Select Committee on Health Minutes of Evidence

Health Select Committee Public Expenditure Inquiry 2002


1.  10 years worth of EU Average, EU countries and UK expenditure figures as a proportion of GDP.

  The information requested is contained in the attached table at Annex A.

2.  Confirmation of the Department's assumption that private sector expenditure on healthcare will remain broadly static.

  The forecasts for Health Care Expenditure as a percentage of GDP are consistent with those used in the independant Wanless Report. The report used a figure of 1.15 per cent for private healthcare expenditure (rounded to one decimal place for publication to 1.2 per cent). Also, due to the difficulties in forecasting this expenditure, Wanless assumed that it would remain constant across the period. This could be considered a prudent assessment but for consistency we have decided to continue to use the figures published by Wanless.

The Health Select Committee may be interested to know that another independent body—The European Observatory on Healthcare Systems also used the same assumptions in their study "European Healthcare systems in Eight Countries".

3.  Information on progress around tele-health/medicine

  The Chairman of the committee had a detailed query on the delivery of tele-health. As such the response is also detailed and has been attached as a separate paper titled "Tele-health"

4.  Confirmation that the apparent reduction in spending on the geriatric sector was due to the transfer of patients with specific ailments to specialists rather than a reduction in care for older people.

  The recent fall in spending on geriatric care as a proportion of total hospital expenditure is primarily because it is becoming more common for elderly patients—those aged 65 and over—to be seen by specialists according to their medical condition. This is consistent with the explanation given the committee by Richard Douglas.

5.  A copy of the letter referred to by Giles Denham in respect of the suggestion that standards of care for older people are falling—(Ian Philps response to article in HSJ 19 September Page 6).

  The letter referred to is attached at Annex B.

6.  An assessment of the cost of agency nurses to the hospital sector as a whole—to be drawn from annual accounts when ready.

  The information requested is not currently available and will follow under separate cover.

7.  Examples of "quality" to be measured for the NHS efficiency index.

  The indicators of quality we aim to use are those that relate most closely to outcomes of care, such as the number of deaths following surgery and strokes. Other indicators that can potentially indicate changes in the quality of care includes: the proportion of people returning home following treatment, the readmission rates and the information we are collecting through the patient survey.

  We have taken care to identify measures that provide a robust indication of quality. The relatively small numbers involved can mean that purely random year on year variation produces fairly large proportionate changes. We also need to ensure that apparent changes in performance are not due to improved data collection. This could occur, for example, if we become better at tracking patients that have been readmitted to hospital following an earlier discharge.

8.  Note on the proportion of consultant to consultant referrals.

  Attached at Annex C is a table and chart showing GP and "other" referrals. The "other" referrals include consultant to consultant, as well as referrals from A&E, and other sources—separate figures are not available.

  The table shows that these and other referrals have recently been growing generally at a faster rate than GP referrals, but these are not necessarily "new" referrals into the system.

9.  Proposals for allocating money in respect of populations transferring between social services/local authority areas.

  There are three potential measures of the elderly population included in the consultation paper. These are resident population; household population (total population minus those in institutions); and household population plus the number of clients supported by local authorities. In recent years the older people formulae have been based on either resident population or household population. If we were to move to a single older people's formula then we would have to adopt a single population measure.

  The residential population includes all people living in an area including those in institutions. As some authorities place clients in other boroughs, there is a risk with using this population measure, as the authority in which the client is placed will gain even though a different authority is responsible for financing their care. On the other hand those authorities that place extensively outside of their boundaries will not be compensated and may suffer from an under-allocation of resources.

  The household population excludes all those living in institutions. This population measure overcomes the problem of out of borough placements, but it does not compensate an authority who may have to support a larger number of older people in residential care, as they will receive no support for those already in care. In the extreme case, if an authority placed all its clients in residential care, they would receive no funding at all.

  The third option includes the local authority household population plus the number of local authority supported residents in residential /nursing placements. The advantage of this option is that it does not count any people in the wrong area as total resident population does, and it includes most care home residents rather than omit them, as household population does.

  Julia Drown MP asked for the justification for not adopting the third option. The main argument authorities have used on why the resident population should be adopted is that neither of the other options include self funders in care homes. The authorities have argued that these clients, who have placed themselves in an area, are likely at some stage to become the responsibility of the host authority, and therefore should be included in the population count. The other argument for using the resident population is that households population is based on census information about the proportion of people resident in households, which is not updateable between censuses and can quickly become out of date.

  The Government is still considering the responses to the consultation and has not yet reached a decision on which population to use in the elderly formula.

10.  How much of "other spend" under the Programme Budget breakdown is "litigation" and how much of that is maternity related?

  Of the "other" spend, £91 million is litigation (clinical negligence) but it is not possible to break that down to say how much is maternity related. This does not reflect the full cost of clinical negligence to the NHS. This is because the Programme Budget is derived from an analysis of Health Authority expenditure. In 2000-01 the majority of expenditure on Clinical Negligence was incurred by NHS trusts.

11.  What steps is the Dept taking to collect data from units which do not submit "maternity tails" data. What is being done to collect data from the private sector and improve data collection outside hospitals?

  Units that find it difficult to submit maternity tails have the option of submitting separate "flat-file" data through a service offered by the NHS Wide Clearing Service. The Department will continue to press for complete and accurate data and to provide feedback to trusts through the data quality indicator. In particular, the Department will approach these trusts to draw attention to their situation in relation to other trusts, to stress the importance of the data and to alert trusts to the "flat-file" service. HES collects "other maternity", which should cover home births and those in private hospitals, but there are limited resources to improve the generally poor coverage.

12.  What progress has been made since March 2001 with the Maternity Care Data Project? Is it on course to achieve its aim by April 2003—to have standardised and consistent recording of data related to maternity and childbirth, for women and infants, within Electronic Patient Record systems in all affected NHS organisations?

  The Committee is referred to the answer provided in the memorandum at question 1.5.2.[1] The Department believes this covers the points raised. DoH is of course happy to supply further information should it be required.

13.  Check on whether information is centrally held on mothers-to-be choosing to have caesarean sections.

14.  Forecast over 30 years of interest and capital costs of PFI schemes excluding the services element.

  The forecast table shows known and estimated cumulative expenditure on the part of PFI unitary payments representing building maintenance costs ("Hard" FM), the cost of the asset and repaying debt on existing and planned PFI projects (called here the "tariff"). The planned schemes are:

    (i)  all the medium (£10-£20 million) and major (£20 million+) schemes currently approved to go ahead and counting towards the NHS Plan target of "100 new hospital schemes by 2010" not yet reached financial close; and

    (ii)  a reasonable assumption that the number of small schemes (£1-£10 million) reaching financial close from now until 2010 will be about the same as have already signed contracts.

  All PFI schemes are different and contain different levels of support services; there is no mathematical formula for calculating precisely what the final unitary payment will be. However, the tariff is certainly a function of capital value and forecasts can therefore be reasonably accurately extrapolated from data for schemes,which have already reached financial close.

  The spreadsheet shows forecast tariff figures for scheme yet to sign alongside the existing tariffs already submitted to the committee so that the relative proportions and totals for all schemes counting towards the NHS Plan target can be clearly seen.

  The supporting table is attached as a separate file titled Annex D—Revenue Forecasts.

1   See Public Expenditure and Health and Personal Social Services 2002 [HC 1210] Back

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