The Department of Health's £4m drive to improve NHS communications is in tatters after events for managers ended in disarray. The exercise was shelved after problems climaxed in a rebellion of managers from North East Thames, who complained that sessions were too simplistic. Consultants hired to conduct the events treated them as if they were 'at school', they said, and refused to acknowledge points raised in order 'to get the answers they wanted'.

London managers accused the Department of Health of keeping them in the dark over plans for the future of the capital's health services after a memo urging bed closures was leaked. It proposes a policy statement declaring that London has too many beds and consultants to meet residents'needs. It also warns of 'major destabilisation' of services following the internal market.

Regional health authorities have hit back at Labour Party claims that they are failing to consult the public on trust applications.

Shadow health secretary Robin Cook said health secretary Kenneth Clarke 'cannot settle the fate of hospitals in Leeds or Newcastle over a cigar in Whitehall or in Spain'.

New bids for trust status are being drawn up by managers throughout the country in a surge of enthusiasm for the second wave of trusts. Candidates say the renewed interest has been prompted by the reforms gaining royal assent and by fear that directly managed units could lose out in staff recruitment and capital development.

Staff are being reassured in a video produced by the NHS Management Executive that the pace of change in the first year of the reforms will be slow. It stresses that HAs should manage the culture change of the purchaser-provider split carefully.