Selling surplus buildings. . . Reducing phone bills. . . Explosion of bureaucracy as management jobs increase. . . Nurse grading appeals. . .

The NHS must sell surplus land and buildings if hospitals are to survive in the internal market, the Audit Commission has warned. It estimates that 10 per cent of NHS land is surplus and that backlog maintenance stands at£2bn. It predicts that capital charges will increase the cost of providing healthcare from 9 to 21 per cent. Audit Commission controller Howard Davies said competition would highlight where space was wasted as property costs would fall on fewer treatments. He warned that closing wards would be one medium-term possibility.

Better management could cut HAs'phone bills by almost a third, according to the National Audit Office.

It found bills varied between£659 per bed in Bloomsbury and£89 in Macclesfield, though it concedes that teaching hospitals are likely to have higher costs. HAs are criticised for not doing enough to prevent staff making long-distance private calls, but the NAO accepts that attempts to replace outdated switchboards have been hampered by lack of capital.

The NHS is on the brink of a nationwide 'explosion of bureaucracy', the British Medical Association has claimed. Citing an increase in the number of management jobs advertised in HSJ, it calculates that the service may have created 3,600 posts last year, adding£80m to the pay bill. 'Compare this with the£14m being spent on cutting junior doctors'hours and the£35m on cutting waiting lists, 'said BMA secretary Ian Field.

Only a handful of the 10,000 to 12,000 nurse grading appeals have been heard so far, and unions are warning that the process could extend into the 21st century. NHS Management Executive personnel director Eric Caines is spearheading moves to speed up national hearings.