NHS expenditure programme budgets: April 2019 to March 2020

Financial figures are collected from all Welsh local health boards and NHS Trusts. This update reflects the move of Bridgend local authority on 1 April 2019; which has not had a significant impact on the profile of expenditure by programme.

This data covers the start of the coronavirus (COVID-19) pandemic. The impact in 2019-20 was limited as a result of the timing of the pandemic. However, there was additional expenditure recorded in 2019-20 over and above an unaffected year. After the deduction of specifically excluded elements, £7.8 million of costs directly identified as relevant to the impact of COVID-19 were included across the full range of programmes. The numbers of patients and thus the costs of providing direct care to patients suffering with COVID-19 were low in 2019-20.

Main points

• Total expenditure for all programme budget categories was £7.3 billion or £2,308 per head of the population in 2019-20.
• Total expenditure in 2019-20 was 7.0% higher than expenditure in 2018-19 and 35.9% higher than a decade ago. Total expenditure has increased each year since 2009-10.
• The programme budget category with the biggest increase was ‘trauma and injuries (including burns)’, which increased by £55 million (11.3%) from 2018-19.
• The largest single programme budget category (excluding ‘other’) was ‘mental health problems’ accounting for 11.1% (£810 million) of the total. This has been the case since 2009-10.
• Spending per head of the population on clinical programmes (excluding ‘other’) ranged from £13.20 on ‘hearing problems’ to £256.86 on ‘mental health problems’.

Notes

Expenditure data are presented at current prices and make no adjustment for inflation.

The costs of a 6.3% increase in Employers Superannuation contributions were included by health boards in 2019-20 and impacted all NHS Wales organisations and staff. Costs have impacted across programmes of care on a largely pro-rata basis with this additional cost representing 2.2% of the programme budget expenditure total.

In 2019-20 the scope of the costing process in Wales was expanded to include the costing of activities that were incomplete at the end of the costing period, fully aligning the boundaries of activity and costs for the first time and allowing the reporting of the full scope of activities that impact a costing period. Prior year costing included only those activities that had completed within the costing period. This has minimal impact as costs would, in the vast majority of instances, have been included in the same programmes pre and post change. 

The 2019-20 expenditure allocation process incorporated an opportunity for all organisations to adopt new guidance in respect of assigning clinically uncoded activity to programmes where there was a high degree of confidence from data indicators to do so. This approach was previously adopted, and continued, by Aneurin Bevan UHB and Hywel Dda UHB, but was also adopted significantly by Cwm Taf Morgannwg UHB in 2019-20 and to a lesser degree by the other UHBs.

Further information, including health board level breakdowns, can be found on StatsWales.

Spend per head figures previously published on StatsWales for 2017-18 have been revised for Cwm Taf LHB and Abertawe Bro Morgannwg LHB as it was found that the LHB populations used to calculate these figures were incorrect.

No full statistical release has been published for 2019-20 due to analytical resources prioritising the response to the COVID-19 pandemic.

Information on quality can be found in the 2018-19 statistical release.