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Department of Health

No, I do not have much time. Also, in the course of his 10 minutes, the hon. Gentleman used as many words as most people would use in 20. I want the Minister to accept reality. Up to now, the Government have refused to respond to freedom of information requests for the month nine and month 10 forecasts of the strategic health authorities. Will the Minister tell us what their forecast estimate is? Will she also be clear about how the SHAs can possibly move from their present position to system balance within the next year, in the light of the way in which resource accounting works? The present structure dictates that if an organisation consumes its resources in the first year of a three-year public expenditure round, it has consumed in advance the resources that would otherwise have been available to it for the following year. That is understandable in theory, but it is going to be disastrous in practice. The Government are going to cover many of the deficits. Let us face it, they have increased their departmental expenditure limit by £112 million for this purpose. They will also add about £116 million by underspending on their central programmes. Procurement on the connecting for health programme is slow, which gives them another £200 million, and the end-year flexibility will give them another £200 million. They were lucky last year, in that a gross error in the calculations of the NHS litigation authority meant that they had hundreds of millions to spare. That is not going to happen this year; the contingent liabilities on that are going up. The Government can cover deficits in regard to the departmental expenditure limit this year—the question is, will they, and what will they do next year to help trusts to achieve these ends? There is a better way forward. It would mean that demand management could not be achieved by manipulating the tariff and that it would have to be achieved by giving genuine budget control to general practitioners through the reintroduction of GP fundholding in a form that allowed the care of patients in the community to be managed by those who have a responsibility both for the clinical care of their patients and for the budgetary consequences of that. This would require genuine freedoms. I suspect that, at the end of the year, we will find that—contrary to the prediction of the Royal College of Nursing—foundation trusts will deliver a far better outcome than other NHS trusts in terms of finances. This is a condemnation of the performance management system in the Department of Health. We do not want to see primary care trusts top-slicing, a return to cash brokerage—which is in fact happening—or short-term measures that are to the long-term detriment of the NHS, including the closure of intermediate care beds in community hospitals and the sacking of staff. A year ago, the staff were the heroes—the Government were cheering as they headed towards their waiting time targets, but now, in too many places, they are going to suffer the consequences of the Government saying, ““Balance your books, and don’t worry about the waiting time targets.”” That is completely contrary to what the then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), was telling the House almost exactly a year ago. He said that people were always forecasting deficits at this time of year, but that things always turned out all right in the end. Either that showed a lamentable failure to understand what was going on—which has continued for months—or he was simply focusing on the general election and the waiting time targets, and to hell with the financial consequences after the year end. I do not know which it was, to be honest, but this must not happen again. Given the present resource constraints—astonishing, despite the 9.6 per cent. cash increase—the Government cannot carry on trying to achieve waiting time targets while loading costs, pressures and change on to the NHS in the way that they are now doing. At the moment, the tariff for next year promises a 6.5 per cent. increase in costs. Hospitals are being told that they will receive a 1.5 per cent. increase in tariff. The squeeze on hospitals will be dramatic. The Government say that everything is to be looked after in the community. Well, Labour Members might like to have a look at the Department of Health’s annual report. The number of health visitors went down between 1998 and 2003, and the number of district nurses also went down during that period. The resources in the community are simply not there, and until they are there cutting back the hospitals will be dangerous for patients. It would be far better for the Government to be realistic about this, to give GPs the opportunity to manage their budgets on behalf of the patients, and to give the professionals throughout the whole of the NHS the freedom to deliver services for patients, and the budgets to do the job.