this week

Health secretary Alan Milburn was on the receiving end of some 'straight talking' at last week's groundbreaking chief executives' conference in London. Senior managers seized the opportunity to tell him about the obstacles they faced in delivering his ambitious programme of reform.

More than 500 chief executives from across the health service accepted NHS chief executive Nigel Crisp's invitation to attend the conference, the first event of its kind.

A chief executives' conference may in future become a regular event - perhaps held every six months or so: ministers and Mr Crisp are reportedly keen to maintain open dialogue with frontline health service leaders. Mr Crisp has also invited chief executives to express an interest in filling a new seconded post, which would involve working alongside him for a year.

Although the meeting was closed to media, HSJ has been told that leadership development was a major area of discussion, with managers seeking clarity about how it, and other policy priorities, can be moved forward.

One chief executive told HSJ:

'There were real concerns expressed and Alan Milburn will have no doubt how chief executives feel.He got to hear some very frank views - straight talk because It is not all motherhood and apple pie.'

Those concerns included the lack ofresources - particularly staff - to deliver the modernisation agenda, as well as the need for the government to 'talk up' the NHS.

Havering primary care trust chief executive Ralph McCormack said that 'straight talking' characterised the conference: 'From the floor - and to be fair from the platform - there was as much realism as I've seen in a long time in the NHS about the progress That is been made and the difficulties that are being faced - such as the growing demand and scepticism from the public.'

Chief executives told the health secretary that funding increases were taking too long to filter through the system.

According to Mr McCormack, he also heard that he was losing the public relations battle with his senior lieutenants when they warned him: 'You are saying that There is money in the system, but the public perception has not altered significantly and we need to address that.'

Chief executive of Dorset health authority Ian Carruthers said it was clear that politicians had an appreciation of the difficulties NHS managers face.

'The general issue was about how we deliver change for patients. The issues raised by chief execs were about targets, about thinking time and space, but also about the pace we are moving at, which is as fast as ever if not faster.'