NHS Trusts: Resources (Hansard, 12 March 2001)

§ Lord Clement-Jones
asked Her Majesty's Government:
Whether National Health Service trusts have adequate resources in the current year to meet their targets and other obligations and still to break even.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the additional resources made available to the National Health Service in 2000–01 mean that overall the service is forecast to achieve financial balance and is on track to deliver the national priorities guidance targets.

§ Lord Clement-Jones
My Lords, I thank the Minister for that Answer. He will have noted that in a letter from finance chiefs of NHS trusts to the NHS Chief Executive they stated: The level of ambition set out for next year is beyond the resources available". They go on to state: We will not be able to deliver the key targets required. We are resolute in our belief that the financial gaps we are now facing cannot be closed by normal measures". In view of the fact that last week the Chancellor failed to give additional current expenditure to NHS trusts, should not the Minister now admit that the targets and initiatives which he and his colleagues set for the NHS are over-ambitious and that some of the targets are unlikely to be achieved?

§ Lord Hunt of Kings Heath
My Lords, it is the time of year when finance directors of trusts negotiate with health authorities exactly what they will spend next year and the services which they will provide. It is not unusual for dire predictions to be forecast by finance directors, which often turn out to be less serious. I suggest we await the outcome of the negotiations before drawing hard conclusions. A real-terms increase of 6.2 per cent will be given to health authorities for next year. That is an extremely significant increase, which will go a long way towards enabling us to improve and increase services, as set out in the National Plan.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that some busy hospitals are under immense pressure? Is he also aware that the chairman of the trust and half the board of the world-famous hospital, Stoke Mandeville, have just resigned?

§ Lord Hunt of Kings Heath
My Lords, I am certainly aware of the enormous contribution made to the NHS by the spinal injuries centre at Stoke Mandeville Hospital. The NHS comes under pressure and has always done so. However, I believe that the additional resources of 6.6 per cent in real terms over four years for health authorities are extremely significant and will enable us to meet the pressures now being placed upon the service.

§ Lord Rotherwick
My Lords, will that significant increase of 6.6 per cent enable those community hospitals which were closed to be re-opened?

§ Lord Hunt of Kings Heath
My Lords, the noble Lord would not expect me to comment on each individual community hospital. Community hospitals and other facilities have a role to play—particularly as regards intermediate care—in allowing people to be discharged from district general hospitals for rehabilitation and then to go back to their own homes. I see a strong case for such facilities.

§ The Lord Bishop of Hereford
My Lords, does the Minister acknowledge that apart from the matter of adequate resources, there is another problem which concerns the announcement of further improvements in the National Health Service? Members of the general public, and in particular NHS staff, find it dispiriting to have announcements of more money, more consultants, more nurses and better services when such resources cannot be delivered overnight. Expectations are raised. It would be much more helpful if the Government were to announce improvements and place upon them a measurable and realistic timescale. I have been asked to put that point to the Minister by administrators in the local health service in Herefordshire who find that to be a particular problem.

§ Lord Hunt of Kings Heath
My Lords, I believe that it is much better that we are able to announce large increases rather than the small increases announced by the previous administration. It is right that we have a concerted plan to ensure that those resources are spent wisely and that there is a realistic timetable. That is what the NHS Plan is about: it sets out a realistic timetable for improving standards of services in the NHS and for increasing the number of staff available. I would be the first to accept that there is currently enormous pressure on staff in the health service, and the first to acknowledge the debt that we owe to them for the tremendous efforts that they make. However, at the end of the day the foundation for future improvement has to be the kind of resource increases which we have announced.

§ Lord Roberts of Conwy
My Lords, in view of the Minister's comments on the tendency of executives of trusts at this time of year to exaggerate their claims and woes, can he tell the House whether there are any signs of an underspend amid trusts this year?

§ Lord Hunt of Kings Heath
My Lords, the forecast for the end of the current financial year made at the 509 half-way stage estimated that, overall, trusts in England forecast a deficit of approximately £9 million in total. At the same time, health authorities forecast a £45 million surplus. Essentially, based on those figures we would expect to end the financial year at a break-even position.

Lord Bruce of Donington
My Lords, does the Minister consider it proper that the National Health Service should be subject to the very pressures to which she refers when there are many other sections of the community, notably the richer, which suffer no stress at all?

§ Lord Hunt of Kings Heath
My Lords, at the end of the day the National Health Service is here to serve the whole of the population, and I believe that in so doing it does an excellent job. The NHS is under pressure. We want to make changes to improve services, and we are succeeding in that. I am convinced that the increases in revenue which have been given over the past few years and promised in the next few years will deliver the kinds of services that the public, quite rightly, expect.

§ Baroness Carnegy of Lour
My Lords, has it occurred to the Government that, given the generous increase of 6.6 per cent, trusts might well be able to put their affairs in order if they were allowed to do it in their own way, instead of having to meet all the centrally imposed targets on which they must concentrate?

§ Lord Hunt of Kings Heath
My Lords, that is the very reason the Government have introduced the concept of earned autonomy which means, essentially, that those trusts which do well will be given much more freedom to decide their destiny, while those which do not do so well can look forward to increased intervention. Surely, that is the appropriate way to proceed.