§ Mr. GrayTo ask the Secretary of State for Health if he will make a statement on the level of health
align="center">Health expenditure align="right">£000 Region 1988–89 1989–90 1990–91 1991–92 1992–93 1993–94 Northern 1,654,441 1,667,915 1,625,681 1,834,342 1,922,756 1,975,788 Yorkshire 1,897,024 1,908,545 1,971,506 2,082,642 2,207,164 2,254,133 Trent 2,352,359 2,370,817 2,459,676 2,586,300 2,766,696 2,889,449 East Anglian 1,020,235 1,036,598 1,080,732 1,117,149 1,177,201 1,209,022 North West Thames 2,002,319 2,008,209 2,029,999 2,207,220 2,309,131 2,345,558 North East Thames 2,363,970 2,369,077 2,388,128 2,498,782 2,582,445 2,659,714 South East Thames 2,116,228 2,116,221 2,144,195 2,323,880 2,387,509 2,437,249 South West Thames 1,703,160 1,718,522 1,691,941 1,840,442 1,917,278 1,914,335 Wessex 1,444,796 1,481,857 1,496,302 1,626,081 1,701,846 1,787,140 Oxford 1,166,629 1,180,398 1,202,070 1,308,099 1,364,260 1,381,495 South Western 1,711,902 1,744,496 1,803,272 1,907,288 1,979,662 2,061,574 West Midlands 2,628,077 2,689,836 2,800,994 2,910,973 3,039,145 3,096,282 Mersey 1,330,474 1,337,632 1,390,558 1,456,967 1,531,795 1,560,497 North Western 2,260,197 2,234,973 2,319,583 2,403,029 2,498,066 2,568,840
align="center">Health expenditure align="right">£000 Region 1994–95 1995–96 Northern and Yorkshire 4,306,507 4,457,663 Trent 2,966,426 3,081,765 Anglian and Oxford 2,893,234 3,010,874 North Thames 5,106,882 5,322,736 South Thames 4,513,941 4,769,425 South and West 4,040,864 4,161,999 West Midlands 3,264,462 3,441,572 North West 4,356,636 4,492,029 Source:
Annual accounts of regional and district health authorities (England); annual accounts of family practitioner committees 1988–89 to 1990–91) and family health services authorities (1991–92 to 1995–96) (England).
Note:
1. The latest available figures are for 1995–96.
2. The figures have been adjusted to 1997–98 prices.
3. The figures are not directly comparable across all years due to changes in the organisational structure and different accounting policies.
§ Mr. Campbell-SavoursTo ask the Secretary of State for Health if he will circulate to each hon. Member a copy of his letter on NHS break-even duties and trust deficit three-year bridging arrangements as set out in his letter of 15 July to trust directors of finance and health authorities. [11858]
§ Mr. MilburnCopies of the letter have been placed in the Library.
§ Mr. JackTo ask the Secretary of State for Health if he will make a statement of the level of health service inflation for the financial years(a) 1994–95, (b) 1995–96 and (c) 1996–97. [11045]
§ Mr. MilburnThe Department of Health does not calculate health service inflation.
§ Mr. JackTo ask the Secretary of State for Health (1) what was the impact on baseline expenditure planned for the NHS in 1998–99 of the increase in its gross384W expenditure at current prices in each of the regions in the United Kingdom in each year since 19979. [11165]
§ Mr. Milburn[holding answer 29 July 1997]: The figures available are shown in the tables. It is not possible to provide a regional analysis prior to 1988–89.
domestic product deflation from 2.5 per cent. to 2.75 per cent.; and what percentage this figure constitutes of the planned increase in NHS spending in 1998–99; [11043]
(2) what is the cost effect on his planned increase in NHS spending for 1998–99 of the change in the GDP deflator to 2.75 per cent. [11035]
§ Mr. MilburnAt the time of the November 1996 Budget, the gross domestic product deflator was forecast at 2 per cent. for 1998–99, and the previous Government planned a 0.25 per cent. real terms increase in expenditure on the national health service in England for that year. At the time of the July 1997 Budget, the Chancellor revised the gross domestic product deflator forecast to 2.75 per cent. for 1998–99.
To maintain the previous Government's planned real terms increase in national health service expenditure in 1998–99 to take account of the change in deflator would have cost £258 million. This is just 14.5 per cent. of the Chancellor's planned increase of £1,775 million in expenditure on the national health service in 1998–99 following the July Budget, which allocated an extra £1 billion to the national health service in England, giving 2.35 per cent. real terms growth.
§ Mr. JackTo ask the Secretary of State for Health, pursuant to paragraph 5.57 of the "Financial Statement and Budget Report 1997–98", what are the assumptions for efficiency savings for the financial year 1998–99. [11855]
§ Mr. MilburnDecisions on the allocation between programmes of the additional resources for the national health service as announced in the Budget, and the related efficiency savings, have not yet been taken.
§ Mr. JackTo ask the Secretary of State for Health how much he expects to save by reducing the administration and management costs of running the NHS in England for the financial years(a) 1997–98, (b) 1998–99, (c) 1999–2000, (d) 2000–01 and (e) 2001–02. [11037]
385W
§ Mr. MilburnWe have set targets to reduce the costs of managing the national health service by £100 million in 1997–98. This represents a significant investment into direct patient services and away from bureaucracy, in line with our commitment to ensure that more of every pound spent in the NHS goes on frontline patient services.
The NHS Executive is working with the NHS to assess the scope for further reductions in the costs of managing the NHS in 1998–9 and beyond.
§ Mr. JackTo ask the Secretary of State for Health if he will express management and administrative staff costs for the financial years(a) 1992–93 and (b) 1997–98 as a percentage of total NHS expenditure. [11041]
§ Mr. MilburnInformation for 1997–98 is not available. The most recent information is set out in the table.
Expenditure on the salaries and wages of general and senior managers and administration and clerical staff costs as a
percentage of total revenue (HCHS) expenditure
align="right">£000 Expenditure 1992–93 (cash prices) Expenditure 1992–93 (1995–96 prices) Expenditure 1995–96 (cash prices) General and Senior Managers 497,625 534,449 789,507 Administrative and Clerical 1,506,163 1,617,619 1,643,200 Total G and S/A and C 2,003,788 2,152,068 2,432,707 Total revenue (HCHS) expenditure 21,265,487 22,839,133 23,889,923 Percentage of total HCHS spend on general and senior managers 2.3 per cent. 2.3 per cent. 3.3 per cent. Percentage of total HCHS spend on administrative and clerical staff 7.1 per cent. 7.1 per cent. 6.9 per cent. Percentage of total HCHS spend on general and senior managers and administrative and clerical staff 9.4 per cent. 9.4 per cent. 10.2 per cent. Notes:
1. Salaries and Wages figures are based upon gross costs and include Employers NI and Superannuation costs.
2. The figures given are for hospital and community health services only. Family health services authorities and other health bodies are excluded as comparable figures are not collected centrally.
Source:
1. Annual financial returns of regional and district health authorities and the special health authorities of the London postgraduate teaching hospitals.
2. Annual financial returns of NHS Trusts.
§ Mr. JackTo ask the Secretary of State for Health what estimates he has made of the effect on NHS expenditure in 1998–99 from the ending of payable tax credit to exempt institutions. [11360]
§ Mr. MilburnThe withdrawal of advance corporation tax credits has no effect on national health service expenditure. I refer the right hon. Member to the reply given by my right hon. Friend the Chancellor of the Exchequer on 14 July 1997, column1.
§ Mr. JackTo ask the Secretary of State for Health what estimate he has made of the additional cost to the NHS in 1998–99 of an overall pay settlement under which wages and salaries rose by 1 per cent. above the gross domestic product deflator. [11274]
§ Mr. MilburnNone.
386W
§ Mr. JackTo ask the Secretary of State for Health what was the administrative cost of the internal market of the NHS in 1996–97. [11276]
§ Mr. MilburnThere are no official estimates of the additional costs associated with the internal market, but independent commentators have in the past suggested a figure of £1.5 billion.
The Government's job now is to ensure that effective action is taken to root out unnecessary bureaucracy to ensure that more of every pound spent in the national health service goes on front-line patient services.
§ Mr. JackTo ask the Secretary of State for Health what amount of his recently announced increase in NHS spending for 1998–99 will be available for capital expenditure. [11277]
§ Mr. MilburnDecisions on the allocation between programmes of the additional resources for the national health service announced in the Budget have yet to be decided.
§ Mr. Campbell-SavoursTo ask the Secretary of State for Health (1) what estimate he has made of the incidence of the use of moneys from the emergency contingency funds of NHS organisations in closing the deficits by the end of the current financial year; and what restrictions he intends to introduce; [11130]
(2) what estimate he has made of the incidence of inter-trust health authority brokerage arrangements for the transfer of cash to meet the cost of closing deficits by the end of the current financial year; and what restrictions he intends to introduce; [11131]
(3) what estimate he has made of the incidence of the rescheduling of debt payments by local NHS organisations to regional NHS executive organisations in seeking to meet the cost of closing deficits by the end of the current financial year; and what restrictions he intends to introduce. [11135]
§ Mr. MilburnWhatever contingency funds are kept by national health service organisations are a matter for the management of the organisations concerned.
The inter-year flexibility arrangements—otherwise known as brokerage—which apply to trusts and health authorities do not address the issue of income and expenditure deficits. Their purpose is to ensure maximum use of the cash resources made available to the NHS as a whole in the financial year. Where appropriate, the external financing limits of trusts and the cash limits of health authorities forecasting cash underspends are reduced and those of other trusts and health authorities requiring temporary in-year assistance with their cash flow are increased. These transactions are normally reversed the following year. These arrangements work well and there are no plans to restrict them.
§ Mr. Campbell-SavoursTo ask the Secretary of State for Health what estimate he has made of the scale of the use of GP fundholder savings in helping health authorities and trusts meet closing of deficit requirements by the end of the current financial year; and what restrictions he intends to introduce. [11132]
§ Mr. MilburnI refer my hon. Friend to the reply I gave him today.
387WFundholders may voluntarily return to their health authority savings which they do not wish to spend. There is no system in place to enable fundholders to give their savings to trusts to meet deficits.
§ Mr. Campbell-SavoursTo ask the Secretary of State for Health what estimate he has made of the scale of the exercise and what restrictions he intends to introduce in the case of the downward revaluation of NHS assets so as to reduce the 6 per cent. return on assets requirements in seeking to meet the costs of closing deficits by the end of the current financial year by NHS trusts. [11133]
§ Mr. MilburnThere is no exercise under way or planned to restrict or systematically reduce the valuation of national health service assets or the requirements to make a 6 per cent. return on them. Health authority allocations and trust prices have already been set on the basis of estimated capital charges for 1997–98 and there are no plans to change them.
§ Mr. Campbell-SavoursTo ask the Secretary of State for Health what estimate he has made of the incidence of, and what restrictions he intends to introduce in the case of, the use of recovery strategy by health authorities and NHS trusts that carry forward deficits for(a) two and (b) three years that would otherwise have to be terminated by the end of the current financial year. [11134]
§ Mr. MilburnIn the normal course of events, health authorities and trusts can be expected to run small surpluses and deficits which even out over a run of years. Health authorities and trusts which have significant financial problems are required to draw up robust recovery plans for approval and monitoring by the National Health Service Executive. These recovery plans are kept under regular review.
§ Mr. Simon HughesTo ask the Secretary of State for Health what expenditure is planned by each health authority on(a) non-NHS purchases, (b) extra-contractual referrals and (c) medical negligence claims. [10422]
§ Mr. MilburnI shall write to the hon. Member in due course with such information as is available.