---

Public Accounts

Let me describe those consequences. As the hon. Lady knows, we are a value-for-money Committee: we scrutinise the value for money of public expenditure. What is going on in my hospital trust is illustrative of a national problem and of exactly the kind of problem that our Committee is here to interrogate. The problem is that the primary care trusts are running out of money. The financial year end is on 31 March and the PCTs are telling the hospital trusts that they will not finance any more out-patient or in-patient procedures in this financial year. Let me explain the consequences of that in value-for-money terms. Hospital consultants and surgeons continue to be employed by the trust and to have their salaries paid. The operating theatres remain open and available, but they are not used. Patients are waiting to be treated, yet consultants and surgeons are being told to go off and play golf, read the newspaper or twiddle their thumbs, on full pay, because they are not allowed to trigger a charge—which is, after all, just a mark on an electronic ledger—this side of 31 March. None of us would doubt that the patients need to be treated. People need to have their hip operations, for example, and they will have to be carried out at some point. However, because of this arbitrary deadline, capacity that is available now is not being used, but it will have to be used in the next financial year, and shared with the patients who come on to the lists in that year. Who knows, perhaps that will give rise to overtime payments or to capacity constraints. This is clearly not offering value for money. I have spoken to the executives in these organisations, and I feel for them. It is very difficult to know what to advise them to do. The trust is merely following the inevitable consequence of the PCT’s decision not to fund any further procedures. The PCTs are under apparently irrevocable instructions not to make funds available if there has been more activity during the year. Whoever is responsible, the consequence is a loss of value for money. There are solutions available, however. One possibility is that, if a PCT and a hospital trust have had their allocation of activity for one year, any further activity could be charged at marginal cost, rather than the full tariff. After all, the only costs that would be incurred in carrying out these operations would be the cost of lighting the operating theatre and of any consumables used during the operation. That is one example, but who would take responsibility for making such a decision? Not the Secretary of State. She would say that these matters are now devolved to the PCTs and the hospital trusts. Yet the PCTs and the trusts have no locus to be able to take decisions that would remedy the problem. So we have a situation that, in economic and value-for-money terms, is completely mad. This is an example of the lack of accountability that is fundamental to the system, and our Committee has an important role in scrutinising such issues. I just wish that the powers of the Committee extended perhaps not to the ability to interrogate Ministers, but to the ability to cause Ministers to take responsibility for some of the consequences of their policy actions. My final observation is on the Office of Fair Trading. This is a body that is only very indirectly accountable to Parliament, but it nevertheless exists to enact the will of Parliament as expressed in, among other things, the Competition Act 1998.