§ Mr. Dobson
asked the Secretary of State for Social Services (1) if he will give the figures and calculations from which he derives his estimate that expansion of the 145W National Health Service services in real terms between 1978–79 and 1983–84 will be 7½ per cent., distinguishing between expenditure on wages and salaries and non-wage related items and between the increases necessary to meet, respectively, demographic change, technological development and inflation and any increases attributed to efficiency savings, showing also the equivalent figures if increased income from charges is deducted;
(2) If he will identify for each year from 1978–79 to 1983–84 the expenditure or estimated expenditure on (a) hospital and community health services, (b) family practitioner services and (c) central health and miscellaneous services; and for each category, what growth in (i) resources and (ii) services the total expenditure over the period represents, showing also the equivalent figures if increased income from charges is deducted.
§ Mr. Kenneth Clarke
[pursuant to his replies, 8 December, c. 230 and 235]: The table gives the figures
A.—TOTAL NHS EXPENDITURE 1978–79
Increase 1983–84 of 1978–79
(a) Expenditure (i) Wages, salaries and remuneration 3,876 4,714 6,109 6,754 7,342 (ii) all other items 2,579 2,998 3,808 4,404 4,888 (iii.) Gross total 6,455 7,712 9,917 11,158 12,229 12,880 6,420 (iv) Net total, excluding charges 6,311 7,528 9,663 10,850 11,865 12,480 6,160 percentage percentage percentage percentage percentage percentage (b) Increase in cash at (iii) 19.5 28.6 12.5 9.6 5.3 99.5 (c) NHS pay and price increases 19.6 27.0 9.0 7.5 5.3 87.4 (d) Growth in resources -0.1 1.2 3.3 1.9 0.0 6.4 Health authorities specifically identified and planned efficiency (e) savings 0.1 0.3 0.3 0.7 (f) Growth in services -0.1 1.2 3.4 2.3 0.3 7.3
B.—EXPENDITURE ON THE SERVICES 1978–79 1979–80 1980–81 1981–82 1982–83 1983–84 (a) Expenditure (i) Hospital and Community Health Services Current Gross expenditure 4,421 5,333 6,886 7,631 8,201 8,630 Net expenditure 4,385 5,291 6,831 7,565 8,132 8,560 (ii) Family Practitioner Services Current Gross expenditure 1,434 1,684 2,114 2,440 2,845 3,000 Net expenditure 1,329 1,548 1,922 2,206 2,558 2,670 (iii) Centrally Financed Services Current Gross expenditure 236 288 364 413 478 540 Net expenditure 233 283 358 406 470 530 (iv) NHS Capital 365 407 552 673 705 710 (b) Growth 1978–79 to 1983–84 Resources per cent. Services per cent. (i) Hospital and Community Health Services Current 4.5 5.7 (ii) Family Practitioner Services Current 7.2 7.2 (iii) Centrally Financed Services Current 32.3 32.3 (iv) NHS Capital 14.4 14.4
Service growth is normally expressed in gross terms as indicative of the total spending power available: for services. Over the period the relative cash increases in gross and net expenditure in the hospital and community health services and centrally financed services are broadly comparable so that changes in charge income will not have significantly affected growth in these two services. As expenditure on the family practitioner services is not cash limited it is not meaningful to try to assess the effect on services had charge income not increased.
Figures to 1981–82 are outturn. Figures for later years are planned expenditure in Cmnd. 8789 as subsequently revised. Figures for 1983–84 and total increase over period are rounded to nearest? 10 million. As figures are rounded individually they may not sum to the total. Outturn figures for 1982–83 will be published in the forthcoming White Paper on public expenditure. The spending figures for 1983–84 are subject to the normal uncertainties in relation to final outturn, including the extent to which Health Authorities have used their power to transfer between current and capital allocations.146W
sought by the hon. Member where these are available. However, the questions ar not a helpful or realistic approach to the relationship between NHS spending and demand for health services. The Government do not accept that the only way to keep up with increased demand is by increasing spending in the same proportion; or that the implications of the various sources of increased demand—that is population structure change, medical advance, and other improvements—can be estimated with equal confidence; or that only these efficiency gains that have so far been identified and quantified for the Department should be brought into account; or that the increase in NHS resources is better measured against NHS pay and price increases rather than against average pay and price changes in the economy overall; or that increases in NHS pay, which have been a significant source of the 17½ per cent, real rise between 1978–79 and 1983–84 in the economic cost of NHS expansion, are in some way different from other sources of increased costs.