The apparent failure of many of Scotland's acute trusts to keep within budget could hasten their demise, senior managers claimed last week.
The Scottish Executive has been accused of allowing some of the country's most prestigious trusts to flounder despite the NHS itself being in good financial shape.
While most health boards and primary care trusts are managing to balance the books, almost all Scotland's acute trusts are taking urgent measures to stave off the prospect of record deficits.
Privately, senior managers have voiced concern that the trusts are playing into the hands of ministers, who have embarked on a modernisation agenda which will significantly weaken the power of trusts.
From 1 October, the main influence in Scotland will be wielded by 15 unified health boards, covering the existing health board areas. While trust chairs and chief executives will sit on these boards, the number of trust non-executive directors has been cut and their powers have been decreased.
These moves have led to concern that trusts are to be abolished - something that would require legislation - and that this could happen in the next term of the Scottish Parliament.
One senior manager, who did not want to be named, told HSJ:
'Managers in acute hospitals are screaming at the moment because they do not have the money to provide the level of service expected of them. This paves the way for ministers to say they'll get rid of trusts because they are not performing properly. But this will just mean that the problems will still be there - but they will be hidden, because there will no longer be public board meetings for trusts.'
Donald McNeill, the Scottish secretary of the Institute of Healthcare Management, said the executive was going the wrong way about building public confidence in the service:
'Why is there such a focus on the financial positions of trusts, particularly acute trusts, when the NHS itself is not broke? If you look at the bigger picture, then NHS Scotland is meeting its financial targets. It is as if this is an exercise to discredit trusts so that their demise will not be mourned.'
Last week Grampian University Hospital trust, which has agreed an action plan to cut its longterm£9m debt, said it had already spent£700,000 over its agreed£6m overspend for this year.
Lothian University Hospitals trust, with a projected end-ofyear deficit of£5.4m, has already promised staffing reductions and a review of the use of agency staff to stay within its£347m annual budget.
A spokesman for the Scottish Executive said: 'We already do a lot to assist the NHS when it is in difficulties. We ensure that the maximum amount of resource is issued to the NHS at the start of the financial year so that local systems can plan with confidence how to match resources against demands.
'When we learn of specific problems with specific organisations, we discuss with them the steps that can be taken reasonably to get back into financial balance, encouraging local NHS systems to work together to tackle problems.'