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NHS trusts in England should be thinking about how to spend a predicted surplus in funding of more than £1bn (€1.4bn; $2.1bn)—and possibly as much as £1.8bn—the head of the NHS has told MPs.
And NHS chief executive David Nicholson said that as most of this surplus for the current financial year lay with primary care trusts it was for them to decide how it should be spent.
That money was not being held centrally by the government, Mr Nicholson said, giving evidence as part of the parliamentary health select committee's inquiry into public expenditure last week.
The surplus was “relatively small” and “healthy,” he said.
Richard Taylor, the independent MP for Wyre Forest, said, “I am going to have the most incredible difficulty explaining to some of my constituents why we've got a £1.8bn surplus, and yet some of the drugs that haven't been through NICE [National Institute for Health and Clinical Excellence] yet, which are being afforded across the country in certain areas, aren't being afforded in mine.”
Mr Nicholson replied, “We are certainly not saying to people that they cannot spend the money. That surplus is not sat with us at the centre. I haven't got it in a safe in my office. It's actually out there with the primary care trusts. It really is a matter for local trusts as to make a judgment on how to use these resources.”
When asked what effect the strategic health authorities' “top slicing” of primary care trust budgets in 2006-7 to help the NHS's then overall deficit problem had had, Mr Nicholson said the decision was taken to slow growth rather than reduce services.
“What we deliberately did in those circumstances is we reduced the speed in which organisations go forward to improve their services both locally and against national targets.”
Mr Nicholson underlined his determination to keep pay rises for NHS staff under control through the coming years.
“Our evidence to the pay review bodies for next year says that we would expect pay increases of around 2% to be appropriate for most of our staff, 1.5% for doctors, and again nothing for GPs,” he said.
Mr Nicholson said that the nature of the NHS in the future with regard to medical consultants was an area of policy still awaiting a decision.
He raised the issue in response to a question about how the NHS would cater for the extra number of doctors coming into the system, as over the next five years it is predicted that there will be about 30000 medical graduates, while 14275 of current doctors will retire.
“There are some really important issues here that haven't finally been teased out,” he said.
“One is: what is the nature of the service that we are going to be taking forward in the future? Is it going to be a consultant led service or a consultant delivered service? That will have a big impact on the numbers of staff and how you deploy them. We've not come to a conclusion on all of that.”
The inquiry continues.