Deaths from Various Causes: NHS Costs (Hansard, 27 January 1998)

§ Baroness Jay of Paddington

The available information is set out as follows. Where information is from different sources, it is not necessarily comparable.

The department does not routinely collect information on the illness or injury that gives rise to a general practitioner consultation. The estimated rates of GP consultations that are presented come from a Morbidity Statistics from General Practice survey in England and Wales in 1992–92. This survey included 60 practices in England and Wales, covering about 1 per cent. of the population.

The number of days in hospital are available for some illnesses and injuries. The estimates of the total number of days in hospital in England, for all the conditions except mental illness and accidents in the home, have been obtained from the hospital episode statistics database (HES). Information on the number of days in hospital taken from different sources may not be comparable.

The department does not record the cost to the National Health Service of illness or injury, although estimates are available for certain illnesses and injuries. Costs are not directly comparable, as some are calculated on different bases.

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(a) Road accidents

There were estimated to be 300,000 bed days in hospital in England during 1994–95 arising from road accidents. The Department of the Environment, Transport and the Regions estimates that in Great Britain in 1996, road accidents cost the NHS £490 million in hospital and community health services.

(b) Accidents in the home

The Department of Trade and Industry estimates that in the United Kingdom in 1995, there were 1,779,000 bed days in hospital resulting from accidents in the home.

Many diseases can be attributable to smoking, such as cancers, heart disease and cerebrovascular disease, but smoking is not the only risk factor for these diseases. The cost to the NHS of treating people for diseases they developed as a result of their smoking is estimated to be between £1.4 and £1.7 billion in 1996 in England. These estimates were produced by the Centre for Health Economics at the University of York and the Health Education Authority. Expenditure on diseases to which smoking may make a contribution ("smoking related diseases") is necessarily higher.

(d) Alcohol related illness

It is very difficult to attribute the cause of any medical condition in any individual directly to alcohol. The diseases assumed to be related to alcohol in this reply are the same as those included in the Answer given by the Lord McIntosh of Haringey on 12 January (WA 133) and are listed as follows. However, these were selective and may not paint a full picture of the true extent of alcohol related activity. It is estimated that in England and Wales between September 1991 and August 1992 there were 60 GP consultations per 10,000 person years at risk arising from alcohol related illness. There were an estimated 1,022,000 bed days in hospital in England during 1994-95 arising from alcohol related illness. The Centre for Health Economics in York estimated that the costs of alcohol misuse to the NHS in 1994 of £164 million: this estimate was published by the Health Education Authority in 1997.

(e) Drug related illness

It is estimated that in England and Wales between September 1991 and August 1992 there were 107 GP consultations per 10,000 person years at risk arising from drug related illness. There were an estimated 190,000 bed days in hospital in England during 1994-95 arising from drug related illness. It is not possible to estimate the costs of drug related illness to the NHS. However, the National Treatment Outcome Research Study, which is tracking 1,100 drug misusers through treatment until 2000, will be providing an estimate of the costs of drugs misuse to the NHS. This will include the cost of drug related illness. The report of the first year follow-up of the cohort is expected to be available in spring 1998.

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(f) AIDS

Information on the rates of GP consultation arising from AIDS is not available. It is estimated that in England in 1994-95 there were 10,000 bed days in hospital arising from AIDS. The following table shows the total amounts allocated to health authorities in England for HIV/AIDS treatment and care. The total amount spent may differ from these.

Year	Allocation for HIV/AIDS Year treatment and care
1996–97	£186 million
1997–98	£199 million
1998–99	£228 million

(g) Food poisoning

It is estimated that in England and Wales between September 1991 and August 1992 there were seven GP consultations per 10,000 person years at risk arising from food poisoning. There were an estimated 190,000 bed days in hospital in England during 1994-95 arising from food poisoning. Information is currently not available on the cost of food poisoning to the NHS.

(h) CJD

There is no reliable information available.

(i) Mental illness

It is estimated that in England and Wales between September 1991 and August 1992 there were 728 GP consultations per 10,000 person years at risk arising from mental illness. The following table shows the estimated number of bed days in hospital.

Year	Number of bed days in hospital
1994–95	15,600,000
1995–96	15,600,000
1996–97	15,500,000

The information on the number of bed days in hospital comes from the Department of Health's Common Information Core Data. The number of days in hospital on account of mental health include 3.2 million NHS-funding days in community occupied beds (i.e., in nursing, residential or group homes) in 1994-95. Comparable figures for 1995-96 and 1996-97 were 3.5 million and 3.7 million, respectively.

The following table shows the estimated cost to the hospital and community health services in England arising from mental illness.

Year	Cost to Hospital and Community Year Health Services
1994–95	£2,377 million
1995–96	£2,512 million

Source:

Hospital and Community Health Services programme budget analysis.

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Disease definitions

Disease definitions are based on ICD9 (International Classification of Disease, Ninth revision) codes. Data were extracted for all codes relating to a particular disease. The codes used for each disease in this reply are listed as follows:

Illness or injury	ICD codes used for GP consultations and bed days in hospital
Road accidents	E810–E819,E826–E829
Alcohol related illness	303,305.0,291,425.5,571,980
Drug related illness¹	304,305.2–305.9
AIDS²	279.1,079.4
Food poisoning³	008.0,003
Mental illness	290–319
¹For drug related illness,the reply to the previous PQ (WA 113) also included E850,E858,E950.0–E950.5,E980.0–E980.5.
²For AIDS the reply to the previous PQ (WA 113) used ICDs 042–044.
³The estimated number of bed days in hospital arising from food poisoning also includes 038.4,283.1,557.0,771.8.