Programme BudgetingDawn Godber

Commissioning and System Management Directorate

Definitions

• Programme Budgeting: a retrospective appraisal of resource allocation broken down into ‘programmes’ - with a view to influencing and tracking future expenditure in those same programmes.

• Marginal Analysis: an appraisal of the added costs and added benefits when the resources in programmes are increased, or deployed in new ways.

• Do the benefits outweigh the costs?

NHS Constitution

Principles That Guide The NHS.

Number 6 - The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.

World Class Commissioning

• Purpose of World Class Commissioning is to Add Life to Years and Years to Life

• Programme Budgeting features in the following two of the 11 WCC commissioning Competencies

• 6 – Prioritise Investment

• 11 – Make Sound Financial Decisions

Investing in Health

• How do we know that we are ‘maximising years to life and life to years’, at the same time as providing ‘best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources’

• How do we know whether we are investing in health?

• Programme Budgeting provides a framework to help commissioners make and evaluate health investment decisions.

From Consumer Intelligence…..

• Do you know how much you spent on electricity last year?

• Do you know what activities are driving your electricity expenditure?

• Can you identify ways in which you can save money….• ….and maintain or improve the level of benefit obtained

from having electricity at the same time?• How would you decide how to spend the money that you

have saved?• What sources of intelligence are available to help you

with these decisions?

..to Commissioning Intelligence

• Do you know what you spent on CVD last year?• Do you know what activities are driving your CVD

expenditure?• Can you identify ways in which you can save money….• ….at the same time as maintaining or improving the level

of benefit obtained?• How would you decide what to spend the money that

you have saved?• What sources of intelligence are available to help you

with these decisions?

Programme Budgeting in a nutshell….

• Programme Budgeting….– Tells us what we are spending– Allows us to look at how we are spending it– Lets us see what we are getting for the money we are

spending…..

How spend data is calculated• PCTs already know what they are spending from their annual

accounts; • But how do they split this expenditure into ‘programmes’

– Providers supply PCTs with expenditure data split by ‘programme’– The Business Services Authority supplies PCTs with prescribing

data by ‘programme’– PCTs analyse their own data for community care– GMS / PMS expenditure goes to category 23 – other.

• So what is a ‘programme’?

1 Infectious Diseases2 Cancers & Tumours3 Blood Disorders4 Endocrine, Nutritional and

Metabolic Problems5 Mental Health Problems6 Learning Disability Problems7 Neurological System Problems8 Eye/Vision Problems9 Hearing Problems10 Circulation Problems (CVD)11 Respiratory System Problems12 Dental Problems13 Gastro Intestinal System

Problems

14 Skin Problems15 Musculo Skeletal System

Problems (excludes Trauma)16 Trauma & Injuries17 Genito Urinary System

Disorders (except infertility)18 Maternity & Reproductive

Health19 Neonates20 Poisoning21 Healthy Individuals22 Social Care Needs23 Other Conditions

23 Programme Budgeting Categories

Which is the biggest Programme?

• The top three Programmes in no particular order are:

Cancer,

CVD, and

Mental Health.

• But which is the biggest?

Programme Budgeting Category2006-07 Max/Min

2007-08 Max/Min

2006-07 COV 2007-08 COV

01 Infectious Diseases 13.5 22.5 0.81 0.87

02 Cancers and Tumours 2.5 3.3 0.16 0.18

03 Disorders of Blood 6.1 9.2 0.33 0.35

04 Endocrine, Nutritional and Metabolic 4.7 3.2 0.17 0.16

05 Mental Health Disorders 3.7 2.9 0.25 0.22

06 Problems of Learning Disability 16.8 29.2 0.33 0.33

07 Neurological 3.0 3.5 0.21 0.19

08 Problems of Vision 6.2 3.6 0.26 0.21

09 Problems of Hearing 8.7 12.0 0.41 0.41

10 Problems of Circulation 2.3 3.6 0.15 0.17

11 Problems of the Respiratory System 2.8 2.6 0.16 0.16

12 Dental Problems 12.5 4.0 0.23 0.18

13 Problems of Gastro Intestinal System 2.6 3.0 0.17 0.18

14 Problems of the Skin 2.8 2.9 0.22 0.21

15 Problems of Musculo Skeletal System Not Available 3.6 0.28 0.23

16 Problems due to Trauma and Injuries 5.2 23.0 0.25 0.28

17 Problems of Genito Urinary System 3.3 4.5 0.21 0.19

18 Maternity and Reproductive Health 4.3 5.3 0.26 0.26

19 Conditions of Neonates 51.3 63.5 0.48 0.49

20 Adverse effects and poisoning 3.5 5.4 0.24 0.26

21 Healthy Individuals 19.9 15.4 0.55 0.45

22 Social Care Needs Not Available 2,176.4 1.64 1.52

23 Other 4.5 4.4 0.29 0.26

What we Publish (Spend)

From 29 October four years worth of benchmarking expenditure data published on DH website:

• 2003/04• 2004/05• 2005/06• 2006/07

As you’ve seen – the 2007-08 data are in – we are just checking them.

Data published on an interactive spreadsheet in terms of levels and changes.

Data presented in terms of spend per 100,000 (weighted/unweighted) population.

Possible to adjust to take account of distance from target.

Spreadsheet enables PCTs to benchmark themselves against PCTs locally or PCTs with similar characteristics.

Also publish data for Cancer and CVD networks

Data are all available to the General Public. And the press. And the HSJ.

BBC News, 8 September 2008

Next Steps Expenditure

Longer term next steps include:

- age specific data?

- prevention spend per programme?

- expenditure estimates based on tariff not cost?

- audited PCT returns?

NHS Comparators

• NHS Comparators can provide data more frequently and at a practice as well as PCT level;

• Working closely with the NHS comparators team to provide

- inpatient admissions / alos / beddays;

- outpatient attendances;

- FHS prescribing.

• Also planning to multiplying inpatients and outpatient activity by tariff to provide estimated expenditure.

• FHS prescribing expenditure data will also be made available at the same level.

NHS Comparators

NHS Comparators

NHS Comparators

NHS Comparators

NHS Comparators

NHS Comparators

NHS Comparators

Programme Budgeting Atlas

• Programme Budgeting Atlas brings together Expenditure and Outcomes Data per Programme.

• Outcomes data are compiled by the National Centre for Health Outcomes Development (NCHOD)

• Data Published (July ‘06) for Top 6 Programme Budgeting Categories in expenditure terms.

• Additional Atlases giving 15 in total published December ‘06.

• New 152 PCT Atlases published October 2008

Health Atlas Next Steps• Final 303 PCT complete including 2005/6 QOF data. These

atlases will then be archived but will remain accessible.

• 2006/7 atlases on the basis of 152 PCTs also now available.

• Still looking to include ‘predicted prevalence’ indicators.

- uses work from the Public Health Observatories;will allow comparison of recorded (through QOF) prevalence with predicted prevalence – an indicator

of unmet need;

- in addition predicted prevalence indicators are forward looking through to 2020.

Liverpool PCT Cancer Mortality

Liverpool PCT – Cancer Incidence

Cancer – Incidence vs Mortality

YLL Cancer – Liverpool PCT

Liverpool PCT – QOF Data Cancer Prevalence

Liverpool PCT 2006/7 Cancer Expenditure

Liverpool PCT – Cancer FHS Prescribing

Cancer – All Admissions

Liverpool PCT Cancer Electives

Liverpool PCT Cancer Non-Electives – High - But Much Lower Rate – 1 in 6 CancerAdmissions in Liverpool Non-Elective

Liverpool PCTCancer – Elective ALOS

Liverpool PCT QOF DataWomen With Smear Test

Smoking Prevalence

Smoking Cessation Advice

Recent Articles on Programme Budgeting

• Ruta D, Mitton C, Bate A, Donaldson C. Programme budgeting and marginal analysis: bridging the divide between doctors and managers. BMJ 2005;330:1501-3

• Gray J.A.M. Better value healthcare. Offox Press. Oxford 2006

• Jackson A, Brambleby P, Young C. Putting health spending on the map. Health Finance, Dec 2006, p 11-13

• Brambleby P, Jackson A, Gray AJM. Better allocation for better health and healthcare. Annual Population Value Review, NHS National Knowledge Service & Commissioning Directorate, DH, Feb 2007, available from: rosemary.lees@dphpc.ox.ac.uk

Information/Guidance

Website address – Department of Health:

http://www.dh.gov.uk/programmebudgeting

Or type ‘Programme Budgeting’ into Google!

NHS website – Programme Budgeting Atlas:

nww.nchod.nhs.uk (N.B. nww prefix not www)

Atlases Require Users to Download SVG Viewer Software