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5. Tim Farron (Westmorland and Lonsdale) (LD): What recent assessment she has made of the effectiveness of measures put in place to improve the NHS financial position; and if she will make a statement. 
The Minister of State, Department of Health (Andy Burnham): Restoring financial balance in the NHS was our top priority in 2006-07. There is now a stronger system for assessing the financial position of all NHS organisations and we are confident that these measures will help the NHS further to improve its financial position. At quarter 3, the NHS overall reported a small surplus, and we expect the final position to show further improvements.
I thank the Minister for that reply. The Government changes to the resources, accounting and budgeting rules have removed £6.3 million of projected debt from my hospital trust in Morecambe Bay, leaving it in the surprise position of having a break-even
budget for the forthcoming year. So far so good, but the Westmorland general hospital stands to lose its excellent heart and stroke unit as a result of an acute service review that took place last summer, which was in part driven by the short-term financial pressures. Now that those pressures have been
Andy Burnham: I think that I can guess where the hon. Gentlemans question was going. I also detected some hint of gratitude in his words for the extra £6 million for his trust this year, which will help to ease the financial position, and of course bring benefits to patients in his area. As he knows, a Cumbria-wide review of health services is being undertaken, which is expected to go out to public consultation in September. I hope that he will understand that I cannot make any concrete statements today about the precise proposals that will be made in that review, but I am sure that local health service planners will hear his words.
Mr. Jim Devine (Livingston) (Lab): When the Conservatives were in power, there was a consistency to NHS funding: all the health boards and authorities were in financial difficulties. Today, only a small minority have financial problems. Does my hon. Friend share my puzzlement as to why that is the case?
Andy Burnham: It is not something that the Conservatives like to talk about, but when they left power the deficit, as a percentage of overall NHS expenditure, was far higher than anything seen in the last financial year. My hon. Friend is correct to say that the problems of overspending are now concentrated in a small number of organisations. It is the transparency of the financial regime that this Government have introduced that has enabled us to focus on that overspending and put in place measures to tackle it. As a whole, the NHS is benefiting. Last week, the Healthcare Commission reported that nine out of 10 patients say that the care they receive is good, very good or excellent, and that was in a year in which we have tackled the financial difficulties in parts of the NHS.
Mr. Simon Burns (West Chelmsford) (Con): Given that health trusts such as mine in mid-Essex are having to take some difficult decisions to improve their financial position, could the Minister give an assurance that he and his colleagues will be sensitive when determining future independent treatment sectorswhich may benefit patient care in some parts of the countryso that they do not cause a setback to those trusts that can fulfil their commitments and targets but would be adversely affected if the decisions were not taken sensitively?
The hon. Gentlemans trust has benefited from the reversal of the resources accounting and budgeting rules as they affect NHS trusts. As predicted at quarter 3, his trust will post a surplus this year. Any changes to local health care will have to be carefully considered, but I can tell the hon. Gentleman that we will make changes when they are in the direct interests of patients. There is evidence to show that where independent sector treatment centres have been
introduced, they have had the effect of challenging local NHS trusts, and waiting lists have fallen dramatically as a result. I would hope that the hon. Gentleman would support any solution that produces the best results in terms of access to the system for his constituents.
Mr. David Anderson (Blaydon) (Lab): Is the Minister aware that the Royal College of Nursing has estimated that it would cost £60 million to pay the full award proposed for nurses by the pay review body? Does he accept that that is a price worth paying, and if not, does he have a strategy for dealing with the industrial dispute that may occur?
Andy Burnham: I know that my hon. Friend works hard on these issues and I hope that he agrees with me that the position of nursing staff under this Government is considerably better than what we inherited in 1997. I also hope that he accepts that the decision taken in respect of public sector pay was a decision taken across the public sector, with the exception of the armed forces, with regard to maintaining the strong economy that this Government have also produced. While those are difficult decisions, I hope that my hon. Friend will accept that they are taken for the best of reasons.
John Penrose (Weston-super-Mare) (Con): Over the past two years, my local primary care trust has received above average increases in spending, which are tremendously welcome and have helped to close the gap between the Governments own target funding formula and the actual amount of money that the trust receives. Would the Minister agree that it would be folly to allow that process to go into reverse and that it is therefore important that the North Somerset primary care trust continues to get above average funding settlements in future?
Andy Burnham: That is an excellent question. It was missing the Vote Labour! bit at the end, but I think that it would have come if the hon. Gentleman had carried on. Yes, we are extremely proud of the money that we have put into PCTs like his around the country, and I am absolutely confident that the huge improvements in health care in recent years will be sustained. An extra £8 billion is going into the NHS this year, and that will produce substantial improvements for patients. I hope that he will continue to support the Government in working towards a well funded and improving NHS.
Mr. Neil Turner (Wigan) (Lab): My hon. Friend will be aware that proper financial management has ensured that no PCT in the north-west will be top sliced this year to subsidise poor management in other areas. He will know too that many north-west PCTs receive less than the formula funding says they should. How is it that they can stay within budget, while others receiving more than their formula funding overspend?
I pay tribute to my hon. Friend for the persistent way in which he has raised matters relating to PCT finance. He is absolutely right: for reasons of basic fairness, we need the maximum health resources in areas where health inequalities are greatest and where ill health is entrenchedsuch as the borough that he
and I represent. Also, I thank him for congratulating the north-west strategic health authority on ensuring that PCTs in the area are not being top sliced. That will enable PCTs such as his and mine to get on with the job of improving public health in our borough. The next funding allocation round will deal with the question of whether we can make further progress towards bringing all PCTs nearer their target allocations, but I shall bear in mind what my hon. Friend says.
Tony Baldry (Banbury) (Con): This year, the Oxford Radcliffe NHS Hospital Trust must save £23 million, so will the Minister give some guidance about PFI repayments? Next year, the trust will have to make PFI repayments worth between £30 million and £36 million. Will the Department take PFI repayments into account when it sets the total sum for trust budgets, or will trusts have to make cuts to meet those repayments in future years?
Andy Burnham: When trusts plan new hospital developments, it is crucial that the decisions taken be sustainable and affordable in the long term. The Government have been reviewing all PFI schemes to ensure that they are precisely thataffordable, and the right size for future requirements. When spending is allocated to local health economies, we must take account of the populations relative age, health need and deprivation. We will continue to do that when we make allocations to PCTs.
The Secretary of State for Health (Ms Patricia Hewitt): The Department has received over 1,300 letters on the topic of Modernising Medical Careers and MTAS this year. Department officials have also had meetings with, and representations from, many organisations, including the royal colleges, the British Medical Association and Remedy UK.
Peter Bottomley (Worthing, West) (Con): Most of the House will welcome the service that James Johnson has given over recent years, to the BMA and in other ways. My question to the Secretary of State has to do with MTAS. Does the Department recognise that examination candidates who want to check whether their marks have been added together correctly or whether their papers have been marked at allshould get an appropriate response before the end of round 2?
Ms Hewitt: The hon. Gentleman refers to the Information Commissioners recent ruling. As a result of the commissioners letter to the Department, a meeting is being arranged between him and appropriate officials to agree the way forward.
Mrs. Louise Ellman (Liverpool, Riverside) (Lab/Co-op): I am aware that the Secretary of State has apologised for the way in which MTAS was carried out. In my meetings with junior doctors, who are extremely concerned about the situation, it became clear that they have a strong commitment to, and belief in, the national health service, so will my right hon. Friend indicate how we can reassure those doctors that they are indeed valued?
Ms Hewitt: My hon. Friend is absolutely right about the enormous commitment of junior doctors, and other health care professionals, to the NHS. In relation to recruitment to medical training, I stress that the interviews in round 1, which include an interview for every applicant, are nearly complete and, subject of course to the outcome of the judicial review, job offers will start to be made as soon as the result of the judicial review is known. By sorting out the very real problems and distress that have arisen this year, we will indeed be able to reassure junior doctors in particular about how much we value them and to ensure that they have a good future in the NHS.
Mr. David Ruffley (Bury St. Edmunds) (Con): Ministerial mismanagement led to the computer chaos that is the medical training application service, which has failed to deliver a fair, open, transparent and efficient selection process for junior doctors, and even threw in for good measure a massive breach of personal security. Can the Secretary of State tell us today how many available training posts there are now for junior doctors and how many applicants there are? If we have those two facts, we can calculate how many thousands of junior doctors will not get a training place this August.
Ms Hewitt: As I have said before, across the United Kingdom there are about 32,700 eligible applicants in the MTAS system, of whom more than 30,000 are already employed in the NHS. There are 23,500 training posts in total, including the GP training posts for which recruitment is separate from MTAS. Let me stress again that thousands of the applicants are currently employed by the NHS in non-training posts and all those jobsin total, more than 30,000will continue to be needed to ensure that patients continue to receive the excellent care the NHS provides.
Mrs. Madeleine Moon (Bridgend) (Lab): What is my right hon. Friends assessment of the article in The Independent today that argues that we should not get excited about the MTAS situation, because due to the expansion in the number of doctors in our medical schools under the Labour Government there will be greater competition for some of the best training jobs?
My hon. Friend makes an important point. I thought that the editorial in The Independent this morning was a breath of fresh air and rationality when the media have not really been characterised by
accurate or rational reporting on this subject. The reality is that there are more junior doctors, and indeed other healthcare professionals, in training for the NHS than ever before. There has always been intense competition for the specialty training posts that lead to a consultancy for successful applicants. That competition is intense this year, but more doctors and even better trained doctors, with the best of them becoming consultants, is all good news for patients.
Rosie Cooper (West Lancashire) (Lab): Junior doctor rotation has always been a difficult time, and over all the time when I was involved in the health service many a junior doctor did not get the specialist job he or she wanted. We have heard about the intense competition due to the massive increase in doctors in training, so to go on from what has been said already, will my right hon. Friend indicate what support is available for junior doctors who are trying to get through the process at present?
Ms Hewitt: My hon. Friend is absolutely right that at this point we should focus on the solutions, rather than simply restating the problem. As I have indicated, job offers for round 1 will be made, subject to the outcome of the judicial review and as soon as we know that court judgment. Detailed information on that process is going out to applicants very shortly. Once we have the court judgment from the judicial review, we will be able to give applicants further details of how round 2 the next round of recruitmentwill be organised and the support that will be available to applicants throughout that process and beyond, as we look to the end of that further round of recruitment.
Norman Lamb (North Norfolk) (LD): The Secretary of State will be aware that the statement of Nicholas Greenfield to the judicial review proceedings last week disclosed that on 25 April there was a report to the review group that disclosed that there were serious flaws with the software within MTAS. Was she informed of those serious problems at that time? If so, why did she not tell the House of those problems in her statement on 1 May? Is it not outrageous that in her statement last week she made no reference to the fact that she had no option but to abandon MTAS, because the system was not working?
The hon. Gentleman, I am afraid not for the first time, has simply misrepresented the position. First, MTAS has not been abandoned. It has been reopened to the postgraduate deaneries, which can
continue to use it for the recruitment process. On the issue of the software, as I told the House last week, because of the continuing concerns of junior doctors [ Interruption. ] Perhaps the hon. Member for North Norfolk (Norman Lamb) should listen to the point that I am making, because it is important. Despite the security improvements that have been made to MTAS, because of the continuing concerns of junior doctors, we decided not to use it for the process of matching applicants to job offers. One of the concerns expressed by the junior doctor representatives on the review group related to the fact that the new software that would be needed to match the applicants to the jobs had not been completed and, because of the other problems, there would not be time to test it properly. That was part of the background to what I told the House last week about the continuing concerns that led us to decide not to use MTAS for the job offer process. That was a perfectly sensible decision. There is no question of misleading the House and I hope that the hon. Gentleman will not repeat that allegation.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Will the Secretary of State now tell the House how many additional training posts the review group has asked the Department of Health to provide for? This is the fifth time in over two months that I have asked the Secretary of State to make a commitment to provide for additional training posts and she still has not done so.
Ms Hewitt: I am afraid that the hon. Gentleman will have to wait until we have the outcome of the judicial review. I will then announce how many additional training posts will be made available for round 2 and other details of round 2.
Mr. Lansley: The Secretary of State will recall that on Sunday James Johnson said that the medical training scheme had been characterised by policy failures. Who does the Secretary of State hold responsible for those policy failures?
Ms Hewitt: As I have said in the House before, Modernising Medical Careers has been a joint effort by the Department of Health, Ministers, the royal colleges, the British Medical Association, the work force deaneries and many others, all of whom have been involved in addressing the problems that were highlighted many years ago by the BMA itself when it rightly called for a new system of training to replace the thoroughly unsatisfactory old system whereby senior house officers became known as the lost tribe because they simply did not have the support that was needed. We know perfectly well that the implementation of the application and recruitment system for this year has not worked properly. We have had a lot of problems with itwe hardly need to say that in this Chamber. We are sorting that out and I take responsibility for doing so.
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