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Department of Health

I am afraid not, because the hon. Gentleman intervened earlier, and other hon. Members wish to speak. The so-called NHS turnaround team consists of one man from Deloitte, who only got his feet under the table last Monday, so he has not had any input. When I asked what was the point of the turnaround man, the reply was, ““Good question.”” The purpose of my gnashing of teeth is to make the point that the process is hardly well stewarded. At times there is a vacuum of governance, accountability and control. I do not want to bog the House down with too much detail, but some is necessary to illustrate the impact on the deficits in my local area of different policies changing at the same time. On Friday I was finally provided with the first draft of    the hospital’s financial recovery plan, dated 18 January—two months out of date, but a first faltering step on the road to accountability. It is clear that for   some time the hospital was allowed to employ accounting staff who found it difficult to recognise basic accounting principles. For example, one does not make up for recurring overspends by using the budget for one-off items. It is clear, too, that there is a cosiness among NHS accountants locally. The hospital did not bill PCTs for extra work, as it did not want to embarrass them and force them into deficit, and it knew that they could not pay. Unfortunately, the numbers have to add up for big payments on private finance initiative projects such as our new hospital, so that eventually leads to a brick wall. We need rigorous accounting, not because the NHS is a business, but because we need to know what everything costs so that the taxpayer can obtain value for money. In the hospital’s predicted deficit, some items stand out like a sore thumb. For example, there are £4.2 million of unfunded costs for the new consultants’ contract, the working time directive and ““Agenda for Change””. In addition, £7.2 million so far this year and £4.2 million next year have been earmarked for the new policy of payment by results. In many respects, those are unknown, unintended or poorly predicted consequences of policy change. The new chief executive has acknowledged that much of the recruitment that has been undertaken is in line with national targets, but we want to know exactly how much. Clearly, I agree with my right hon. Friend the Member for Rother Valley and other hon. Members that we must know not just what we spend in the NHS, but how well we spend it and what everything costs. In North Staffordshire and elsewhere, the financial recovery plan does not seek to restore finances just to an even keel. The requirement is that in the following year, trusts must recover the underlying deficit, plus an element of the deficit carried forward from the previous year. That is a painful incentive not to get into deficit in the first place and a powerful signal, but where recognisable failures have occurred in the NHS system at a time of great change, it is too brutal in its effects now. In North Staffordshire, some of the vagaries of the modelling, particularly with payment by results, may yet lead us to predict another £20 million of deficit. Staff and patients in areas such as north Staffordshire, which are already underprivileged, should not bear the pain of that brutality. The response must be managed and planned; it should not cause chaos, run amok or be out of control.