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I realise that time is marching on, so I shall keep my contribution as brief as possible. I simply want to put on record some of the specific challenges facing my primary care trust in Milton Keynes, and I am grateful to my hon. Friend Tony Baldry for setting out some of the special problems that we face.
I start by paying tribute to the primary care trusts' hard-working staff. All too often, the focus is on doctors and nurses, and little credit seems to be given to the support staff, so I would like to sort that out today.
Like virtually every trust in the country, Milton Keynes primary care trust faces a difficult financial year in 2006–07. I can, however, praise the Government—this is one thing I can praise them for—because, for first time in many years, due recognition will be given to the fact that the population of my city has increased rapidly. That has helped to relieve some of the pressure, because the old funding formula was based on out-of-date population figures, which made life difficult for trusts such as Milton Keynes.
Although I am always happy to give the Government credit where credit is due, I would probably struggle to go any further, and I apologise for that. One of the principal problems facing the trust is that although it has extra cash to take the population increase into account it feels that it has much less control over that cash. Given the current NHS crisis, it does not understand why the Government are retreating into centralised control, rather than allowing it to have total control over its cash.
With that issue to one side, it is clear that this will be yet another difficult year for the health service in Milton Keynes. However, one of the things that impresses me most about Milton Keynes PCT is that it has a clear strategy, despite the financial constraints, of developing services. It is not simply retreating. At the heart of that strategy is the start of a major change, with the trust moving from being an illness service to a health service, and I am sure that all of us would support that. Two key priorities will be to start moving more services closer to where people live and to change the pattern of emergency care. The hope is that that will be achieved by experimenting with emergency care practitioners visiting people at home, opening a walk-in centre and reducing the need for emergency care.
That, however, is where I begin to have a problem. Although those are innovative ideas, which should be applauded, the primary care trust admits that part of its motivation comes from the fact that emergency care costs are spiralling and that reducing emergency admissions is a key target in the trust's effort to contain costs.
Other factors also mean that the trust's scope for manoeuvre in the next financial year will be extremely restricted. First, the strategic health authority has charged the trust a one-off levy of £5.5 million to pay off debts from the current financial year across the region and meet the cost of reorganising the health service—an issue to which my hon. Friend the Member for Banbury referred. The idea is that some of that money will be returned to the trust at an unknown date in the future, but that is the key point—the date is unknown. My question is whether the financial crisis in the NHS has reached such a point that we now have to rob Peter to pay Paul. When will that money be returned? How can people plan?
Secondly, virtually all the £2.5 million that the trust has been told that it can use to provide extra services is already committed to the running of the new walk-in centre and paying for the new electronic care records system—there is simply no room for manoeuvre. An added problem is that the tariff and rules associated with payment by results are still being revised, and the final figures have not been released. Combined with the fact that the trust simply does not know when the money that it has to pay to meet the one-off levy will be returned to it, such problems make budgeting for the future very difficult.
I have a message for the Minister. As she may be aware, Milton Keynes is an unusual city in that it has a Labour MP, a Conservative MP and a Liberal Democrat council. However, all three political parties are united in their belief that the only future for Milton Keynes primary care trust is for its boundaries to be coterminous with those of a unitary authority. We have a great history of working closely with our great council, and not a single person believes that we should move to a wider primary care trust, which would share the north of Buckinghamshire.
My final point is about the Two Shires Ambulance NHS trust, which is an excellent three-star trust based in Northamptonshire and Buckinghamshire. It has a budget of just £30 million, and although there might be financial incentives for creating a larger trust, there is great unease locally that a super-trust that stretched all the way down to the Isle of Wight would be too large and that much local knowledge would be lost. There is great cynicism locally when the Government say that they are consulting on the reorganisation of the Two Shires trust. Will the Minister explain why, if the consultation period is still open, the jobs of chief executive and chairman in the proposed new super-trust were advertised in The Times on