PBMA for HE Evaluation
PCT Spend and Outcome Tool and Factsheets
The Department of Health has commissioned the Association of Public Health Observatories (APHO) to develop a tool which helps commissioners to link health outcomes and expenditure. The development of this tool and a Spend and Outcome Factsheet for every PCT in England has been led by Yorkshire and Humber Public Health Observatory.
PCTs can use the tool and the factsheets to gain an overview of outcome and expenditure across all programmes. The tool allows for further exploration of the data.
PCT Spend and Outcome Factsheets and Tool (SPOT)
PBMA Pilot Site Reports
The NHS Institute for Innovation and Improvement funded a study to road-test PBMA in three English Regions. The reports below summarise the findings from the pilot sites. The three sites which took part in the study were Newcastle ( Child and Adolescent Mental Health), Norfolk (Mental Health) and Hull (Diabetes.)
PBMA
To optimize how resources are allocated within a budget, a reliable method for making choices about which interventions and programmes to fund is required. Programme Budgeting Marginal Analysis (PBMA) can be used as a systematic way of identifying the range of options available, the resources required to produce the options and their expected effectiveness.
NHS Programme Budgeting allocates Primary Care Trust (PCT) and Strategic Health Authorities (SHAs) expenditure, including primary care services, to programmes of care based on medical condition.
There are 23 programme budget categories (listed below), they are based off the International Classification of Diseases Version 10 codes (ICD 10).
| PBC | Description | Expanded description |
| 1 | Total | Infectious Diseases | All disease caused by infectious organisms, excluding Tuberculosis and Sexually transmitted disease |
| 1 | A | HIV & AIDS | Sub-category of Infectious Diseases: HIV infection |
| 1 | X | Other | Sub-category of Infectious Diseases: Excludes HIV infection |
| 2 | X | Cancers & Tumours | All cancers and tumours, malignant and benign. Including those with suspected or at risk of developing cancer |
| 3 | X | Blood Disorders | Disorders of the blood and blood forming systems |
| 4 | Total | Endocrine, Nutritional and Metabolic Problems [ENM] | Disorders of internal metabolism and its regulation |
| 4 | A | Diabetes | Sub-category of ENM: Diabetes |
| 4 | X | Other | Sub-category of ENM: Excludes Diabetes |
| 5 | Total | Mental Health Problems | Problems of mental health including patients with Alzheimer's syndrome |
| 5 | A | Substance Abuse | Sub-category of MH problems: Substance Abuse |
| 5 | B | Dementia | Sub-category of MH problems: Dementia |
| 5 | X | Other | Sub-category of MH problems: Excludes substance abuse & dementia |
| 6 | X | Learning Disability Problems | Patients where the primary issue is the problem of learning disability |
| 7 | X | Neurological System Problems | Problems relating to the Neurological system |
| 8 | X | Eye/Vision Problems | Problems relating to the eye and vision |
| 9 | X | Hearing Problems | Problems relating to the ear and hearing and balance |
| 10 | Total | Circulation Problems | Problems relating to the heart, and the circulation of blood in central and peripheral vessels |
| 10 | A | Coronary Heart Disease | Sub-category of Circulation: Problems relating to atheroma of the coronary arteries |
| 10 | B | Cerebrovascular Disease | Sub-category of Circulation: Problems due to interruptions to the blood supply of the brain |
| 10 | X | Other | Sub-category of Circulation: Excludes conditions associated with 10A & 10B |
| 11 | X | Respiratory System Problems | Problems of respiration, including tuberculosis and sleep apnoea |
| 12 | X | Dental Problems | Problems due to the teeth, including preventive checks and community surveys |
| 13 | X | Gastro Intestinal System Problems | Problems of the gastro intestinal systems |
| 14 | X | Skin Problems | Problems of the skin, including breast. |
| 15 | X | Musculo Skeletal | System Problems (excluding Trauma) Problems of the Musculo Skeletal system, excluding trauma |
| 16 | Total | Trauma & Injuries (inc burns) | Problems of Trauma & Injuries (including burns) |
| 16 | A | Falls | Sub-category of Trauma & Injuries: Falls ( Elderly NSF) |
| 16 | X | Other | Sub-category of Trauma & Injuries: Excludes Falls (16A) |
| 17 | Total | Genito Urinary System Disorders (except infertility) | All Genito urinary problems except for those relating to infertility |
| 17 | A | Genital tract Problems | Sub-category of GUS: Genital tract Problems |
| 17 | B | Renal problems | Sub-category of GUS: Renal problems |
| 17 | C | Chronic Renal Failure | Sub-category of GUS: Chronic Renal Failure (Renal NSF) |
| 17 | X | Other | Sub-category of GUS: Excludes conditions associated with 17 A, B & C |
| 18 | X | Maternity & Reproductive | Health Maternity and problems associated with reproduction |
| 19 | X | Neonates | Conditions of babies in the neonatal period. |
| 20 | X | Poisoning | Poisoning, toxic effects and other adverse events, whether accidental or deliberate |
| 21 | Total | Healthy Individuals | Individuals who have no current problems but who are involved in programs for prevention of illness and promotion of good health |
| 21 | A | NSF Prevention programme | Sub-category of Healthy Individuals: Specific Prevention interventions for CHD, Cancer Diabetes and Chronic Renal Failure |
| 21 | B | NSF Mental health prevention | Sub-category of Healthy Individuals: Intervention to reduce the risk of development of mental illness |
| 21 | X | Other | Sub-category of Healthy Individuals: Excludes programmes associated with 21A & 21B |
| 22 | X | Social Care Needs | Problems related to life-management difficulty and problems related to care-provider dependency |
| 23 | X | Other | Other conditions and Other congenital malformations |
Source : Appendix 2 - Programme Budgeting Guidance Manual, Department of Health
The Department of Health website for the National Programme Budget project can be accessed from the link below, also listed are useful links to data and methodology included on the website.
DoH National Programme Budget project website
Click here for more information
Programme Budgeting Guidance Manual - provides detailed explanation on how the data is collected and what it is used for
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PCT expenditure across the programme budget codes - allows comparison between PCTs across any of the programme budget codes.
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Interactive atlasses (NHS Net only) - NHS users can access the data as an interactive atlas, allowing visual comparison acoss all PCTs and correlation with other datasets such as IMD 2004 (requires SVG browser plugin).
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Save to Invest - refers to "work in progress" which has been undertaken by the London Health Observatory and London PCTs to support effective and equitable commissioning for hospital care.
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Better Allocation for Better Health and Healthcare: The First and Second Annual Population Value Reviews. Offers a step by step approach to using the Programme Budget information available through the National Programme Budget Project website to carry out an annual population value review.
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Last Updated: Thursday, 10th December 2009