Where your health cash is being spent

The accident and emergency department at Queen Alexandra Hospital in Cosham.
The accident and emergency department at Queen Alexandra Hospital in Cosham.
Fareham Community Hospital in Salisbury Green. Picture: Paul Jacobs (151666-2)

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More than half of the area’s annual budget for health is spent on Queen Alexandra Hospital.

In this financial year, Portsmouth Hospitals NHS Trust, which runs QA, gets about £362m from the three commissioning groups in the south-east Hampshire area.

As part of our Under Pressure Week, today we take a look at how health services are funded, and where our money goes.

Locally there are three Clinical Commissioning Groups (CCGs) that fund provisions such as hospital care, mental health, community services and running costs.

The CCGs are Portsmouth; Fareham and Gosport; and South Eastern Hampshire, and between them have £668.7m to spend in this year.

The CCGs receive money from central government, based on the population each commissioning group serves, and any specific health needs.

Jo Gooch, chief finance officer for the Portsmouth CCG, said: ‘Upon establishment, the CCG received a nationally-set allocation for 2013/14, which was based on how much the former commissioners, the primary care trust, had previously spent on CCG-related activities.

‘Since then, a national formula has been devised to inform allocations to CCGs, taking into account demographic and population characteristics.’

The biggest spending areas for the commissioners are acute – or hospital – care, primary care and mental health services.

About 55p of every pound spent in health locally goes to the hospital trust, about 16p is spent on primary care, and 9p on mental health.

Mrs Gooch added: ‘For acute services, most services commissioned by CCGs are paid for under a national payment system which sets a national tariff for each activity.

‘As these are nationally specified there is little mandate to vary the price, without agreement.

‘There are a smaller number of areas where the price paid will be calculated and set locally.

‘Most community and mental health activities are currently paid on a local price arrangement, this is based on previous years’ spend, adjusted for known changes.’

As previously reported, the Portsmouth CCG said it wants to look at having more services out in the community.

Chief operating officer Innes Richens said: ‘The CCG and Portsmouth City Council have worked extremely closely together and aim to set up an integrated team to achieve our prime mutual objective of creating a single health and social care system.

‘This will also help us to take services out more into the community. We feel that it must be better for most patients if they can be cared for outside an acute hospital environment, providing it is appropriate for their needs to do so and where it enables us to offer them care in the right place, at the right time, by the right staff.

‘As well as the integrated community health and social care teams, we will also review the use of community beds and align re-ablement services such as domiciliary care to support the integrated community teams.

‘For the acute hospital, taking more services out into the community mean having to deal with less emergencies so it can spend more time providing the services we know it already excels at.

‘For our community providers, they will need to change some of their existing services so that their work is also integrated with the work of the community care teams.’

Solent NHS is a provider of community and mental health services in Portsmouth.

The trust’s director of strategy Sarah Austin said: ‘By providing services in a much more integrated way with community health, social care and GPs all working together, we are making significant headway in reducing inappropriate admissions to hospital and also reducing their length of hospital stay when admitted.

‘We, therefore, strongly welcome our commissioners’ focus on investing more in community services to enable us to make even bigger differences to our local community and better manage needs.’

How money is spent:

South Eastern Hampshire CCG (covers the Havant area)

. Acute – £121.2m

. Mental health – £19.8m

. Community services – £19.7m

. Primary care – £34.6m

. Continuing care – £15m

. Other commissioning – £0.6m

. Running costs – £4.2m

. Reserves and contingencies – £5.5m

. Total – £220.6m

Fareham and Gosport CCG

. Acute – £111.7m

. Mental health – £19.5m

. Community services – £13.1m

. Primary care – £33.3m

. Continuing care – £14.1m

. Other commissioning – £1.4m

. Running costs – £4.1m

. Reserves and contingencies – £5.9m

. Total – £203.1m

Portsmouth CCG

. Acute – £124.7m

. Mental health – £30m

. Community services – £24.8m

. Primary care – £31.7m

. Continuing care – £13.8m

. Other commissioning – £4.4m

. Running costs – £5.3m

. Reserves and contingencies – £10.9m

. Total – £248m