§ Mr. Ralph Howellasked the Secretary of State for Social Services if, in the manner of the answer to the hon. Member for Norfolk, North of 21 December, at columns 412 to 414, he will provide figures for expenditure by the family practitioner services, the Dental Estimates Board, the Prescription Pricing Authority and other special health authorities providing National Health Service central services for 1983–84; and if he will also publish comparable figures, at current and at 1983–84 prices, and comparable percentages for 1960 and 1970, for the above categories and those in the original answer.
§ Mr. Kenneth Clarke[pursuant to his reply, 22 January 1985, c. 414]: The tables give the analysis of expenditure requested as far as it can be provided on a comparable basis.
The figures for 1960–61, 1970–71 and 1983–84 are derived from the annual accounts of health authorities—and their predecessor hospital authorities, executive councils, etc.—in England for the respective financial years. Those for 1960–61 and 1970–71 at 1983–84 prices 451W are calculated from the base years' figures by adjusting for general inflation as measured by the gross domestic product deflator at market prices.
TABLE 1 Current expenditure by hospital authorities etc. analysed subjectively (ie by type) 1960–61 1970–71 From annual accounts At 1983–84 prices Proportion of total From annual accounts At 1983–84 prices Proportion of total £ million £ million per cent. £ million £ million per cent. A. Pay Total staff salaries and wages 286.2 2,003.4 69.23 706.0 3,233.5 74.49 B. Non-pay Drugs 14.8 103.6 3.58 27.4 125.5 2.89 Dressings 6.2 28.4 0.65 Medical and surgical appliances and equipment 16.4 114.8 3.97 43.4 198.8 4.58 Provisions 37.5 262.5 9.08 46.0 210.7 4.85 Staff uniforms and patient's clothing 3.6 25.2 0.87 6.8 31.1 0.72 General services (power, light, heating, water, cleaning and laundry) 29.4 205.8 7.11 42.1 192.8 4.44 Maintenance of buildings, plant and grounds 17.3 121.1 4.18 26.0 119.1 2.74 Domestic repairs, renewals and replacement 7.2 50.4 1.74 12.6 57.7 1.33 Office services (office equipment, printing, stationery, advertising, postage, telephone, etc.) 5.9 41.3 1.43 15.0 68.7 1.58 Transport 2.0 14.0 0.48 4.7 21.5 0.50 Travelling and subsistence expenses 1.4 9.8 0.34 2.8 12.8 0.29 Rents, rates and tithes 6.2 43.4 1.50 14.1 64.6 1.49 Contractual arrangements for patient care 2.9 20.3 0.70 5.0 22.9 0.53 Other expenses 11.2 78.4 2.71 19.4 88.8 2.05 Total 155.8 1,090.6 37.69 271.5 1,243.4 28.64 C. Total pay and non-pay 442.0 3,094.0 106.92 977.5 4,476.9 103.13 Less direct credits (staff lodging charges, canteen and other sales, etc.) (28.6) (200.2) (6.92) (29.7) (136.0) (3.13) D. Total 413.4 2,893.8 100.00 947.8 4,340.9 100.00 Notes to Table 1
1. The figures do not include expenditure on community health and ambulance services which prior to NHS re-organisation on 1 April 1974 were the responsibility of local government authorities.
2. The administrative expenses of executive councils which were responsible for the administration of family practitioner services are included in the table as such costs are reflected in the annual accounts of health authorities from 1974–75. For 1960–61 an apportionment of composite England and Wales figures was necessary to derive figures for England only.
3. For years prior to 1974–75 the analyses of expenditure by type provided by the annual accounts are less detailed than those for later years and analyses by function were not prepared.
4. "Other expenses" includes the total non-pay expenditure on the blood transfusion and mass radiography services for which component details are not readily available—£1.0 million in 1960–61 and 1.8 million 1970–71 (£7.0 million and £8.2 million at 1983–84 prices).
5. Total capital expenditure by the authorities whose current expenditure is included in the table was £25.1 million in 1960–61 and £119.2 million in 1970–71 (£175.7 million and £545.9 million at 1983–84 prices).
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Table 2 Expenditure on family practitioner services 1960–61 1970–71 1983–84 From annual accounts At 1983–84 prices Proportion of total From annual accounts At 1983.84 prices Proportion of total From annual accounts Proportion of total £ million £ million Per cent. £ million £ million Per cent. £ million Per cent. A. General medical services 1. Payments to general medical practitioners (a) Basic practice allowance and additions 79.4 555.8 38.94 38.4 175.9 9.50 202.1 7.29 (b) Standard capitation fees 66.0 302.3 16.34 294.9 10.64 (c) Payments for out of hours responsibilities 11.5 52.7 2.85 65.8 2.37 (d) Direct payment for practice accommodation and ancillary staff 11.4 52.2 2.82 148.0 5.34 (e) Other payments, fees and allowances 14.5 66.4 3.59 120.1 4.33 2. Superannuation contributions (authorities' share) 4.9 34.3 2.40 7.1 32.5 1.76 34.4 1.24 3. Payments to contractors for disposable sterile syringes — — — 0.2 0.9 0.05 0.8 0.03 Total 84.3 590.1 41.34 149.1 682.9 36.91 866.1 31.24 B. Pharmaceutical services 1. Supply and dispensing of drugs and appliances by pharmacists 75.3 527.1 36.93 167.8 768.5 41.54 1,322.1 47.69 Less charges to patients (retained by pharmacists) (10.8) (75.6) (5.30) (14.3) (65.5) (3.54) (94.7) (3.42) 2. Supply and dispensing of drugs and appliances by medical and dental practitioners 2.5 17.5 1.23 8.4 38.5 2.08 101.4 3.66 Comparisons over this long period cannot be entirely reliable because of changes in the structure of GDP and in the organisation of the NHS.
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1960–61 1970–71 1983–84 From annual accounts At 1983–84 prices Proportion of total From annual accounts At 1983–84 prices Proportion of total From annual accounts Proportion of total £ million £ million Per cent. £ million £ million Per cent. £ million Per cent. 3. Basic practice allowance — — — — — — 20.6 0.74 4. Superannuation contributions (authorities' share) 0.1 0.7 0.05 0.3 1.4 0.07 0.9 0.03 5. Other expenditure 0.3 2.1 0.15 — — — 3.8 0.14 Total 67.4 471.8 33.06 162.2 742.9 40.15 1,354.1 48.84 C. General dental services 1. Fees to dental practitioners 49.5 346.5 24.27 90.0 412.2 22.28 572.0 20.63 Less charges to patients (retained by dentists) (9.0) (63.0) (4.41) (16.2) (74.2) (4.01) (158.2) (5.71) 2. Salaries of dental practitioners practising at health centres, etc. 0.1 0.7 0.05 0.1 0.5 0.02 1.0 0.04 3. Superannuation contributions (authorities' share) 1.9 13.3 0.93 3.2 14.6 0.79 17.9 0.65 4. Other expenditure — — — — — — 1.1 0.04 Total 42.5 297.5 20.84 77.1 353.1 19.08 433.8 15.65 D. General ophthalmic services 1. Fees for sight testing 4.7 32.9 2.31 8.9 40.7 2.20 72.2 2.60 2. Supply and repair of glasses 10.2 71.4 5.00 16.9 77.4 4.18 89.6 3.24 Less charges to patients (retained by opticians) (5.2) (36.4) (2.55) (10.2) (46.7) (2.52) (44.3) (1.60) 3. Superannuation contributions (authorities' share) — — — — — — 0.3 0.01 4. Other expenditure — — — — — — 0.5 0.02 Total 9.7 67.9 4.76 15.6 71.4 3.86 118.3 4.27 Total expenditure on family practitioner services 203.9 1,427.3 100.00 404.0 1,850.3 100.00 2,772.3 100.00 Notes to Table 2
1. The table shows total payments made to doctors, pharmacists, dentists, opticians and others contracted to the NHS to provide family practitioner services (FPS).
2. Annual accounts of health authorities (and their predecessor executive councils) provide one analysis only of such expenditure which assigns it functionally to service.
3. The table shows 1960–61 and 1970–71 FPS expenditure categorised as far as practicable in the same format as that of the annual white papers on the summarised accounts of health authorities since 1974–75. Thus, charges to patients retained by pharmacists, dentists and opticians are reflected in the table but other items of FPS income collected by health authorities (or executive councils) such as charges to patients for dental treatment at health centres and receipts from the sale of prescription charge pre-payment certificates, are excluded.
4. For 1960–61 the accounts provide separate services totals for England and similar totals for Wales with detailed analyses of only the composite England and Wales totals. It has therefore been necessary to derive the detailed figures for England pro-rata.
5. All spending on FPS is regarded as current expenditure. Some relatively insignificant costs strictly of a capital nature (relating only to certain payments made to general medical practitioners for practice accommodation) are however included.
Table 3 Expenditure by the Dental Estimates Board, the prescription pricing authority and other special health authorities providing NHS central services 1960–61 1970–71 1983–84 From Annual Accounts £ million At 1983–84 Prices £ million Proportion of Total Per cent. From Annual Accounts £ million At 1983–84 Prices £ million Proportion of Total Per cent. From Annual Accounts £ million Proportion of Total Per cent. 1. Expenditure by the Dental Estimates Board (a) Salaries and Wages 0.7 4.9 87.50 1.9 8.7 73.08 10.2 92.73 (b) Non-pay 0.1 0.7 12.50 0.7 3.2 26.92 0.8 7.27 Total 0.8 5.6 100.00 2.6 11.9 100.00 11.0 100.00 2. Expenditure by the Prescription Pricing Authority (a) Salaries and Wages 0.7 4.9 87.50 1.6 7.3 88.89 11.3 88.98 (b) Non-pay 0.1 0.7 12.50 0.2 0.9 11.11 1.4 11.02 Total 0.8 5.6 100.00 1.8 8.2 100.00 12.7 100.00 3. Expenditure by other special health authorities providing NHS central services (a) Salaries and Wages N/A — — N/A — — 1.6 32.00 (b) Non-pay N/A — — N/A — — 3.4 68.00 Total N/A — — N/A — — 5.0 100.00 Notes to Table 3
1. The table shows summaries of the detailed accounts of the Dental Estimates Board (DEB), the Prescription Pricing Authority (PPA) and its predecessor Joint Pricing Committee for England (JPC); together with a composite summary of the accounts for 1983–84 only of other special health authorities providing NHS central services.
2. (a) Other special health authorities providing NHS central services comprise:
(i) the Central Blood Laboratories Authority (CBLA)—established 1 December 1982.
(ii) the Mental Health Act Commission—established 1 September 1983.
455W(iii) the Rampton Hospital Review Board—established 11 June 1981.
(iv) the Rural Dispensing Committee—established 1 April 1983.
(b) The expenses of two analogous authorities are excluded. The first is the Health Service Supply Council, established on 14 July 1980, the expenses of which are met in full from charges made to regional health authorities. The second is the National Health Service Training Authority which was established on 1 October 1983 and whose first complete financial year ends on 31 March 1985.
(c) The functions of all these special health authorities are either new or were devolved by the Department and comparable figures for 1960–61 and 1970–71 are consequently not available.
3. Capital expenditure by the DEB and the JPC is not separately identifiable and is included in the totals. The amounts are known to be insignificant except that there was substantial capital expenditure by the DEB in 1970–71.
For 1983–84 the PPA and the CBLA recorded capital expenditure of £2.8 million and £5.4 million. These sums are excluded from the table.