SDR 112/2008
31 July 2008
NHS Expenditure Programme Budgets: 2003-04 to 2006-07
Introduction
The programme budgeting project provides a retrospective analysis of NHS resources broken down into 'programmes', with a view to a greater understanding of where the money is going. Previous analyses of expenditure were often based on the provider of care and broken down in a way which illustrated the organisational structure of the NHS rather than the medical conditions experienced by the patient. Programme budget information has been made available within the NHS before, but this Statistical Release is the first publication for a general audience. This publication covers all Local Health Board (LHB) and Health Commission Wales (HCW) expenditure, including that on primary care services. Key results for Wales are presented in Tables 2-5 and Figure 1. The two largest budget categories are shown in Figures 2 and 3 as examples of the range of expenditure by LHB. Full details for individual LHBs are published on the StatsWales website www.statswales.wales.gov.uk .
Background
In 2004, the Welsh Assembly Government initiated the national programme budget project. The aim of the project is to develop a primary source of information, which can be used by all bodies, to give a greater understanding of ‘where the money is going’ in the NHS. The project aims to provide evidence to answer this question by mapping all LHB and HCW expenditure, including that on primary care services, to programmes of care based on medical conditions. The programmes of care, i.e. programme budget categories (PBCs), are defined by reference to the International Classification of Diseases Version 10 codes (ICD 10). Most PBCs reflect ICD 10 chapter headings, e.g. cancer, coronary heart disease, problems of the skin, etc. In this context, each category represents a programme of care focused on the recipient, rather than the provider of care. The focus on medical conditions clearly forges a closer and more obvious link between the expenditure and the patient care it delivers.
Key Points for 2006-07
• • The largest single programme budget category is spending on mental health problems, which amounted to 12% of the total. 11.3% of expenditure overall is commissioned by Health Commission Wales, ranging from 0.1% of the category total for dental problems to 30.5% for neonatal conditions (problems in the first four weeks after birth). Spending per head of the population ranged from £7.70 on hearing problems to £185 on mental health problems.
•
Contact: Tel: 029 2082 3134 E-mail: stats.healthinfo@wales.gsi.gov.uk
Next Update: March 2009 (provisional)
Table 1: NHS expenditure by programme budget category, 2003-04 to 2006-07.
£ millions 2006-07 64.6 294.6 46.7 141.2 67.3 73.9 546.5 235.4 145.5 36.1 129.6 89.9 154.3 93.9 22.8 465.4 301.7 173.3 269.7 97.0 238.2 304.6 204.1 84.7 15.6 26.3 77.5 178.4 37.6 54.8 134.8 47.5 608.7 294.6 52.8 54.3 206.9 4,570.3
2003-04 Infectious diseases Cancers & tumours Blood disorders Endocrine, nutritional & metabolic problems Diabetes Other Mental health problems General mental illness Elderly mental illness Child & adolescent mental health Other mental health Learning disability problems Neurological system problems Eye/vision problems Hearing problems Circulation problems Respiratory problems Dental problems Gastro intestinal problems Skin problems Musculo skeletal system problems (exc Trauma) Trauma & injuries (inc burns) Genito Urinary system disorders (exc infertility) Genital tract problems Renal problems Chronic renal failure Other Maternity & reproductive health Neonates Poisoning Total Healthy individuals Social care needs Unknown programme category General medical services Open access Continuing care Other expenditure Total, all PBC 51.2 226.2 36.1 112.2 . . 429.0 . . . . 75.3 106.7 78.5 19.8 381.9 241.1 136.7 239.9 81.1 163.8 221.9 159.1 . . . . 152.1 27.0 34.5 89.4 44.6 518.3 . . . . 3,626.5
2004-05 57.1 244.8 41.2 123.0 . . 469.8 214.4 125.6 28.7 101.0 78.5 115.5 82.1 24.7 417.0 249.5 141.5 261.8 86.8 208.4 253.0 173.5 . . . . 151.0 33.4 40.3 121.4 51.7 567.9 301.8 47.3 41.2 177.6 3,993.9
2005-06 58.3 265.8 37.7 141.7 64.8 76.9 510.0 219.5 135.0 37.3 118.1 87.4 132.3 86.7 24.9 429.5 273.4 156.2 276.1 89.4 224.6 294.1 193.2 80.9 13.1 25.5 73.8 160.8 36.1 47.7 123.8 45.1 574.9 311.6 53.9 45.5 163.9 4,269.6
.
Data item not applicable : Breakdown figures not available for some sub-categories in the financial years 2003-04 and 2004-05.
Table 2: NHS expenditure per head of population by programme budget category, 2003-04 to 200607.
£ per head 2006-07 21.8 99.3 15.7 47.6 22.7 24.9 184.3 79.4 49.1 12.2 43.7 30.3 52.0 31.6 7.7 156.9 101.7 58.4 90.9 32.7 80.3 102.7 68.8 28.6 5.3 8.9 26.1 60.1 12.7 18.5 45.5 16.0 205.2 99.3 17.8 18.3 69.8 1,540.9
2003-04 Infectious diseases Cancers & tumours Blood disorders Endocrine, nutritional & metabolic problems Diabetes Other Mental health problems General mental illness Elderly mental illness Child & adolescent mental health Other mental health Learning disability problems Neurological system problems Eye/vision problems Hearing problems Circulation problems Respiratory problems Dental problems Gastro intestinal problems Skin problems Musculo skeletal system problems (exc Trauma) Trauma & injuries (inc burns) Genito Urinary system disorders (exc infertility) Genital tract problems Renal problems Chronic renal failure Other Maternity & reproductive health Neonates Poisoning Total Healthy individuals Social care needs Unknown programme category General medical services Open access Continuing care Other expenditure Total, all PBC 17.4 76.8 12.3 38.1 . . 145.6 . . . . 25.6 36.2 26.7 6.7 129.6 81.8 46.4 81.4 27.5 55.6 75.3 54.0 . . . . 51.6 9.2 11.7 30.4 15.1 175.9 . . . . 1,230.8
2004-05 19.4 83.1 14.0 41.7 . . 159.4 72.8 42.6 9.7 34.3 26.7 39.2 27.9 8.4 141.5 84.7 48.0 88.9 29.5 70.7 85.9 58.9 . . . . 51.2 11.3 13.7 41.2 17.5 192.7 102.4 16.1 14.0 60.3 1,355.5
2005-06 19.7 90.0 12.8 48.0 21.9 26.0 172.7 74.3 45.7 12.6 40.0 29.6 44.8 29.4 8.4 145.4 92.6 52.9 93.5 30.3 76.1 99.6 65.4 27.4 4.5 8.6 25.0 54.4 12.2 16.1 41.9 15.3 194.7 105.5 18.3 15.4 55.5 1,445.6
.
Data item not applicable : Breakdown figures not available for some sub-categories in the financial years 2003-04 and 2004-05.
Table 3: NHS expenditure by programme budget category and commissioning sector, 2006-07.
£ millions LHB (1) primary 26.6 29.8 7.6 92.1 47.1 44.9 77.6 15.4 5.2 8.2 48.9 1.9 37.8 36.9 1.0 174.2 92.4 140.5 61.5 31.3 35.2 14.4 29.3 7.1 4.2 1.9 16.2 10.4 0.4 0.7 28.1 3.0 359.9 285.0 1.0 2.6 71.3 1,292.9 LHB secondary 35.4 229.1 25.3 41.9 18.7 23.2 402.6 193.0 140.3 18.3 51.1 87.7 91.8 54.5 19.4 195.4 190.0 32.6 192.4 60.7 191.8 232.4 133.3 76.0 5.1 3.2 49.0 162.8 25.7 46.0 71.7 30.8 209.4 8.7 51.8 51.7 97.1 2,763.0 LHB total 62.0 258.9 32.9 134.0 65.9 68.1 480.3 208.5 145.4 26.4 99.9 89.7 129.6 91.5 20.4 369.7 282.4 173.1 254.0 92.0 227.1 246.8 162.6 83.1 9.4 5.0 65.1 173.2 26.1 46.8 99.7 33.9 569.3 293.7 52.8 54.3 168.5 4,055.9 HCW
(2)
All
(3)
Infectious diseases Cancers & tumours Blood disorders Endocrine, nutritional & metabolic problems Diabetes Other Mental health problems General mental illness Elderly mental illness Child & adolescent mental health Other mental health Learning disability problems Neurological system problems Eye/vision problems Hearing problems Circulation problems Respiratory problems Dental problems Gastro intestinal problems Skin problems Musculo skeletal system problems (exc Trauma) Trauma & injuries (inc burns) Genito Urinary system disorders (exc infertility) Genital tract problems Renal problems Chronic renal failure Other Maternity & reproductive health Neonates Poisoning Total Healthy individuals Social care needs Unknown programme category General medical services Open access Continuing care Other expenditure Total, all PBC
2.6 35.7 13.8 7.2 1.4 5.8 66.3 26.9 0.1 9.6 29.7 0.2 24.7 2.4 2.4 95.8 19.4 0.2 15.7 5.0 11.1 57.7 41.5 1.6 6.3 21.2 12.4 5.2 11.4 8.1 35.1 13.6 39.3 0.9 0.0 0.0 38.4 514.3
64.6 294.6 46.7 141.2 67.3 73.9 546.5 235.4 145.5 36.1 129.6 89.9 154.3 93.9 22.8 465.4 301.7 173.3 269.7 97.0 238.2 304.6 204.1 84.7 15.6 26.3 77.5 178.4 37.6 54.8 134.8 47.5 608.7 294.6 52.8 54.3 206.9 4,570.3
(1) (2) (3)
Includes other 'non-primary' costs (see Key Quality Information: Coverage). Health Commission Wales Total of all commissioning sectors
Table 4: NHS expenditure per head of population by programme budget category and commissioning sector, 2006-07.
£ per head LHB (1) primary 9.0 10.1 2.6 31.0 15.9 15.2 26.2 5.2 1.7 2.8 16.5 0.6 12.7 12.5 0.3 58.7 31.2 47.4 20.7 10.5 11.9 4.9 9.9 2.4 1.4 0.6 5.4 3.5 0.1 0.3 9.5 1.0 121.3 96.1 0.3 0.9 24.0 435.9 LHB secondary 11.9 77.2 8.5 14.1 6.3 7.8 135.7 65.1 47.3 6.2 17.2 29.6 31.0 18.4 6.5 65.9 64.1 11.0 64.9 20.5 64.7 78.4 44.9 25.6 1.7 1.1 16.5 54.9 8.7 15.5 24.2 10.4 70.6 2.9 17.5 17.4 32.8 931.6 LHB total 20.9 87.3 11.1 45.2 22.2 23.0 161.9 70.3 49.0 8.9 33.7 30.2 43.7 30.8 6.9 124.6 95.2 58.4 85.6 31.0 76.6 83.2 54.8 28.0 3.2 1.7 22.0 58.4 8.8 15.8 33.6 11.4 192.0 99.0 17.8 18.3 56.8 1,367.5 HCW
(2)
All
(3)
Infectious diseases Cancers & tumours Blood disorders Endocrine, nutritional & metabolic problems Diabetes Other Mental health problems General mental illness Elderly mental illness Child & adolescent mental health Other mental health Learning disability problems Neurological system problems Eye/vision problems Hearing problems Circulation problems Respiratory problems Dental problems Gastro intestinal problems Skin problems Musculo skeletal system problems (exc Trauma) Trauma & injuries (inc burns) Genito Urinary system disorders (exc infertility) Genital tract problems Renal problems Chronic renal failure Other Maternity & reproductive health Neonates Poisoning Total Healthy individuals Social care needs Unknown programme category General medical services Open access Continuing care Other expenditure Total, all PBC
0.9 12.0 4.7 2.4 0.5 1.9 22.3 9.1 0.0 3.3 10.0 0.1 8.3 0.8 0.8 32.3 6.5 0.1 5.3 1.7 3.8 19.5 14.0 0.5 2.1 7.2 4.2 1.7 3.9 2.7 11.8 4.6 13.3 0.3 0.0 0.0 12.9 173.4
21.8 99.3 15.7 47.6 22.7 24.9 184.3 79.4 49.1 12.2 43.7 30.3 52.0 31.6 7.7 156.9 101.7 58.4 90.9 32.7 80.3 102.7 68.8 28.6 5.3 8.9 26.1 60.1 12.7 18.5 45.5 16.0 205.2 99.3 17.8 18.3 69.8 1,540.9
(1) (2) (3)
Includes other 'non-primary' costs (see Key Quality Information: Coverage). Health Commission Wales Total of all commissioning sectors.
Table 5: NHS Expenditure by programme budget category, 2003-04 to 2006-07.
2003-04 Infectious diseases Cancers & tumours Blood disorders Endocrine, nutritional & metabolic problems Diabetes Other Mental health problems General mental illness Elderly mental illness Child & adolescent mental health Other mental health Learning disability problems Neurological system problems Eye/vision problems Hearing problems Circulation problems Respiratory problems Dental problems Gastro intestinal problems Skin problems Musculo skeletal system problems (exc Trauma) Trauma & injuries (inc burns) Genito Urinary system disorders (exc infertility) Genital tract problems Renal problems Chronic renal failure Other Maternity & reproductive health Neonates Poisoning Total Healthy individuals Social care needs Unknown programme category General medical services Open access Continuing care Other expenditure Total, all PBC 1.41 6.24 1.00 3.09 . . 11.83 . . . . 2.08 2.94 2.17 0.55 10.53 6.65 3.77 6.62 2.24 4.52 6.12 4.39 . . . . 4.19 0.74 0.95 2.47 1.23 14.29 . . . . 100.00 2004-05 1.43 6.13 1.03 3.08 . . 11.76 5.37 3.15 0.72 2.53 1.97 2.89 2.05 0.62 10.44 6.25 3.54 6.56 2.17 5.22 6.33 4.34 . . . . 3.78 0.84 1.01 3.04 1.29 14.22 7.56 1.18 1.03 4.45 100.00 2005-06 1.37 6.23 0.88 3.32 1.52 1.80 11.94 5.14 3.16 0.87 2.77 2.05 3.10 2.03 0.58 10.06 6.40 3.66 6.47 2.09 5.26 6.89 4.53 1.89 0.31 0.60 1.73 3.77 0.85 1.12 2.90 1.06 13.47 7.30 1.26 1.07 3.84 100.00 Percentage 2006-07 1.41 6.45 1.02 3.09 1.47 1.62 11.96 5.15 3.18 0.79 2.83 1.97 3.38 2.05 0.50 10.18 6.60 3.79 5.90 2.12 5.21 6.66 4.47 1.85 0.34 0.57 1.70 3.90 0.82 1.20 2.95 1.04 13.32 6.45 1.16 1.19 4.53 100.00
.
Data item not applicable : Breakdown figures not available for some sub-categories in the financial years 2003-04 and 2004-05.
%
En d In r in fe
Is le
oc
%
10.00
C
12.00
14.00
16.00
18.00
0.00
2.00
4.00
6.00
8.00
Bl
nu
of A
e,
10
12
14
0
2
4
6
8
10.0 13.9 15.3 12.5 12.8 13.5
9.3
9.2
10.5
9.4
Figure 1: Percentage of NHS expenditure (all commissioning sectors, all LHBs) by programme budget category, 2004-05 to 2006-07.
Figure 2: Percentage of NHS expenditure (all commissioning sectors) by LHB for mental health programme budget category, 2006-07.
2006-07
2004-05
12.0 11.9
2005-06
9.4
2006-07
13.2
All Wales: 2006-07
12.3 13.5 12.4 14.4
9.7
11.3
9.0
n ae gle na se y u G we Br n t id g Ca end er ph illy Ca rm Ca r ar th diff en Ce sh ir re e di gi on Co De nb nw y ig hs hi r Fl in e ts hir G wy e M er ne d t M hyr d on Ty Ne mo dfi l ut at h h Po s hir e rt Ta lb o Pe Ne t wp m br or ok t es R ho hi re nd da Po ,C w yn ys on ,T Sw aff Th an e Va se le To a of rfa G e la m n or ga W re n xh am
ct io us an c e d is tri ea rs tio se & na s tu Bl l& m oo ou m d et rs di M a so e n bo rd Le li c ta lh ar p r e rs ni ob ea N ng eu le lth ro di pr ms sa lo ob gi ca b ilit le m y ls s pr ys ob te le Ey m m e/ pr vi ob s si le on m H s pr ea ob rin C le g irc pr m s ul ob Re ati o le n m sp M s i ra p ro us bl to cu em ry lo G p s as D sk en ro b tr o el l ta et in l p em al te s sy ro G st bl st en in em em al ito p s pr Ur Sk r ob o Tr in le in ar au b le m m y pr s s y ma s (e ob le st xc e m & in m s ju T di M s o ri e s rau at m er rd a) ni er (in c ty s bu (e & rn xc re s pr od in fe ) rti uc li t ti v y) e he al N To e o th ta na lH te e a Po s is lth on y in So in G g di en ci vi al er du al ca al m r s ed e n ee ic al ds se r O pe vi ce s Co n a cc n es O tinu s th in er g ca ex re pe nd i tu re
10.6
Figure 3: Percentage of NHS expenditure (all commissioning sectors) by LHB for circulation problems programme budget category, 2006-07.
14.00 12.00 10.00
9.5 9.2 10.6 9.9 9.2 10.6 12.6 12.0 11.3 10.1 10.2 9.7 11.8 11.8 10.4 9.3 8.7 10.0 9.3 8.6 10.5 10.0
8.00 % 6.00 4.00 2.00 0.00
Notes
1. A total of 23 categories have been chosen for analysis of expenditure against programme areas. Subcategories have also been identified to provide greater analysis. The aim of the PBCs is principally to identify the amount of resource deployed to broad areas of illness on a basis that is mutually exclusive, comprehensive and based on the primary diagnosis for any encounter. The primary classification is, therefore, relative to condition rather than activity (whether preventative, curative or supportive) and uses chapter headings of the International Classification of Diseases Version 10 codes (ICD 10). 2. A total of 23 PBCs represents a compromise between the overall number of groups and the specificity of each. However, the currently drafted PBCs (and their ICD 10 definitions) may need to be revisited in light of the practical experience gained as Programme Budgeting develops. 3. It is recognised that a medical model of care may not always be appropriate in the areas of community services and social care. Accordingly there are two specific groups for ‘Healthy Individuals’ and ‘Social Care Needs’. These capture the costs of prevention programmes and services that support individuals with social rather than health care needs. In some cases, it is not possible to assign activity by medical condition, preventative activity or social care need. In such instances expenditure is allocated to a category of ‘Unknown programme category’.
4. LHB figures are based on PB returns from public and private providers of healthcare in England and
Wales. 5. Expenditure data are presented at current prices, i.e. prices relating to the period being measured, and therefore include the effects of inflation in the prices of goods and services. This should be considered when making comparisons between years. An increase in expenditure does not necessarily mean an increase in the volume or quantity of goods and services purchased
Missing value types . The data item is not applicable.
of Bl Ang ae l na ese y u G we Br nt id g Ca end er ph illy Ca rm Ca r ar th diff en Ce shir re e di gi on De Co n b nw y ig hs hi r Fl in e ts hi re G M wyn er ed t M hy r d on T Ne mo ydfi l ut at h h Po sh ir e rt Ta lb o Pe Ne t wp m br ok ort es R ho hi re nd da Po ,C w yn ys on ,T Sw aff Th an e Va se a le of Tor fa G e la m n or ga W re n xh am
2006-07 All Wales: 2006-07
Is le
Key Quality Information
Coverage 6. All expenditure on Welsh residents is included in this Release, including expenditure on services provided by NHS Trusts outside Wales. 7. The control total for the PB exercise comprises the total expenditure of LHBs in Wales, the programme expenditure of Health Commission Wales (HCW) and the Assembly funding for the Second Offer Scheme. The total figure reported in the LHB return must agree with the total expenditure figure shown in the LHB accounts (operating cost statement). The HCW figure is the programme expenditure figure in the HCW accounts. It should be noted that in 2006/07 the LHBs received an allocation for Dental expenditure which was previously held by the Dental Practice Board. Thus the StatsWales website holds figures against the Dental Practice Board as a commissioner only for years before 2006/07. 8. LHB Primary commissioning includes various other ‘non-primary’ costs such as general LHB administrative costs and voluntary sector expenditure.
Level of detail
9. The breakdowns between subcategories are less reliable than the 23 main programme budgets. The category of circulatory disease is not broken down in this Release because the subcategory of ‘Other circulatory disease’ is likely to include a significant amount of expenditure for coronary heart disease and cerebrovascular disease which can not be analysed directly to those two subcategories. Data sources 10. Figures relating to secondary care are supplied by NHS Trusts to Local Health Boards and Health Commission Wales. The allocation of expenditure to programme budget categories is carried out using the best available information, e.g. for acute inpatients and day cases, episodes are allocated to program budget category by ICD10 code and the unit cost of each episode is determined by its HRG (Healthcare Resource Group). For other types of expenditure there may be specific data from Trust Financial Returns (the TFR2 form) to support an allocation, e.g. TFR2 expenditure on mental illness services for children and adolescents can be assigned directly to the corresponding programme budget category. 11. To calculate the expenditure per head of population, the Office for National Statistics (ONS) revised Mid-Year Population Estimates (MYEs) by local authority were used. For the financial years 2003-04 and 2004-05, the 2004 MYE was included in calculations; the 2005 MYE was used for the financial year 2005-06, and the 2006 MYE was used for 2006-07. 12. Further information on how costs are allocated is contained in the guidance for the NHS issued in July 2007 (Welsh Health Circular (2007) 56 ).
We welcome comments from users of our publications on content and presentation. If you have any comments or require further information, please contact: Craig Haskins, Health Statistics and Analysis Unit Room 2-002, Welsh Assembly Government Cathays Park, Cardiff, CF10 3NQ Telephone: (029) 2082 3134 Fax: (029) 2082 5350 E-mail: stats.healthinfo@wales.gsi.gov.uk Further copies of this statistical release are available from the address above.