Programme Budgeting in NHSScotland

Discussion

21.Programme budgeting allows us to identify – in very broad categories - spend on particular diseases and particular areas of high spend which may be a source of budgetary pressure.

22.There are, however, a number of limitations worth noting:

• Not all activity can be mapped to an appropriate programme. This is particularly true of community activity where no diagnostic information is routinely collected. Prevention activity such as cancer screening programmes are also not well represented as they are included in the “other” category.
• For some sub programmes, (diabetes is a case in point) the reliance on first diagnostic place for coding may mean an under-recording of activity & associated cost against some programmes.
• The sub-programme approach may not be the most useful disaggregation for some types of disease. For example in cancer, it might be more appropriate to have analysis by stages of care – diagnosis, treatment, palliation.
• This analysis has given us a useful comparison over 2 time periods but most useful would be a continued time series to be able to observe change in the relative proportions of spend.