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Simple fact that health and social care has peaks and troughs of demand. If you allocate it a rigid budget then the only way to meet this is to have to say no to certain care when you are in a peak demand period. HSSD overspent in 2010 and then underspent in 2011. It does make me laugh though when you will have the same people shouting "outrage, heads must roll" at the announcement of the overspend a week or so ago and they will now shout the same things when measures are being taken to control the spend.