Work Area / Health
Economics / PBMA
for HE Evaluation
Programme Budgeting and Marginal Analysis (PBMA)
Programme Budgeting Fact Sheets
Yorkshire and Humber Public Health Observatory in conjunction with NHS Yorkshire and the Humber have produced a fact sheet for each PCT in the region using the programme budgeting data and a selection of related 'outcome' measures. The fact sheets aim to build on the programme budgeting data contained in the WCC strategic planning data packs released at the beginning of June 2008. The fact sheets have been sent to Directors of Finance, Commissioning and Public Health in each PCT. North Yorkshire and York PCT's fact sheet is attached here as an example. If you would like a copy of the fact sheet for your PCT please email Sue Baughan at
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
http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/ProgrammeBudgeting/fs/en
Programme Budgeting Guidance Manual - provides detailed explanation on how the data is collected and what it is used for
http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/
FinanceAndPlanning/ProgrammeBudgeting/ProgrammeBudgetingArticle/fs/en?CONTENT_ID=4117326&chk=u7Eq17
PCT expenditure across the programme budget codes - allows comparison between PCTs across any of the programme budget codes.
http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=137052&anp;Rendition=Web
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).
http://nww.nchod.nhs.uk/NCHOD/HomeDb2R6.nsf/
089DE59E1CFFBE8F65256CD100209BF0/B704F6AD68D9A5EC802571FD004DA54E?OpenDocument
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.
http://www.lho.org.uk/commissioning/save_to_invest.aspx
Better Allocation for Better Health and Healthcare: The First Annual Population Value Review. 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.
http://www.nks.nhs.uk/APVR.pdf