A £150m Lottery cash boost for cancer care provoked a row this week as managers called for a more consistent investment programme and a leading cancer specialist accused them of allowing essential machinery to go to 'rack and ruin'.
Geoff Greenwood, chief executive of Clatterbridge Hospital, which is receiving two replacement linear accelerators and one new machine, said the Lottery money was 'brilliant' but added: 'What is not helpful is unplanned boosts of capital investment.'
He revealed that his radiotherapy department had two linear accelerators which were up to 20 years old. 'Our brilliant technical staff keep these old machines going - but it means (replacing the machines) hasn't come to the forefront as a priority issue.'
And Jane Herbert, chief executive of South Manchester University Hospitals trust, said her trust's annual allocation of capital funds had been eaten up by other demands, such as building projects and year 2000 compliance.
Privately some managers admitted that they thought the reliance on Lottery money was wrong. The decision to use Lottery money for essential equipment had earlier been condemned by the British Medical Association.
One chief executive said he was 'very uncomfortable' about it. He said: 'As a citizen it troubles me, as a hospital manager it's a great relief. It's bailing out the NHS from the government's petty cash, funded by the Lottery. It's blatant populist healthcare.'
But Professor Gordon McVie, director-general of the Cancer Research Campaign, said managers were to blame for the run-down state of radiotherapy machines. 'I cannot for the life of me work out why the most expensive equipment you can have in a hospital has been allowed to go to rack and ruin,' he said.
'I think hospital managers must be made accountable. I'd like to know how they have failed to forward plan for hundreds of machines.
'With this Lottery money, health service managers are being rewarded for incompetent book-keeping. The audit people should go in and ask: 'How can it be that you are over£90m short of capital equipment?''
The argument that government underfunding was entirely to blame for run- down equipment was 'hogwash', he said.
The New Opportunities Fund, set up by the government to distribute lottery money to good causes, is giving£150m to cancer services, with£93m earmarked for breast screening equipment, MRI machines and linear accelerators. The money will buy trusts 36 linear accelerators to replace old machines, and an additional 11. The remaining£57m will go on palliative care and prevention.
But the lottery windfall is not enough to iron out regional variations in linear accelerator provision, still less to catch up with other European countries.
Studies by the Royal College of Radiologists found that only 6.2 per cent of the UK population was covered by the recommended level of provision of four linear accelerators for every million people.
By the college's calculation, 48 additional and 44 replacement machines are needed.
Staffing crisis blamed
Managers have blamed one region's poor performance in meeting government breast cancer waiting time guarantees on problems recruiting specialist surgeons.
Department of Health figures show nine out of 10 women with suspected breast cancer see a specialist within two weeks of referral, but just 69.3 per cent of women in North West region are seen on target, against 99.1 per cent in the South West.
Where the referral takes more than 24 hours, just 46.8 per cent of women in the North West see a specialist on time.
A spokesperson said: 'We have had some recruitment problems. There were at one time seven vacant posts for specialist breast surgeons. That is now down to three.'