165.8 192.1 15.9 20.5 22.3 8.8 8.3 : Sex Hormones & Antag In Malig Disease 2.0 2.0 1.7 181.1 196.0 8.3 92.7 98 4.2 : Drugs Used In Psychoses & Rel.Disorders 6.4 6.6 3.8 197.3 219.2 11.1 31 3.1 : Bronchodilators 24.6 24.8 0.6 245.6 253.6 3.3 10.0 10.2 2.6 4.7 : Analgesics 45.8 46.6 1.7 273.9 298.7 9.1 6.0 6.4 7.2 4.3 : Antidepressant Drugs 27.7 29.0 4.8 395.2 400.7 1.4 14.3 13.8 3.2 : Corticosteroids (Respiratory) 12.9 13.5 4.4 363.2 410.7 13.1 28.1 30 2.6 : Nit,Calc Blockers & Potassium Activators” 29.2 30.7 5.3 403.9 412.4 2 6.1 : Drugs Used In Diabetes 22.3 24.5 9.8 390.6 450.6 15.4 17.5 18.4 5.1 1.3 : Ulcer-Healing Drugs 22.4 24.5 9.5 466.5 469.4 0.6 20.8 19.1 2.5 : Antihypertensive Therapy 33.8 38.6 14.2 575.8 610.0 6.0 17.0 15.8 14.4 : Vaccines And Antisera 13.1 13.8 5.3 111.9 122.7 9.7 8.6 8.9 4.2 10.1 : Drugs Used In Rheumatic Diseases & Gout 23.9 24.4 1.9 247.1 265.6 7.5 1 included in the analysis. Dressings and appliances and other items in the P E BNF Section 2003 2004 * Change 2003 2004 * Change 2003 2004 * Change administered. 2. BNF sections are based on the British National Formulary (September 200 2.12 : Lipid-Regulating Drugs 22.7 29.4 30.0N 715.0 769.2 7.6 31.6 26.1 1. The data are from the PCA system and cover prescription items dispensed b 3178271230 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 363
Q (187) 18–week target—data modelling on the diagnostic waiting times
Answer 1. To support delivery of the 18–week patient pathway, the Department of Health has been working with 21 pilot sites from across the NHSduring 2005 on developing a diagnostics w aiting times and activity data collection. Drawing on the outcomes of this work, the new commissioner based diagnostics data collection will be rolled out to the NHSin January 2006. 2. The pilot sites collected data on waiting times and activity for a short list of diagnostic tests/procedures. Details of the sites and diagnostic tests piloted are shown in the annex below. Pilot diagnostics data collections have helped refine the list of diagnostic tests/procedures to be included in the national data collection. 3. Since this has been a pilot exercise, we have no plans to publish the associated data. The data collected from the pilots is unvalidated management information collected to help to refine the list of diagnostic tests/ procedures to be included in the national data collection. Pilot sites submitted data in the knowledge that it was unvalidated and of variable data quality. The data may potentially be misleading, therefore, and it would not be appropriate to publish it. 4. Once we commence the national data collection in January 2006, we will need to do some preliminary quality assurance of the data prior to committing to dissemination. However, over time, we will commence routine publication of data on diagnostic waiting times and activity and expect the first report to be published during Spring 2006.
Annex
List of 18 weeks pilot sites
Aintree Hospitals NHSTrust Blackpool, Fylde and Wyre Hospitals NHSTrust Bromley Hospitals NHSTrust Central Manchester & Manchester Childrens’s Hospitals University NHSTr ust East Lancashire Hospitals NHSTrust Gateshead Health NHSTrust Guy’s & St Thomas’ NHS Foundation Trust Harrogate and District NHSFoundation Trust Luton & Dunstable Hospital NHSTrust Mayday Healthcare NHSTrust Morecambe Bay Hospitals NHSTrust Royal Orthopaedic Hospital NHSTrust Royal Surrey County Hospital NHS Trust Royal United Hospitals Bath NHSTrust Sherwood Forest Hospitals NHS Trust St George’s Healthcare NHS Trust Stockport NHS Foundation Trust Surrey & Sussex Healthcare NHS Trust University College London Hospitals NHSFoundation Trust Wirral Hospitals NHSTrust 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 3178271230 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 364 Health Committee: Evidence
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 NHSFoundation Trusts, was estab lished 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 NHSfoundation 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 NHStrusts 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 NHSfounda tion trusts are attached.
Cash support payments
Wave & Group NHS Foundation Trust Group Backfill Funding £ Wave 1 “Group 1”: Basildon and Thurrock University Hospitals NHSFoundati on Trust 250,000 Authorised from 01-Apr-04 Wave 1 “Group 1”: Bradford Teaching Hospitals NHSFoundation Trust 250,00 0 Authorised from 01-Apr-04 Wave 1 “Group 1”: Countess of Chester NHSFoundation Trust 250,000 Authorised from 01-Apr-04 Wave 1 “Group 1”: Doncaster and Bassetlaw Hospitals NHSFoundation Trust 2 50,000 Authorised from 01-Apr-04 Wave 1 “Group 1”: Homerton University Hospital NHSFoundation Trust 250,0 00 Authorised from 01-Apr-04 Wave 1A “Group 1”: Moorfields Eye Hospital NHSFoundation Trust 250,000 Authorised from 01-Apr-05 3178271231 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 365
Wave & Group NHS Foundation Trust Group Backfill Funding £ Wave 1A “Group 1”: Peterborough and Stamford Hospitals NHS Foundation Trust 250,000 Authorised from 01-Apr-05 Wave 1A “Group 1”: Royal Devon and Exeter NHSFoundation Trust 250,000 Authorised from 01-Apr-05 Wave 1A “Group 1”: Stockport NHS Foundation Trust 250,000 Authorised from 01-Apr-05 Wave 1A “Group 1”: The Royal Marsden NHSFoundation Trust 250,000 Authorised from 01-Apr-05 Wave 1A “Group 2” Cambridge University Hospitals NHSFoundation Trust 250 ,000 Authorised from 01-Jul-05 Wave 1A “Group 2” City Hospital Sunderland NHS Foundation Trust 250,000 Authorised from 01-Jul-05 Wave 1A “Group 2” Gloucestershire Hospitals NHSFoundation Trust 250,000 Authorised from 01-Jul-05 Wave 1A “Group 2” Guy’s and St Thomas’ Hospital NHS Foundation Trust 250,000 Authorised from 01-Jul-05 Wave 1A “Group 2” Papworth Hospital NHSFoundation Trust 250,000 Authorised from 01-Jul-05 Wave 1 “Group 2”: SheYeld Teaching Hospitals NHSFoundation Trust 250,000 Authorised from 01-Jul-04 Wave 1 “Group 2”: Derby Hospitals NHSFoundation Trust 250,000 Authorised from 01-Jul-04 Wave 1 “Group 2”: The Queen Victoria Hospital NHSFoundation Trust 250,000 Authorised from 01-Jul-04 Wave 1 “Group 2”: University College London Hospitals NHSFoundation Trus t 250,000 Authorised from 01-Jul-04 Wave 1 “Group 2”: University Hospital Birmingham NHSFoundation Trust 250 ,000 Authorised from 01-Jul-04 Wave 1A “Group 3”: Barnsley District General Hospital NHSFoundation Trus t 175,000 Authorised from 01-Jan-05 Wave 1A “Group 3”: Chesterfield and North Derbyshire Royal Hospitals NHSTr ust 175,000 Authorised from 01-Jan-05 Wave 1A “Group 3”: Gateshead Health NHSFoundation Trust (authorised 175, 000 Authorised 5 January) from 01-Jan-05 Wave 1A “Group 3”: Harrogate Healthcare NHSFoundation Trust 175,000 Authorised from 01-Jan-05 3178271232 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 366 Health Committee: Evidence
Wave & Group NHS Foundation Trust Group Backfill Funding £ Wave 1A “Group 3”: South Tyneside Healthcare NHS Foundation Trust 175,000 Authorised from 01-Jan-05
Wave 1A “Group 4” Heart of England NHSFoundation Trust 175,000 Authorised from 01-Apr-05
Wave 1A “Group 4” Frimley Park Hospitals NHSFoundation Trust 175,000 Authorised from 01-Apr-05
Wave 1A “Group 4” Lancashire Teaching Hospitals NHSFoundation Trust 175, 000 Authorised from 01-Apr-05
Wave 1A “Group 4” Liverpool Women’s Hospital NHSFoundation Trust 175,000 Authorised from 01-Apr-05
Wave 1A “Group 4” Royal National Hospital for Rheumatic Diseases NHSFound ation 175,000 Authorised Trust from 01-Apr-05
Wave 1A “Group 4” The Royal Bournemouth and Christchurch NHSFoundation Tr ust 175,000 Authorised from 01-Apr-05
Wave 1A “Group 4” Rotherham General Hospital NHSFoundation Trust 175,000 Authorised on 1 June 2005
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 3178271233 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 367
Activity Type Cost £ 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 NHScapital expenditure attributed to PFI is n ormally 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 3178271233 Page Type [E] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Ev 368 Health Committee: Evidence
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 NHSfoundation 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 NHSfoundation trusts for a full ye ar and a further 15 for a part year. The 2005–06 update figures cover 32 NHSfoundation trusts.
2. Financial performance 2004–05
Monitor’s “Review and consolidated accounts of NHSfoundation trusts 200 4–05” was laid before Parliament on 22 November 2005. The consolidated accounts show that NHSfoundation trusts had a surplus fo r 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 NHSfoundation trusts had deficits for 2004–05—five of those were of less t han £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 NHSfounda tion trusts for the year to date. 3178271234 Page Type [O] 27-04-06 16:18:00 Pag Table: COENEW PPSysB Unit: PAG2
Health Committee: Evidence Ev 369
The half-year update shows that NHSfoundation trusts had a deficit of £2 mil lion 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 NHSfoundation trusts make payments to government on the public dividend c apital which they have in their balance sheets. As NHSfoundation trusts are autonomous organisati ons 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 NHSfoundation trusts are subject to a di Verent 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 NHSfoundation 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 NHSfoundation trusts with deficits with the rest of the NHS. Monitor scrutinises NHSfoundation trusts to ensure that they remain comp liant 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 NHSactivity is transferred to the ISTC,NHStraining will also transfer—this will include the transfer of NHStraining 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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