'Huge risks' ahead for NHS as structural rebuilding begins

Health secretary Alan Milburn has admitted that the structural upheavals currently under way in the NHS present 'huge risks' across the service.

With just over a month before 28 strategic health authorities and a new wave of primary care trusts go live, he told an audience of more than 500 trust chairs in London: 'There are huge risks over the coming months.We are basically taking a piece of the architecture away.'

But he said that he and NHS chief executive Nigel Crisp had concluded that the improvements needed could not be delivered without structural changes to empower frontline services. He said that whatever the difficulties in the coming months, the NHS plan would be judged over its 10-year timescale.

The most difficult moment for the health secretary came during a question from Sarah Dunnett, chair of zero-starred Dartford and Gravesham trust. She highlighted anger over the Department of Health announcement that four trusts had made 'no significant improvements' and would have their management franchised, while being told by Mr Crisp that it had met the standards of a two-star trust.

In an impassioned speech, which won a heartfelt round of applause from the floor, Ms Dunnett said: 'I cannot begin to describe the damage your press statement caused. If you had asked how to destroy the efforts of the workforce determined to improve the trust, you could not have done it more effectively.'

Mr Milburn appeared uncomfortable and ended up repeating that the public had 'a right to know' how their local hospital was performing.

Ironically, the clash followed an address by DoH director of communications Sian Jarvis, who blamed media coverage for falling public confidence in the NHS.

She urged managers to promote hospitals and services, saying: 'We have to bridge the gap in perception and reality if we are to stop the NHS-bashing we see every day.'

Mr Milburn used his speech to reinforce prime minister Tony Blair's indications that tax will rise to fund the NHS: 'The [tax debate] is one that we need to take to the country and will take to the country, ' he said.'No-one should pretend for a moment that this is an easy thing for a New Labour government. It is not. But I believe the right priority for our country is to raise the resources to properly fund the NHS.'

Mr Milburn was asked by Nottinghamshire Healthcare trust chair Professor Brian Edwards whether investments in mental health services could in the future be protected. Mr Milburn expressed scepticism over the idea of earmarking money, which many inside the NHS have been calling for to protect low-profile services.

'Every week I get at least one request to earmark money for one purpose or another by different organisations, but I have to say although it is necessary in some circumstances I do have doubts about it.'

He said earmarking reduced the flexibility of health economies to meet the particular needs of patients within local areas.