BMJ  2006;332:927 (22 April), doi:10.1136/bmj.332.7547.927

News

Prime minister tells troubled trusts to "hold their nerve"

London

Tony Blair has intervened personally in the financial and political storm over NHS debts and job losses. He summoned the chief executives of 16 of the most debt ridden hospital and primary care trusts to Downing Street to discuss the progress of "turnaround teams," the financial and management specialists despatched to help the trusts balance their books.

The meeting on Wednesday last week came just hours after the West Hertfordshire Hospitals NHS Trust announced that it would axe up to 500 jobs to tackle its deficit of £28.6m (41.3m; $50.3m).

In recent weeks trusts in England and Wales have announced around 7000 job losses as they battle financial difficulties. The NHS is thought to have reached a record debt of more than £700m in the latest financial year.

At the Downing Street summit three areas were on the agenda: wages bills, particularly those for temporary staff; patients' length of stay in hospital; and procurement of drugs and equipment. Mr Blair is reported to have told the trust managers that it was important for them to "hold their nerve" in the present round of belt tightening.

And on Tuesday this week he repeated his call for steady nerves in a speech to the New Health Network think tank. Mr Blair said he wanted to create an NHS for "2008, not 1948" and that to achieve this it was necessary to "take the tough decisions which are not the cause of the NHS problems but the route to making the NHS even better, even fitter for the modern world."

The health secretary for England, Patricia Hewitt, repeated her assertion that "only a minority" of trusts were in difficulty and that the NHS "would continue hitting targets, treating more patients, and cutting waiting lists."

However, Andrew Lansley, the Conservative shadow health secretary, said ministers and not NHS chiefs were to blame for the current situation. He said, "It's the Department of Health that needs a turnaround team. It is perfectly clear that the government has allowed there to be a dramatic increase in the number of administrators in the NHS, without a commensurate increase in the overall quality of management."

However, the government had some unlikely—although not entirely welcome—support from the right of centre think tank Reform, which said in a report that the current reforms would eventually lead to 100 000 jobs losses and radically improve the efficiency of the NHS.

The report's author, Nick Bosanquet, professor of health policy at Imperial College London, said reforms such as foundation hospitals, the payment by results system, and choice for patients would boost productivity.

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Longer versions of these articles are on bmj.com

Staffing and Human Resources in the NHS: Facing up to the Reform Agenda is at www.reform.co.uk.

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