---

Health Care in London

No, as I want to make some points about the Healthcare for London programme. In January, NHS London published an overall strategic plan, and we have begun to see some of the so-called "sector plans" for different areas of London. The plan for outer north-east London has been published and the one for north-west London has been leaked. In addition, people are speculating about what the implications might be for other places across London. There are questions about the assumptions underlying the NHS London approach. It does not help that the text of the document published in January by NHS London is confusing and erroneous. The notes relating to the scenarios and the funding figures were transposed, they did not include the base case at all, and they were wrong. For example, there was a reference to 2.3 per cent. per annum funding growth in the next spending review period, which should have been minus 2.3 per cent. Essentially, NHS London is assuming that there will be unchanged real terms funding for the NHS all the way through to 2016-17. Alongside that, it assumes 3.5 per cent. cost inflation in the NHS. We need to challenge the assumption that costs can be accommodated in that way. NHS London also assumes 4 per cent. a year demand growth, which is not in line with the projections of demand growth produced by the King's Fund and the Institute for Fiscal Studies on a national basis. We know what NHS London set out to do—make a set of assumptions, arrive at a big funding shortfall in 2017, and tell everyone that they must do the things that NHS London is calling for them to do—but let us leave that on one side. Under any reasonable set of assumptions, we have to deliver efficiency savings and improving productivity in the NHS, including in London, in ways that have not been adopted in the past. Over the past 10 years, when funding for the NHS has more than doubled, how is it possible that in London there is still legacy debt of more than £500 million for the NHS trusts and a worrying number of financially challenged trusts, and very few of the changes that should have taken place in the NHS to redesign services and deliver care more appropriately and more effectively have happened? Perhaps the Minister will explain. The moment when the financial pressures are assumed to begin is the moment when NHS London feels that it must start taking the management action necessary to respond to it. There has been a dereliction of duty. After a 20 per cent. increase in management costs and a £25 million management consultancy cost the year before last, many of the things that needed to be done have not been done.