A survivor's guide to programme budgeting.

In this paper a descriptive account is given of programme budgeting in the Hastings and Rother localities of East Sussex Health Authority. The primary purpose of the exercise was to track past resource consumption in a comprehensive and overlapping matrix of programmes, with a view to simplifying past annual expenditure into a single matrix, informing the health authority of the overall pattern of resource consumption, planning future expenditure, co-ordinating the strategic plans and purchasing intentions of all those involved in commissioning health care, and communicating the health authority's view of past and future spending. Many of the findings gave new insights and led either to changes in resource allocation or to plans for future study. They have proved to be a useful tool for communication and education, especially with providers of health care and public representative bodies. The process will now feed into long-term strategic planning and short-term purchasing intentions. Marginal analysis is now being undertaken in a number of clinical specialties and disease areas. The cumulative effect of a series of planned investment and disinvestment decisions can be tested against agreed priorities for programmes before final decisions are taken. Thus, programme budgeting can be a powerful tool in the commissioning process and should be within the capabilities of even the smallest health authorities.