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Hilary Pickles is absolutely right in highlighting the particular
difficulties involved in turning round financial deficits in PCTs. These
are particularly exacerbated for those trusts that commission largely from
Foundation Trusts, for whom the earlier introduction of the 'Payment By
Results' regime has effectively meant that we no longer have any real
control over the amount of expenditure on secondary care (since the money
has to follow the patient, and it is other people who decide where the
patients go, and how many of them).
However PCTs do still have control over Public Health budgets, and when
they face large deficits it is inevitable that these are turned to first
as a source of savings. Though this may be attractive as a means to help
short term financial balance, it is misguided in the longer term, because
public health spending is part of the solution, not part of the problem.