Allocations to the West Gloucestershire, Cheltenham and Tewkesbury, and Cotswold and Vale primary care trusts totalled more than £561 million in 2005-06—an increase of about 30 per cent. over the past three years.
I thank my right hon. Friend for her response, and I apologise for the typo in the question. It should of course say “Avon, Gloucestershire and Wiltshire strategic health authority”, but that somehow got lost in translation. It would, however, be much easier if we were just dealing with Gloucestershire. The letter that the Minister of State, my hon. Friend the Member for Don Valley (Caroline Flint), sent to the hon. Member for Tewkesbury (Mr. Robertson), whom I see in his place, concluded by saying:
“However, we would expect the new organisations to inherit the liabilities and obligations of predecessor organisations.”
If that is the case, would it not be appropriate to have complete transparency within a strategic health authority such as Avon, Gloucestershire and Wiltshire, so that we can understand exactly where the deficits have come from? There is a great deal of unfairness involved in offloading deficits on to areas that have not created them, and the people involved believe that they are quite within their rights to feel let down.
My hon. Friend is absolutely right about the need for transparency, but there was no such transparency in the past. Underspending areas, often in much poorer parts of the country, were constantly bailing out overspending areas of the NHS, which were often in the better off and healthier parts of the country. We are creating the transparency that my hon. Friend mentioned, as well as asking each strategic health authority to ensure that its area returns to balance. Where an organisation is overspending, and particularly if it is going to take more than a year to get back into balance, other organisations will have to hold back on the improvements that they want to make. However, that all needs to be open, transparent and understood. In particular, the organisations that are overspending need to take decisions—difficult though some of them will be—to ensure that they give their patients the best possible care within the substantially increased budgets that we are continuing to give them.
In the letter to which the hon. Member for Stroud (Mr. Drew) referred, which followed a two-hour Adjournment debate that I had last week, the Minister of State, the hon. Member for Don Valley (Caroline Flint), attempted to explain the position with regard to the recovery of the financial position. There is a great deal of confusion surrounding this issue, however. The question to which we are trying to get an answer is: do trusts have to achieve a month-by-month balance towards the end of this year, or do they have to have a full-year balance, including the historic deficits? If the Secretary of State could answer that one question, it would clear up an awful lot of confusion. The answer will determine the degree and the level of the cuts that the primary care trusts will inflict on everyone.
I had an opportunity to read the report of the two-hour debate—an extensive and excellent debate—on the health service in Gloucestershire to which the hon. Gentleman referred.
The national framework that we have set out is quite clear. We will return the NHS as a whole to financial balance by the end of March next year. Within that, we would like all overspending organisations to achieve a monthly balance between income and expenditure, again by the end of March next year. Some will not be able to do so, but overspending in one organisation will have to be matched by underspending in another.
The proposals for Gloucestershire and the wider region have not yet been finalised. Not only is local consultation taking place on the proposals that are being made, but discussions are continuing between the strategic health authority and my Department so that we can be satisfied that the proposals will achieve the best possible patient care and return the region to balance as quickly as makes sense. I know that the hon. Gentleman and other Members representing the area will continue to participate in those discussions.
Does the Secretary of State realise that primary care trusts in Gloucestershire are currently planning not only to recover deficits and restore balance this year, but to do so after having their budgets top-sliced so that Gloucestershire is contributing to deficits in Avon and Wiltshire as well? That could have substantial consequences for services in Gloucestershire. As the hon. Member for Stroud (Mr. Drew) is aware, the closure of Stroud maternity unit is being contemplated. Will the Secretary of State tell us whether she intends the PCTs to go beyond restoring financial balance and initiate a cut such as that closure?
I have made it very clear that we expect each of the regions to establish financial balance. Within that, there must be discretion for specific areas and organisations. I have spelt that out, and we repeated it most recently in the report on the financial situation that I published alongside the chief executive’s report.
What the hon. Gentleman has said reflects the fact that not only has there been overspending in Gloucestershire, despite substantial increases in the budgets, but there are even larger problems in Avon and Wiltshire—many of them deep-seated problems that have been continuing for years. For far too long, those organisations have expected other parts of the NHS to bail them out.
None of the proposals has been finalised. The plan for Stroud maternity unit needs to be considered on the basis of what will give women the best and safest maternity services within the budget that is available to that health community. I hope that instead of continuing to pretend that an unlimited sum is available and difficult decisions never have to be made, the hon. Gentleman will support the NHS in every part of the country, helping to ensure that it can provide the best possible services for patients and the best value—
Thank you, Mr. Speaker.
The Secretary of State is trying to resolve the situation in a single year. The point is that Gloucestershire is prepared to try to resolve its financial deficits; what it objects to is having to contribute this year, on top of that, to the resolution of deficits in other places some of which have been around for years, and will be around for years.
I return to the question. We have asked the Secretary of State repeatedly to avoid short-term, financially driven cuts that will be to the long-term detriment of the service. In her manifesto, she said
“By 2009 all women will have choice over where and how they have their baby”.
Thousands of women in Stroud and related areas want to be able to choose to have their antenatal care or delivery at Stroud maternity unit. Will the Secretary of State promise that in 2009 they will be able to exercise that choice?
Those are decisions that need to be made locally and on the basis that the best and safest care is provided to all patients, within the available budget. As I understand the current proposals, Gloucestershire SHA will contribute some £6.5 million to the regional reserves, with somewhat more being drawn down in that county to compensate for the overspending in its health service. In the maternity services, continuing support will be given to providing home births for those women who choose them and for whom they are safe, although midwife-led care must also be available as part of the broader service. Those difficult decisions will be made locally, in the context of the Government’s very generous national settlement.