Staff increment proposal . . . 'presumptuous'staff ads. . . Clarke says watershed ahead. . .

Planning could see chaos. . . Escalating claims. . .

Two hospitals hoping to form a trust are considering abolishing staff increments in favour of some form of 'profit-sharing'. But unions have attacked the draft proposals - from the prospective Wirral Hospitals trust - which include offering staff 'personal employment packages' to reward them according to their ability. NUPE said the idea showed a desire to put money before patients.

Unions have described as 'presumptuous' advertisements for staff to work at trusts before health secretary Kenneth Clarke has approved any applications for trust status. The Royal London Hospital is offering£50,000 plus a car for a finance director. NALGO claimed this was the first evidence that trust managers would raise their wages at the expense of lower-grade staff.

Representatives of 144 hospitals and community units interested in becoming trusts in the second wave of applications have been told by Mr Clarke: 'This second wave is going to be a watershed in the reform of the NHS'. Speaking at a Department of Health conference, he said the level of interest proved trusts were not a 'one-day wonder'.

Pressure group London Health Emergency has claimed that if the 18 units in London which have applied for trust status in the first wave are successful, it will reduce disaster planning to chaos.

South Western regional health authority has calculated that medical negligence cases in the pipeline are likely to cost it an estimated£20m over the next four years.

The National Association of Health Authorities and Trusts has called on the government to set up a central fund to meet the escalating cost of claims.

'It is very unpredictable. A claim might come in which wipes out a HA's reserves, 'NAHAT says.