When public sector accountants gathered for their annual conference, they complained of initiative overload. Seamus Ward was there

Birmingham's millennium countdown clock appeared to have stopped, but inside the nearby International Convention Centre there was little sense that time was standing still.

Public sector accountants, gathered in the city last week for the annual conference of the Chartered Institute of Public Finance and Accountancy, were reminded time and again that they work in a fast-changing world.

The conference's theme - partnerships - captures much of what the government has planned for the NHS and the broader public sector.

But as delegates debated the implementation of health action zones, pooling budgets with local authorities or working more closely with the private sector, their concerns about the pace of change became apparent.

NHS delegates felt swamped by the plethora of joint projects. Many called on the Department of Health to slap a moratorium on new schemes.

This 'initiative-itis' was even acknowledged by health minister John Denham. 'There are areas of concern. In some deprived areas there is a feeling of initiative overload,' he said.

But he told the conference that he remained convinced of the benefits of working closely with local people.

'One good example is a group of general practices that did a lot of work with the local community to identify health problems and priorities. The list the local people came up with was not the same as the health professionals'.'

Smoking and obesity, for example, were on the community's priority list, but further down - and the GPs found they could achieve more by working on the priorities people had identified than with their own.

Liam Hughes, strategic director of Bradford social services, said his HAZ had made great strides in co-operative working. 'We are focusing on the localities and groups with the worst health. We have built a strong link with bodies working on the New Deal, the single regeneration budget and local authority Best Value.

'The HAZ is trying to put its mark on all these other programmes. But it is not about additional money. Our role is about the total amount we can spend together.'

Where public bodies were already spending a total of around£1bn, small amounts of money could make a difference to the services provided, he added.

'In our area we estimate there are 3,000 people in the south Asian community with diabetes who don't know about it,' said Mr Hughes.

'The implications are quite horrendous. We are aiming to improve early detection in primary care clinics and work with families and schools so that fewer will have strokes, need radical surgery or need long-term care. This will lead to a saving of perhaps£15m or more over the next decade.'

But even in an HAZ that had clear objectives, a cloud remained over the future of the project. 'Will HAZs run out of steam?' Mr Hughes asked.

'We are creating virtual organisations and want them to become more solid but is there a threat in that? Who is going to be in charge? Is that even the right language to use?'

The government hopes that commissioning groups will foster greater co- operation in the NHS. But shadow health minister Alan Duncan, appearing at a last public event before moving to his new job, was scathing about their chances of success. 'Compulsorily corralling family doctors into groups will level down, not level up,' he said. 'They will not match the benefits of fundholding.'

Earlier, Mr Duncan told HSJ that his party was examining the future role of the private sector in health service private finance initiative deals.

'We need more imaginative design going into PFI. We want a future where one can break down the Berlin walls between the public and private sectors.'

But would the public not be worried if clinicians were employed by private firms? 'It depends what the arrangements are,' said Mr Duncan.

'Clinical care is delivered by the NHS under contracts and no one worries about that.'

Professor Chris Ham, director of Birmingham University's health services management centre, told the conference that politicians' attitudes to all health service managers were changing.

'Having been through a period of concerted attack the tide is beginning to turn,' he said. 'There is a recognition we need good leadership and good managers, but we don't always have them where we need it.'

But if Labour is now more sympathetic to managers, it also expects its agenda to be delivered quickly. Birmingham's millennium clock may be broken, but the countdown to the next general election has begun.