NHS expenditure programme budgets: April 2020 to March 2021

This includes expenditure on primary care services, such as GPs and dentists, as well as secondary care services, such as hospitals.

Financial figures are collected from all Welsh local health boards and NHS Trusts.

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

Main points

• Total expenditure for all programme budget categories was £8.3 billion or £2,632 per head of the population in 2020-21.
• Total expenditure increased by just over £1 billion in 2020-21. It was 14.6% higher than expenditure in 2019-20 and 55.8% higher than a decade ago.
• Total expenditure has increased each year since 2009-10. The latest annual increase is the biggest seen and was more than double the increase between 2018-19 and 2019-20.
• The programme budget category with the biggest increase was ‘Infectious diseases’, which increased by £373 million (306.6%) from 2019-20 due to the Coronavirus pandemic. The second biggest increase was ‘Trauma & injuries (including burns)’, which increased by £127 million (23.6%).
• The largest single programme budget category (excluding ‘Other’) was ‘Mental health problems’ accounting for 11.2% (£936 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 £11.37 on ‘Hearing problems’ to £295.41 on ‘Mental health problems’.

Notes

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

Coronavirus (COVID-19)

2020-21 was significantly impacted by the Coronavirus (COVID-19) pandemic. The impact on health service access, provision and financing is apparent in the Programme Budgeting data.

In total, the data includes £1.17 billion of additional resourcing related to the COVID-19 pandemic, though this amount is relevant to both COVID and non-COVID patient activities.

The cost of activities for patients confirmed as suffering with COVID-19 and for services specifically related to the management of the pandemic was identified as £628 million. The remainder of the resourcing funded activities required as a result of the pandemic, but which apply to all patients such as cover for shielding staff, PPE costs, enhanced cleaning activities and many others.

The impact of the pandemic in the detail of the Programme Budgeting analysis is also extensive and complex. Some of the key aspects to consider are detailed here:

A number of programmes experienced significant fluctuation during 2020-21 as a direct result of the pandemic, primarily as a result of the direct cost of COVID-19 care and the changes in activity as a result of management of health services during the pandemic. This is primarily highlighted by the substantial increase in costs associated with the Infectious diseases programme.

In addition to capturing the cost of care to those patients for whom COVID-19 was their principal diagnosis (approximately half of all patients receiving care for COVID-19), this programme also contains the costs of the provision of the Test, Trace, Protect programme, the National COVID Call Centre and an element of Field Hospital capacity, these elements accounting for £145 million of the £373 million increase.

A number of programme areas were impacted by considerable reductions in activity with the cessation of planned activity such as outpatients and elective admissions resulting in a significant change to programmes such as Hearing problems, Eye/vision problems, Genito Urinary system disorders, Musculo skeletal system problems and Respiratory problems.

Some programme areas did not see such sizeable reductions in activity levels due to the nature of services (Cancer & tumours, Maternity and Neonates) and were impacted by large increases in cost, partly as a result of the general increase in cost of care provision, but also a result of the impact of costing methodologies and areas of targeted investment in response to the pandemic.

Neonates was one of only two programmes of care that experienced an increase in activity compared to the previous year, in addition to Infectious diseases, the other being Learning disability problems. The Cancers & tumours programme saw some increase, along with Poisoning.

Further notes

The pandemic bought an extraordinary response in service change and flexibility and presented a new challenge to costing process by reducing established links between cost and activity cohorts. As a result, cost models focussed on activity undertaken and applying a pooled cost methodology in those areas where staff cost and activity could not be directly linked. The outcome of the revised methodology is difficult to isolate from the range of other impacts in the year, but will have certainly contributed to the change in spend profile across the programmes. Due to the changes in methodology comparisons at programme level with previous years should be treated with caution.

The ‘Other’ programme category contains significant service areas where organisations are unable to allocate costs to programmes with current data sources and methodologies. Whilst not new for 2020-21 and no significant change in process in year, this category has a great impact when assessing the cost of programmes of care delivery. 94% of Primary Care General Medical Services costs are identified to the ‘Other GMS’ sub-category, whilst 30% of Continuing Healthcare spend is also unallocated to programmes. In total, with the addition of Open Access, unallocated PHW function and non-coded secondary care elements, £1.1 billion (13%) of spend sits outside the clinical programmes.

The 2020-21 expenditure allocation process again incorporated an opportunity for all organisations to implement provisions allowing clinically uncoded activity to be assigned to programmes where there was a high degree of confidence from data indicators to do so. All local health boards except from Powys University Health Board adopted this approach in 2020-21.

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

No full statistical release has been published for 2020-21.