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Health: Expenditure

Volume 716: debated on Wednesday 27 January 2010

Questions

Asked by

To ask Her Majesty’s Government what the National Health Service and Department of Health combined expenditure was on (a) pharmaceuticals, and (b) influenza and other vaccines, in cash and real terms in (1) 1996-97, (2) 2003-04, (3) 2005-06 and (4) 2008-09; and what the estimated expenditure is in 2009-10 for those items. [HL1344]

Pharmaceuticals (drugs) expenditure includes National Health Service expenditure in primary care and the Hospital and Community Health Service (HCHS). The primary care expenditure reflects amounts paid to pharmacy and appliance contractors and amounts authorised for dispensing doctors and personal administration in England. This includes expenditure on the seasonal influenza and adult pneumococcal vaccines, which are procured and administered by general practitioners and other contractors.

Table 1 provides details of NHS expenditure on drugs in cash and real terms (2008-09 base year).

Table 1: NHS expenditure on drugs

£ million

NHS drugs expenditure

Year

Cash

Real Terms

1996-97

4,735

6,323

2003-04

9,271

10,541

2005-06

9,979

10,837

2008-09

11,378

11,378

2009-10 (April to September primary care)

3,796

3,722

Sources:

Prescription Pricing Division of the NHS Business Services Authority, England, Department of Health Finance Division, Foundation Trust year-end accounts.

Notes:

1. Government accounting policy changed in 2000-01; as a result, figures prior to 2000-01 are not strictly comparable to figures thereafter. Expenditure prior to 2000-01 represents the amounts paid between April to March for medicines and appliances and relate to prescriptions dispensed between March and February. This is due to the delay in prescription processing and payment calculations. From 2000-01, figures represent the actual cost of the prescriptions for medicines and appliances dispensed in the period April to March.

2. Year-to-date primary care figures have been provided for 2009-10. We do not have HCHS figures, which are sourced from accounts information available at year-end only. Primary care drugs expenditure is approximately 70 per cent of total NHS drugs expenditure.

3. Real-term calculation uses GDP deflator series at January 2010, 2008-09 = 100.

Additionally, the department provides centrally purchased vaccines for the NHS routine childhood immunisation programme and catch up programmes, vaccines against anthrax, rabies, smallpox, and the swine influenza vaccination programme 2009-10. The department is not able to divulge expenditure on swine influenza vaccine as it would violate confidentiality clauses in the contracts with the manufacturers. The available information about the department’s expenditure on vaccines for England (not including swine influenza vaccine) is given in Table 2 in cash and real terms (2008-09 base year).

Table 2: Department of Health expenditure on vaccines

£ million

Vaccines

Year

Cash

Real Terms

1996-97

-

-

2003-04

88

101

2005-06

107

116

2008-09

229

229

2009-10 (April to December)

160

157

Notes:

1. Where relevant, figures for England have been calculated as 84 per cent. of expenditure on vaccines for the United Kingdom. Childhood vaccines and smallpox vaccine are purchased for the UK. Anthrax and rabies vaccines are purchased for England and Wales.

2. Year-to-date figures to December 2009 have been supplied for 2009-10.

3. Real-term calculation uses GDP deflator series at January 2010, 2008-09 = 100.

The vaccines provided for NHS programmes have changed over the period of time shown in the table. For example, the higher level of expenditure in 2008-09 partly reflects the addition of human papilloma virus vaccination against cervical cancer.

Information about vaccine expenditure in 1996-97 is not available. It has not been possible to confirm whether or not records of vaccine expenditure for 1996-97 have been retained centrally by the department and there is no obligation for such records of this age to be retained.

Asked by

To ask Her Majesty’s Government how much was spent on public health and health promotion combined in (a) 1996-97, and (b) 2008-09, in cash and real terms. [HL1345]

The department does not collect detailed expenditure information in these areas since, subject to delivering national targets, there is local discretion on how the funding is spent. However, for public health and prevention, a report by Health England shows (mostly using end of year information) expenditure in England on public health and prevention for 2006-07. See Table 3 in the Report: Health England Report No 4. Public Health and Prevention Expenditure in England 2009, which is available from: http://healthengland.org/health_england_publications.htm.

Table 3 in that report is replicated here as follows, entitled Table 1, and provides a breakdown of spending based as closely as possible on Organisation for Economic Co-operation and Development (OECD) definitions

Table 1: Detailed Prevention Expenditure in England 2006-07

Primary prevention

Secondary prevention

Total £m

Screening

Other

Medication

Total prevention and public health services

1,771

1,482

482

1,337

5,072

Maternal and child health; family planning and counselling

840

21

0

0

861

Maternity services

618

618

Family Planning Clinics

101

101

Contraceptives

66

66

Health Visiting Group Services

53

53

Neonatal audiological screening

14

14

Quality and Outcomes Framework (1)

2

6

9

School health services

44

0

115

0

159

School-based Children’s Individual Health Services

115

115

School-based Children’s Group Health Services

27

27

Healthy Schools Programme (2)

17

17

Prevention of communicable diseases

284

0

0

0

284

Immunisation (2)

238

238

Other infectious diseases (2)

24

24

Quality and Outcomes Framework

19

19

Reducing MRSA incidence (2)

3

3

Prevention of non-communicable diseases

206

1,461

348

1,337

3,352

Pharmaceuticals

1,337

1,337

Dental check-ups

937

937

Quality and Outcomes Framework

28

41

348

417

Screening programmes

275

275

Sight tests

208

208

Obesity/diet/lifestyle

116

116

NHS Stop Smoking Services

56

56

NICE Public Health Guidelines

4

4

CJD surveillance (2)

2

2

Occupational health care

4

0

0

0

4

Occupational Health for Dentists

4

4

Quality and Outcomes Framework

1

1

All other miscellaneous public health services (1)

394

0

19

0

412

Health Protection Agency

248

248

NHS Blood and Transplant (2)

53

53

Publicity for prevention activities

34

34

Charitable expenditure on prevention

33

33

National Biological Standards Board

25

25

Public Health in Prisons (2)

19

19

Source:

Health Inequalities and Partnership, DH (Health England Report No 4. Public Health and Prevention Expenditure in England 2009)

Notes:

1. Figures may not sum due to rounding

2. Refers to expenditure from the central budget, data available only for 2006-07

The expenditure on pharmaceuticals is included as its primary aim is prevention. Nevertheless, strictly, expenditure on pharmaceuticals is not included in the OECD prevention and public health category. Hence, for comparison with other countries using OECD data, these medication figures should be excluded. Excluding pharmaceuticals in line with OECD methodology gives a total expenditure on public health and prevention of £3.7 billion. If pharmaceuticals were included, the overall total for 2006-07 would be £5 billion.

Total health expenditure for England for the same period was approximately £93.5 billion. This suggests that about 4 per cent of health expenditure is directed towards prevention (using the figure without pharmaceuticals and without health-related expenditure, so that this can be compared with other OECD countries). This share indicates that England is above the average of other OECD countries, where prevention was only 2.8 per cent of total health spending in the same period.

A decade ago, the share of total health spending going to prevention and public health stood at only 1.8 per cent in the United Kingdom, which was below the OECD average at that time.

Asked by

To ask Her Majesty’s Government what the expenditure was on adult social care in cash and real terms in each year from 1996-97 to 2008-09 inclusive; what the percentage increase was in real terms in each year; what was the real terms increase in NHS expenditure in each of those years; and what adult social care expenditure was in each of those years as a percentage of NHS expenditure. [HL1346]

Table 1 shows the total gross current expenditure on social services for adults aged 18 and over in England for the period 1996-97 to 2008-09, in both cash and real terms.

Table 2 shows the real terms increase in National Health Service expenditure in England for the period 1996-97 to 2008-09.

Table 3 compares the difference in spend between adult social care and the NHS by showing the percentage of adult social care expenditure of NHS expenditure for the period 1996-97 to 2008-09.

Table 1: Gross Current Expenditure 1, 2 on Social Services for Adults aged 18 and over, 1996-97 to 2008-09

England

£ millions and percentage

Gross Current Expenditure (Cash)

Gross Current Expenditure (Real Terms3)

Percentage increase (Real Terms3)

1996-97

7,049

9,414

1997-98

7,609

9,902

5

1998-99

8,196

10,447

6

1999-2000

8,928

11,160

7

2000-014

9,628

11,878

6

2001-02

10,106

12,197

3

2002-035

11,312

13,224

8

2003-046

12,480

14,190

7

2004-05

13,492

14,927

5

2005-06

14,345

15,578

4

2006-07

14,893

15,710

1

2007-08

15,275

15,660

0

2008-097

16,066

16,066

3

PSS Ex1

Notes:

1. Gross current expenditure includes income from client contributions but excludes certain income items which count as expenditure from elsewhere in the public sector, such as contributions from primary care trusts (PCTs). This is to avoid double counting within the aggregate public sector accounts of the money involved.

2. 1996-97 to 2006-07 figures include estimated Service Strategy and Asylum Seekers Assessment and Care Management apportioned to Adult Services and Children and Families Services using proportions calculated using 2007-08 data. From 2007-08 this information was collected separately.

3. Real term figures have been converted from cash terms using the Gross Domestic Product (GDP) deflator.

4. From the 2000-01 financial year, the PSS EX1 replaced the Chartered Institute of Public Finance and Accountancy (CIPFA) Actuals return, which was discontinued after 1999-2000.

5. The figures from 2002-03 include the cost of residential and nursing placements for adults and older people with Preserved Rights; councils took over responsibilities for those people in April 2002.

6. Expenditure funded from the Supporting People (SP) grant that councils have classified as social services expenditure rather than housing expenditure was introduced from 2003-04 onwards.

7. Data for 2008-09 are provisional. Final data for 2008-09 are expected to be published by the NHS Information Centre in April 2010.

Table 2 - Total Net NHS Expenditure in England, 1996-97 to 2008-09

Year

Net NHS Expenditure (4) £ billion

% increase

% real terms increase (7)

1996-97

Outturn

32.997

3.2

-0.5

1997-98

Outturn

34.664

5.1

2.4

1998-99

Outturn

36.608

5.6

3.4

1999-2000

Outturn

39.881

8.9

6.8

Resource Budgeting Stage 1(2)

1999-2000

Outturn

40.201

-

-

2000-01

Outturn

43.932

9.3

7.9

2001-02

Outturn

49.021

11.6

9.1

2002-03

Outturn

54.042

10.2

6.8

Resource Budgeting Stage 2(3)(5)

2003-04

Outturn

64.173

-

-

2004-05

Outturn

69.051

7.6

4.7

2005-06

Outturn

75.822

9.8

7.8

2006-07

Outturn

80.561

6.3

3.2

2007-08

Outturn

89.261

10.8

7.7

2008-09

Estimated Outturn

94.522

5.9

3.3

Notes:

1.Expenditure pre 1999-2000 is on a cash basis

2.Expenditure figures from 1999-2000 to 2002-03 are on a Stage 1 Resource Budgeting basis

3.Expenditure figures from 2003-04 to 2010-11 are on a Stage 2 Resource Budgeting basis

4.Figures are not consistent over the period (1971-72 to 2010-11), therefore it is difficult to make comparisons across different periods

5. Figures from 2003-04 include a technical adjustment for trust depreciation

6. Expenditure excludes NHS (AME)

7. GDP deflator 4 January 2010

8. Total expenditure is calculated as the sum of revenue and capital expenditure net of non-trust depreciation and impairments. This is in line with HMT Guidance

Table 3 - What adult social care expenditure was in each of those years as a percentage of NHS expenditure

Proportion of Spend % (1)

1996-97

22%

1997-98

23%

1998-99

23%

1999-2000

23%

2000-014

23%

2001-02

21%

2002-035

22%

2003-046

20%

2004-05

20%

2005-06

19%

2006-07

19%

2007-08

18%

2008-097

18%

Note:

(1) This proportion is based on gross current personal social services expenditure (cash) as shown in table 1, of total net NHS expenditure as shown in table 2.