What the overall financial status of NHS hospital trusts in 2003–04 was; and if she will make a statement.
The Government have delivered record increases in investment for the NHS—funding that has been used to deliver substantial improvements across a range of services. In 2003–04, the NHS recorded a small surplus of £73 million. In the same year, 204 NHS trusts were in financial balance or had a surplus and 65 trusts posted a deficit.
The Secretary of State will know that many NHS trusts and primary care trusts, particularly those that do badly out of the funding formula, have been able to reach NHS targets and deliver improved levels of care only by running up substantial financial deficits. Will the right hon. Lady give the House an absolute assurance that the new financial imperatives under which the trusts are now working will not result in unacceptable levels of patient safety?
I know that the right hon. Gentleman will welcome the fact that his primary care trust has had an increase in its allocation from £1.4 billion in 2002–03 to £2.3 billion in 2007–08. There are enormous and unprecedented amounts of money going into the NHS. The reforms that we are making to the system, including money following the patient as patients are enabled to exercise greater choice and control over their health care, will improve patient safety and care rather than damage it.
Does my right hon. Friend agree that foundation status has brought great freedoms to some hospitals, including Homerton hospital in my constituency, which has excellent financial management and excellent leadership? I would be glad if she were to comment on her recent visit to that hospital.
I had the opportunity recently to visit the excellent Homerton hospital in my hon. Friend's constituency. I am delighted that she has given me the opportunity to place on the record my admiration for its chief executive who, together with her staff, is delivering superb patient care. I especially welcome the fact that the hospital has taken advantage of its new status as a foundation trust to make a rapid decision to invest in and build a new perinatal centre to deal with the fact that in my hon. Friend's constituency, and more broadly in Hackney, there is a high level of premature births, with all the consequential effects that that has for the life chances of those children. Excellent work is being done.
Is the right hon. Lady aware that when the Princess Royal hospital in my constituency merged with the Brighton and Sussex NHS Trust, it did so with a substantial debt? The trust has not recovered from that debt, and because of a number of changes that have been made and a difficult financial situation, it finds itself in some difficulty. Will the right hon. Lady consider the position and when trusts merge ensure that careful attention is given to whether debts should be written down to enable a new trust to start with a clean sheet of paper?
I am not aware of the specific situation of the two trusts before and since the merger to which the hon. Gentleman refers. Given the substantial increase in NHS investment that has taken place in every part of England, it is important that all NHS trusts live within their means. I will look at the specific situation of the hon. Gentleman's trust and write to him about that. I would not generally favour a writing off of historic debts before or after a merger, for the simple reason that that would have to be carried by other parts of the NHS where services might well suffer as a result.
Will the Secretary of State come to Hemel Hempstead and visit our excellent hospital, which I am sure is just as good as the Homerton hospital? Sadly, we have been snubbed with funding. This year alone, as the right hon. Lady knows, we will be £30 million in debt. Doctors, nurses and clinical staff will be made redundant. Will she come to Hemel Hempstead and explain to my constituents why the Government are doing this to them?
I am in fact meeting the hon. Gentleman and several of his colleagues from Bedfordshire and Hertfordshire later this afternoon to discuss the position in more detail. The national health service in his constituency and right across Bedfordshire and Hertfordshire is receiving, again, unprecedented increases—a 7 per cent. increase in funding over the past year alone. There are serious financial problems right across the health service in Bedfordshire and Hertfordshire. Those must be addressed by the local trusts, and my Department is working with the strategic health authority and the local trusts to resolve those financial problems.
Under patient choice, if a hospital trust loses business it will get into financial difficulty. When the Department is asked whether the Secretary of State will allow a trust, in extremis, to go to the wall, the answer has been uncertain. Sometimes she has said yes, in extremis a trust can go to the wall. On other occasions it has been said that if there is an accident and emergency department attached, perhaps the casualty department will be kept going. I shall give the Secretary of State the opportunity to make the position clear now, because trusts need to know where they stand. Will trusts, in extremis, be allowed to go to the wall—yes or no?
As a Labour Health Secretary, I shall certainly not force patients to use services that they do not want to use, nor will I allow any part of our country to find itself without accident and emergency services or other health services that people need. The detailed guidance, both on patient choice and on payment by results, will be published in due course, but there will be departments that patients do not want or need to use and those, I have no doubt at all, will either close or be reorganised as a result.
Opposition Members join the Secretary of State and the Minister in a warm appreciation of the magnificent response of NHS staff to the tragic events last Thursday. I think of hospitals such as University College hospital and St. Mary's, which I have visited in the past year, and, indeed, the Royal Free—they all have financial pressures with which they have to deal.
This is an important issue for many those hospitals. In 2003–04, 106 NHS bodies ended the year in deficit, up from 71 the year before. Can the Secretary of State say how many NHS bodies were in deficit at the end of the 2004–05 financial year? She says that much more money has gone into the NHS—but as we need more capacity in the NHS, can she explain why front-line services are being cut not just in Bedfordshire and Hertfordshire, but in Leeds, Bradford, South Teesside, Suffolk, Hampshire, Surrey, Sussex and Cornwall?
All over the country national health services and care for patients have been improving, compared with what we inherited in 1997. I note that eight years ago there were 384 people waiting in Hinchingbrooke Health Care Trust for more than nine months. Today, that figure is zero. With regard to 2004–05, we are anticipating a deficit of around £140 million. That is the total picture. It is around 0.2 per cent. of the total NHS budget. It will be considerably more serious than that for individual trusts, but we will not publish the details of which trusts are in deficit until the 2004–05 figures have been audited.
There are two essential questions: where is all the money going, and does the Secretary of State know how bad the problem is? The National Audit Office said that auditors expressed concern about the financial standing of one third of NHS trusts. A dozen strategic health authorities are reported to have overspent in the last financial year. Leaving aside the net figure of £140 million that she has just cited, what does the right hon. Lady expect to have been the aggregate overspend in the last financial year? It was £366 million in the 2003–04 financial year. I have received reports that that figure has more than doubled, and that it is £800 million in 2004–05. What level of financial support has been provided by the Department, directly or through the NHS bank, to offset those burgeoning deficits?
Every year, all kinds of wild figures are published in various places about the overall deficit. I have just given the figures that have been audited for 2003–04, and we will give the detailed figures for 2004–05 when the audit is complete. The net figure, however, is less than a quarter of 1 per cent for the total NHS budget. The hon. Gentleman seems determined to ignore the unprecedented increase in national health service funding that we have made available across the country. The minority of trusts with serious financial problems are now being helped to put the necessary financial recovery plans into place, where necessary with the help of the NHS bank.
Would the Secretary of State mind if I said something controversial? Listening to that exchange, it occurred to me that one problem that is not discussed, particularly by the two Front-Bench teams, is the fact that since 1975 there have been 27 reorganisations of the national health service. What people want most of all is a settlement. When people paint the Forth bridge, they normally finish the job before they start again. Under both Tory and Labour Governments we have altered the NHS. When a new Minister comes in, he undoes what his predecessor did—but what patients want above all else is a settlement and an agreement. The two Front-Bench teams should get together and agree at least some norms to achieve a settlement of the NHS so that we get a better product.
I agree most warmly with my hon. Friend. At least we can agree on the need for long-term sustained increases in funding for our national health service. That is exactly what we have been delivering, and those record increases in funding will continue until 2008 and, indeed, beyond. I hope that my hon. Friend will join me in welcoming that increased support and the stability of funding that we are making available to the NHS. I only regret that the Opposition are unable to do so.