'What we don't need is more negative images perpetuated by those at the centre'

'It will be seen as just another excuse to bash managers,' was how one finance director summed up the Audit Commission's report on NHS deficits published last week.

'Putting the blame at the feet of management, even if it's not the current managers: it's not really helpful,' they add.

The hard-hitting report, which analysed 25 NHS organisations issued with public interest reports in 2005-06, strongly attacks the 'inadequate calibre of leadership, particularly in the key posts of chief executive and finance director'.

'With the current primary care trust reorganisation the worry is that we will continue to lose even more talented managers across all areas including finance,' says another PCT finance director based in the South.

'What we don't need is more negative images perpetuated by those at the centre; we need support, guidance and help to make sure we get it right for our populations'.

The commission would no doubt agree, but the report found that if an organisation is failing financially it is likely to be a strong indication that the trust's management structures and systems as a whole are not up to scratch.

Commission head of health Andy McKeon is at pains to stress that the report was retrospective and was not meant as a slight on the current management performance of the 25 trusts in question. But its conclusions are a bitter pill to swallow.

However, the report contains some recommendations with which finance directors agree.

'The recommendations made in the report about the NHS Appointments Commission speeding up the appointment of non-executive directors can only be a good thing,' says one northern-based PCT finance director.

'When a non-executive director with a particular expertise in, say, business or finance leaves it can often take a long time to appoint someone with the right calibre to give the right support and to scrutinise the executive,' they say.

However, another PCT finance director reacted angrily: 'We must not be made a scapegoat for all the NHS's financial woes; it's time the government took some of the responsibility for the collective and spiralling costs of its policies.'

Helen Mooney