Cost data collected from the national health service do not distinguish between the costs of individual patients.
We are therefore unable to separately identify the number of patients whose complex needs cost £100,000 to £249,999, £250,000 to £499,999 and more than £500,000 per annum in each of the last three years.
The purpose and value of the centrally funded initiatives services and special allocations (CFISSA) funds issued with primary care trust (PCT) initial allocations are in the following table. These allocations differ from other CFISSA allocations only in that they are incorporated into PCT initial resource limits and are allocated at the start of the financial year. Other funds issued to the national health service from the CFISSA programme are made as in year allocation adjustments.
£000 Primary medical services resource limit adjustment 4,517,190 General medical services cash limited rebasing -702,554 Pension indexation: PCT contribution 1,333,343 NHS funded nursing care 584,000 Palliative care 50,000 Pensions indexation adjustment for personal medical services practice staff 33,171 Neo natal intensive care 20,709 Revascularisation 16,901 Dangerous people with serious personality disorders 12,286 Health Protection Agency 9,674 Dentistry 3,907 Health Protection Agency 2,315 Medium secure services for deaf people 1,394 Non medical education and training 870 Improving services for people with multiple sclerosis 758 Health Protection Agency 610 Pensions indexation 500 Regional directors of public health support 437 Prison healthcare 90 Defibrillator funding to PCTs 66 PRION 52 Multiple Sclerosis service improvements 42 NHS funded nursing care—short-term respite care adjustment 4 National specialist commissioning—pancreatic transplantation -2,473 Cancer registries -8,770 National specialist commissioning—children and adolescent mental health services -12,109 Old long stay -44,934 Total 5,817,479
Tables are available in the Library providing:
(a) listings of all allocations by budget title and value to National Health Service organisations from 1997-98 to 2005-06;
(b) total expenditure of the centrally funded, initiatives services and special allocations (CFISSA) programme from 1997-98 to 2005-06;
(c) special allocations issued with initial allocations from 1997-98 to 2005-06; and
(d) special allocations and associated budgets issued to NHS organisations as additional allocations (and which are included in the tables described in (a) and (b) above).
Full year 2006-07 information and anticipated expenditure in 2007-08 on centrally funded initiatives services and special allocations is not yet available. This information will be contained within the 2006-07 Departmental Report that has an estimated publishing date of May 2007.
The reversals set out in the written ministerial statement of 28 March 2007, Official Report, columns 96-98WS, are for income deductions applied to NHS trusts in 2006-07 as a result of deficits incurred during 2005-06. No such income deduction was made to Maidstone and Tunbridge Wells NHS Trust as the trust’s financial position reported in the 2005-06 final accounts was a surplus of £112,000.
Under the new rules, NHS trusts that had income deductions made in years prior to 2006-07 will be able to agree a disregard for these deductions in the calculation of their statutory breakeven duty. This means that they will no longer have to generate a surplus to recover any part of their cumulative deficit that arose solely from the application of resource accounting and budgeting (RAB) income deductions.
Maidstone and Tunbridge Wells NHS Trust will therefore need to agree with its auditors the impact on its breakeven duty of any RAB income deductions applied in 2005-06 and earlier years. The breakeven note would then be adjusted to exclude these in the 2006-07 final accounts.
The NHS Plan (2000) introduced national health service local improvement finance trusts (LIFT) as a way of supporting the delivery of more investment in primary care premises. LIFT is providing modern integrated super surgeries, often in the heart of deprived communities. As of 31 March 2007, it has delivered 115 new buildings open to patients with another 74 under construction, supported by over £1.2 billion of investment. The NAO report on LIFT, Innovation in the NHS, noted that LIFT is well designed and offered advantages over other forms of procurement.
Information is not held centrally to allow for an assessment on the effectiveness of the buildings commissioning period for each scheme. It is for PCTs to manage the commissioning of their new facilities.
Information is not held centrally to allow for an assessment of effectiveness of the financing of each individual scheme. However, as part of the business case approval for each scheme financing terms are assessed, with the support of expert financial advice. The Department is also assembling benchmarking data to support this analysis in current and future LIFTs.
The Department as part of its Better Healthcare Buildings policy initiative is working closely with the commission for architecture and the built environment who have undertaken a detailed design quality survey of a representational cross section of primary care buildings procured under the LIFT initiative. They are preparing findings, which the Department will learn from and implement policy aimed at continually raising the standards of LIFT buildings.
Individual national health service accounts must, by statute, be published locally on or before 30 September 2007. The Department expects that this date will be met or bettered by all NHS bodies.
The Department plans to submit draft summarised accounts that consolidate NHS bodies' accounts to the National Audit Office for review by 20 August 2007. The date of publication is a matter for the Comptroller and Auditor General and depends on the date of completion of the audit process.