Demands to cut the number of watchdogs overseeing the NHS were given a cautious welcome by the regulators.

Richard Emmess, assistant chief executive of North West Lancashire health authority, said up to 27 different bodies were monitoring the NHS.

Hospitals and HAs were spending time dealing with auditors instead of running services.

He asked Peter Homa, director of the Commission for Health Improvement: 'Will CHI add to this burden or reduce it?'

Dr Homa admitted: 'We need to be very cautious about the overheads that we impose.' There was a shared ambition between regulators to 'do less more thoroughly', he added. 'In the medium term I would hope to see some rationalisation of monitoring visits.'

Catherine Simmonds from Riverside Community Health Care trust said:

'While endorsing the principles of monitoring, how can we ensure frontline workers don't feel overwhelmed by the consequent administrative burden?'

Audit Commission controller Andrew Foster said it was important that regulators agreed with each other on the priorities for investigation and assessment.

A bottom-up approach organised around the needs of individual trust needs was better than a 'one size fits all' approach. But reducing the number of regulators was 'a matter for government'.

Mr Foster said there was room for rationalisation and agreed the Audit Commission itself could be a target.

Each monitor had a value - the commission had a role in sharing good practice. Regulators should not be territorial but work together to reduce the administrative burden on the NHS.

London regional director Nigel Crisp said bodies such as his were 'much more than a monitor', with roles in strategy and planning. He called on staff in trusts and HAs to look at 'how we respond to monitoring'.

Mr Emmess said: 'The issue for us is time.' Staff in NHS organisations had to get on with the job and regulators had to set some 'core standards for monitoring'.

Delegates warned that the demand for year-on-year efficiency savings could be an obstacle to improving performance.

John Mangan, chief executive of Thames Gateway trust, said while managers should be aiming for 'best value', staff on hospital wards felt they were 'hav ing to provide more services for less money'.

More than 70 per cent of delegates said cost savings were a major obstacle to improving performance, and in a vote only 26 per cent felt there was no difficulty.

Dr Homa said any organisation that claimed its services had been hit by lack of funds would have to show it was using resources effectively. But if CHI found there was 'a national phenomenon' of financial difficulties hitting services it would report it.

He said managers could save time and money by ending 'redundant' activity. But 'short-term cost reductions in one organisation have an impact on other organisations, ' he pointed out. 'We have to be much more systematic in looking at cost reductions.'